Chapter 5: Evidence Based Practice (Week 1)

Question 1

Evidence Based Care

Question 2

What is the best scientific evidence come from?

Answer 2

It comes from well designed, systematically, conducted research studies found in scientific, peer review journals 

Question 3

What is the model for evidence-based clinical decision making

Answer 3

• clinical expertise
• Information about patient preferences and values
• Evidence from assessment of a patient’s history and physical and available healthcare resources
• Evidence from research evidence-based theories, clinical experts, and opinion leaders 

Question 4

What are some sources of evidence?

Answer 4

Textbooks
Articles from nursing in healthcare literature
Peer reviewed journals 

Question 5

What are the steps of evidence based practice?

Answer 5

0. Cultivate a spirit of inquiry.
1. Ask a clinical question in PICOT format.
2. Search for the best evidence.
3. Critically appraise the evidence.
4. Integrate the evidence.
5. Evaluate the outcomes of practice decision or changes.
6. Communicate the outcomes of the evidence based practice decision. 

Question 6

What does it mean to cultivate a spirit of inquiry?

Answer 6

Must have never ending spirit of inquiry
Constantly questioning current practices, lead to consistent use of evidence based practice
Evidence based practice institutions demonstrate a culture in which nurses are encouraged to question practices and they also support inquiries and provide tools to support evidence. Based practice, they have evidence-based policies and procedures, they integrate evidence based practice competencies in their performance, evaluations



Question 7

How do you ask a clinical question in PICOT format

Answer 7

P = patient population of interest
I = intervention of interest
C = comparison of interest
O = outcome
T = time 

Question 8

What is involved in the search for the best evidence step of evidence based practice 

Answer 8

Ask experts for help which include nursing faculty, librarians, advanced practice, nurses, staff, educators, and risk managers

A medical librarian can identify the databases that are available to you and identify keywords that will provide the best answer to your PICOT question 

Question 9

What is the critically appraised evidence step in evidence based practice

Answer 9

After critiquing all articles for a PICOT question you synthesize, or combined the findings and consider the scientific rigor of the evidence and whether it has application and practice

This requires systematic approach, determine the value of feasibility and usefulness of the evidence 

Question 10

What is involved in integrate the evidence step of the evidence based practice?

Answer 10

Apply the research in your plan of care for a patient use evidence as rationale
Education about the change must occur
Large scale change requires planning
Pilot study can show of change can be implemented easily
Incorporate into policies and procedures
Some ways to integrate our teaching tools clinical practice guidelines new assessment, tools

Question 11

What is involved in evaluating the outcomes of practice changes based on evidence

Answer 11

After applying the evidence, evaluate the outcome
When evaluating an evidence base change, determine whether the change was effective. Weather modifications are needed, and should change be discontinued.
Unexpected events are results may occur
Never implement a practice change without evaluating its effects

Question 12

What is involved in communicating the outcomes of the evidence based practice decision

Answer 12

After implementing an evidence-based change, it is important to communicate the results with the following people
1. Clinical staff on the unit.
2. Nursing practice counsel, or the research council.
3. Clinician.
4. Professional conferences and meeting. 

Question 13

What are the five phases of translation re-search

Answer 13

1. Pre-clinical an animal studies.
2. Phase 1 clinical trials - testing safety and efficacy in a small group of human subjects
3. Phase 2 and 3 clinical trials - testing safety and efficacy in a larger group of human subjects, and testing for comparison to standard treatment
4. Phase 4 clinical trials and outcomes research - translation to practice
5. Phase 5 population-level outcomes research - translation to community

Question 14

Outcomes research

Answer 14

Helps patients healthcare providers in those in healthcare policy make informed decisions on the basis of current evidence
Typically focuses on the benefits and risks costs and holistic affects of a treatment on patients
Outcomes must be observable or measurable
Researchers need to select appropriate outcomes when designing their studies 

Question 15

Scientific Method

Answer 15

Foundation of research
The most reliable and objective means of acquiring and conducting research and gaining knowledge
It is a step-by-step process to ensure that findings from a study are valid, reliable, and generalizable to a similar group of subjects
The study supports validity, reliability, and generalizability of the data

Question 16

What is the first step of the research process?

Answer 16

Identify the problem 

Question 17

What are the different types of research studies?

Answer 17

1. Quantitative. - relies on methods that precisely measure and quantify the studies variables. Some commonly used quantitative methods include: experimental, non-experimental’s, surveys, and evaluation research
2. Qualitative research studies phenomena that are difficult to quantify or categorize, such as patients perceptions of illness or quality of life. Different qualitative research methods include ethnography, phenomenology, and grounded theory 

Question 18

Compare the steps of the nursing process with the scientific method process 

Answer 18

Question 19

Performance improvement

Answer 19

A formal approach with analysis of healthcare related processes
Outcome measures
Performance improvement programs - begins at staff level in identifying quality problems, such as sentinel events, active errors, Layton errors
Performance improvement combined with evidence based practice is the foundation for excellent patient care and outcomes 

Question 20

What are some examples of performance improvement models

Answer 20

1. Balance scoreboard. - multi dimensional framework for managing strategy by linking objectives, initiatives, targets and performance measures across cute organization perspective
2. Root cause analysis (RCA) - used to analyze serious adverse events
3. Six Sigma - disciplined methodology for process improvement that is deploys a wide set of tools based on rigorous state analysis to identify sources of variation and performance, in ways of reducing them.
4. Plan do study act. - analyzing a quality problem, and testing a change by developing a plan to test the change (Plan), carrying out the test (DO) and observing and learning from the consequences (STUDY) and determining which modification should be made to the test (ACT)

Question 21

Describe the relationship between evidence based practice, research, and performance improvement

Answer 21

1. Evidence based practice - use of information from research and other sources to determine safe and effective nursing care with the goal of improving, patient care and outcomes
2. Research.= systematic inquiry, answers questions, solves problems, and contributes to the generalizable knowledge base of nursing may or may not improve patient care.
3. Performance improvement = improves local work processes to improve patient outcomes and health system. Efficiency results usually not generalizable.