Chapter 7 Flashcards
What is evidence-based practice (EBP)?
A problem-solving approach by conscientiously using:
• Best evidence
• W/ experience, patients values, available health care resources.
What are the three biggest challenge to obtain/have for EBP? (3)
- Best information
- Most current information
- Information @ right time, when you need it for patient care.
What are the 6 EBP steps?
- Ask the clinical question
- Collect the best evidence
- Critique the evidence
- Integrate the evidence
- Evaluate the practice decisions or change
- Share the outcomes of EBP changes with others
What does PICOT stand for?
What does each one represent?
P= Patient population of interest
ID your patients by age, gender, ethnicity, disease or health problem
I = Intervention of interest
Which intervention do you want to practice (treatment, diagnostic test, edu approach)?
C= Comparison of interest
What is the USUAL standard of care (current intervention) you practice?
O= Outcome
What result do you wish to achieve or observe as a result of an intervention? (pt behavior, physical findings, patient perspective)
T= Time
The time it takes to demonstrate outcome.
How can you collect the best evidence?
- Ask a focused question; the more focused the question, the easier to search
- Talk with expert clinicians; expert clinicians are a rich sources
- Critique evidence found: what is the usefulness of evidence in making a practice change?
What should you never use in EBP?
opinions, only evidence!
What is the hierarchy of evidence? (bottom of pyramid to top) (6)
- Opinion of authorities or expert committees
- Internal organization: qualified/risk managing.
- Systematic reviews of descriptive & qualitative studies
- Well-designed controlled trials w/out randomization
- One well designed RCT
- Systematic reviews & meta-analysis of RTS’s.
What do evidence based articles include? (elements of E.B. article)
- Abstract
- Introduction
- Literature review or background
- Manuscript narrative (purpose statement, method or design
- Analysis
- Results and/or conclusion
- Clinical implications
What is done with the evidence base information once it is discovered?
Teaching tools
Clinical practice guidelines
Policies & procedures
Assessment or documentation
What should you consider before you decide to apply evidence?
Staff & available resources
Setting
How do you evaluate the practice decision or change?
Nursing-sensitive outcomes
Consistency & accuracy
Process indicators
Quality/Preformence improvement programs: (an example of PDSA cycle)
PLAN-review avbl data to understand existing policies, conditions/ problems to identify the need for change
DO-select an intervention on the basis of the data reviewed and implement the change..
STUDY- evaluate the results of the change
ACT- if the process change is successful with positive outcomes, act on these practices by incorporating them into daily unit performance.
Meta-Analysis:
A quantitative statistical analysis of several separate but similar studies or experiments in order to test the pooled data for statistical purposes.
Qualitative vs. Quantitative in data collection:
Qualitative: Good information, not necessarily a lot.
Quantitative: a lot of info
Sentinel event
An unexpected occurrence involving death or serious physical or psychological injury of a patient.
