Evidence-based practice Flashcards
evidence based practice
integrating best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care
Evidence based practice (tanner)
Analytical processes
Intuition
Narrative thinking
Analytical processes
Measurable phenomena yielding measurable patient outcomes
Intuition
Experience, observation, expectations
Narrative thinking
Stories and accounts of patient experiences, nurses’ experience
Evidence based practice requires…
The need for nurses and nursing students to be capable of “locating and critiquing research studies including systematic reviews, identify gaps between current practice and best practice, and develop the skill set to address these gaps and make the appropriate changes in nursing practice” EBP knowledge and skills Belief in the value of EBP Saltire and resources to support EBP EBP mentors
Evidence informed decision making
A continuous interactive process involving the explicit, conscientious and judicious consideration of the best available evidence to provide care
Decision making in nursing practice is influenced by…
Evidence and also by individual values, client choice, theories, clinical judgement, ethics, legislation, regulation, health-care resources and practice environments
History of evidence based practice
Cochrane
Guyett and sackett
British medical journal
Cochrane
Medical researcher
1972
Initiated the need for treatment decisions to be based on a systematic review of clinical evidence
Proposed = international collaboration of researches to systematically review all the best clinical trials specialty by specialty
Cochrane centre for systematic review opened in 1992 in the United Kingdom
Guyett and sackett
McMaster university
1980
Introduced term “evidence-based medicine”
British medical journal
Identified evidence-based practice as one of the 15 greatest breakthroughs since the journal’s launch in 1840
Evidence was originally directly related to
Quantitative research evidence
Elements of evidence based practice
Research evidence = quantitative, qualitative, mixed methods
Clinical expertise/judgement/expertise
Patient perspectives/values
Local context and environment
Research as evidence for practice
Needs to be interpreted within the context of the situation
Is not the only factor that informs decision making
Research alone will not change practice
Strengths of evidence based practice
Increased patient safety
Higher quality care, better health outcomes
Greater efficiency and reduced health care costs
Increased autonomous practice
Higher levels of job satisfaction
Criticisms of evidence based practice
Serves cost clutters and suppresses clinical freedom
Keeping up to date with literature is impossible
Insufficient time for evidence based practice with demanding case loads and staffing shortages
Lack of evidence that it improves health outcomes
Difficult to make happen
Emphasizing research over clinical judgement and family-cantered approaches = cookbook approach
Values randomized control trials and systematic reviews above all other research
Disconnect between evidence based practice and the theory guiding practice
Challenges of evidence based practice
Researchers expertise in doing research is not equal to their expertise in interpreting and knowing whether the findings make a meaningful difference in practice
Starting with a known or preferred intervention and then find research to support it
Evidence may not be meaningful in daily practice- disconnected
Using a general recipient without consideration for specific needs/preferences of the family and the context of care
Ensuring evidence is kept current
Appropriate evidence for one profession may be different than others- interprofessional conflict
Complexity of evidence based practice use
Need for rapid decisions
Multiple and diverse (sometimes conflicting) decisions
Conflicting evidence from different practitioners
Lack of complete information on which to base decisions
Availability of evidence-based guidelines
Need to explain decision-making processes
What would help nurses develop evidence based practice
A spirit of inquiry = consistently questioning practices
Strong belief in the value of EBP
Knowledge and skills in EBP
Commitment to deliver highest quality care to patients and families
An organizational culture that supports EBP
Evidence based practice seven steps
Zero = cultivate a spirit of inquiry One = formulate practice questions Two = search for best evidence Three = critically appraise evidence Four = integrate evidence with other knowledge Five = evaluate outcomes of change Six = disseminate EBP results
Evidence is…
That which tends to prove or disprove something; grounds for belief; proof
Something that makes plain or clear; an indication or sign
Data or information used to determine whether a claim or view should be trusted
Knowledge derived from research
Evidence of…
Feasibility = economic and policy research Appropriateness = ethical and philosophical research Meaningfulness = interpretive research Effectiveness = randomized control trials and cohort research
4 types of evidence
Research evidence-based
Clinical experience practice
Service user/carer perspectives
Local context
