Evidence Based Practice Flashcards
what is the cochrane collaboration
▪ Cochrane is a global independent network of researchers, professionals, patients, carers and people interested in health.
▪ Not-for-profit organisation with contributors from more than 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest.
▪ Produce reviews summarising the best available evidence generated through research to inform decisions about health
define EBP
“….the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”
(Sackett et al 1996)
what 3 components make up EBP
best research evidence
patient values
clinical expertise
what are the 6 steps in the Evidence-Based Practice Process
ASSESS the patient: 1. Start with the patient – a clinical problem or question arises from the care of the patient
ASK
the question: 2. Construct a well built clinical question derived from the case
ACQUIRE
the evidence: 3. Select the appropriate resource(s) and conduct a search of the literature
APPRAISE the evidence: 4. Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice)
APPLY:
talk with the patient: 5. Return to the patient – integrate that evidence with clinical expertise, patient preferences and apply it to practice
Self-evaluation: 6. Evaluate your performance with this patient
describe where RCTs sit on evidence hierarchy
▪ Early in EBP movement bias towards evidence only arising from RCTs.
▪ Reflection of Cochrane Collaboration initial focus on evidence regarding the effectiveness of interventions/therapies.
▪ Resistance by some HCPs who felt evidence from qualitative and non- RCT studies would be ignored.
(Polit & Beck 2014)
describe evidence hierarchies
▪ Evidence hierarchies rank evidence according to the strength of the evidence they provide.
▪ Less rigid than they historically were.
▪ Overall, the ranking of evidence depends on the clinical question that is being asked (refer to paper by Evans 2003)
▪ Multiple hierarchies exist, it is not necessarily as simple as the picture on this slide illustrates
what are the 6 levels of evidence
1- systematic reviews, large multi center clinical trials
2- single experimental study (RCT)
3- quasi-experimental studies
4- non experimental studies
5- case report/programme evaluation/narrative lit review
6- opinions of respected authorities
What are the Barriers to Evidence Based-Nursing?
Barriers fall within 3 main categories: ▪ Quality & Nature of the Research ▪ Characteristics of Nurses ▪ Organisational Factors (Haynes & Haines 1998; NICE, 2007; Tacia et al 2015; Ubbink et al 2013)
examples:
Lack of time
No authority to bring about change
Staff need to see a clear link between findings and implications
Staff may discount findings is the results conflict with their own beliefs
what is best evidence for nursing practice
▪ Research findings that are methodologically appropriate, rigorous & clinically relevant for answering questions.
▪ Questions can be about efficacy, safety, cost-effectiveness of nursing interventions, but also the reliability/validity of nursing assessment tests, the causes and consequences of health problems, and the meaning and nature of patients experiences
▪ Confidence in evidence is enhanced when there have been multiple confirmatory studies and the evidence has been carefully evaluated and synthesised (systematic reviews, meta-analysis, metasynthesis)
(Polit & Beck, 2014)
what is the objective of EBP
Increase awareness of practice from practitioners, educators and policy makers
Improve clinical decision making and achieve effectiveness by enabling clinicians to use the most effective interventions
Reduce waste and limiting unnecessary practice
Reduce the reliance in expert knowledge and
increase transparency in decision making
With evidence in the public domain it can enable lay persons to look for and inform their decisions with the health professionals
why is EBP important
As nurses we have a responsibility to provide the best care for our patients It allows us to understand the rational behind practices
Enables us to understand how people experience the care we provide
Provides us with a knowledge base that we can adapt or develop and implement changes we have made ourselves
what are limitations of EBP
Knowledge changes over time
Not everything may be researched
Not everything may be audited
No to situations are identical
Researched outcomes only apply to broadly similar outcomes
Caring for people who have the right to make non-recommended decisions