Two types of questions
Background = broad and asks the question: who, what, where, when, how, why. About a situation or a medical condition
Foreground questions = more specific
PICO(T) question
P = population/patient/problem, disease/condition, population and setting I = intervention, treatment, activity, procedure, action C = comparison (implicit/explicit), alternative intervention for comparison, usual intervention/control O = outcome, results T = time frame, over a period of time
Considerations prior to developing a question
Re-examine aspects of the practice issue
What is the context and basis for the question
Research is a systematic process of…
Collecting, analyzing, and interpreting information in order to increase our understanding of the phenomenon about which we are interested or concerned
Informally = as we assess, acquire, and interpret information in daily practice
Formally = as we participate in research, and as we assess, critique, and acquire information from research studies
History of nursing research: Florence nightingale
1859
Focused on improving physical and emotional well being
History of nursing research: 1900-1940
Research focused on nursing education
History of nursing research: 1950s
Research focused on nurses- supply, demand, and time involved in nursing activities; and the identity of the professional nurse
Research advanced with increased academic preparation, development of greater research skills and founding of the nursing research journal
History of nursing research: 1960s
Research focused on nursing practice - clinical nursing problems, practice-orientated concerns
Florence nightingale and evidence based nursing
Statistician
Epidemiologist
Made decisions based on best available evidence/best possible research
Made efforts to collect data for evidence to influence public policy and healthcare
Made attempt to demonstrate the value of having trained nurses caring for patients
The start of nursing sensitive outcomes
History of nursing research: worldwide publications
1963 = the international journal of nursing studies 1968 = the Canadian journal of nursing research 1970s = advances in nursing science; the western journal of nursing research; the journal of advanced nursing 1983 = first volume of the annual review of nursing research 1980s = applied nursing research 1993 = national institute of nursing research initiated 1990s = qualitative health research; clinical nursing research; clinical effectiveness in nursing
Future of nursing research
Increased focus on outcomes research
Advancement of evidence-based practice
Improving multidisciplinary/interprofessional collaboration
Increasing dissemination of research findings
Making nursing research more visible
Increased focus on outcomes research
Research assessing and monitoring the quality and cost-effectiveness of health care delivery and safety in patient care
Advancement of evidence-based practice
Using research and nursing knowledge to provide quality, appropriate, effective, safe patient care capturing the uniqueness of the individual
Improving multidisciplinary/interprofessional collaboration
To improve research and quality and safety in patient care
Increasing dissemination of research findings
Through internet access, open access journals
Making nursing research more visible
Recognizing and supporting research opportunities; advancing and promoting use of research findings; facilitating development of nursing researchers
Quantitative research
Used to answer questions about relationships among measurable variables with the purpose of explaining, predicting, and controlling phenomena
Randomized control trials - to evaluate the effectiveness of an intervention
Case-control studies - to investigate the cause of a disease or the adverse effects of treatment
Cohort studies - to study a group of people over a period of time
Cross-sectional studies - to study a phenomena at one point in time
Longitudinal studies - to study a phenomena over an extended length of time
Descriptive studies - to observe, describe, and document a situation
Qualitative research
Used to answer questions about the complex nature of phenomena with the purpose of describing and understanding phenomena from the participants point of view
Case study - to understand one person or situation
Ethnography - to understand how behaviours reflect the culture of a group
Phenomenological study - to understand an experience from the participants point of view
Grounded theory study - to derive a theory from data collected in a natural setting
Content analysis - to identify the specific characteristics of a body of material
Mixed research
An integration of both quantitative and qualitative research
The qualitative approach emphasizes the capacity of the human to know, understand and reflect, encompassing context, interaction, and connection
The quantitative approach strives for precision by focusing on things that can be counted
Peer review
Systematic distribution, evaluation, and reaching of consensus on the merits of a submitted manuscript or abstract
Editors direct the process - select reviewers, make final decisions on publication
Reviewers selected based on expertise and availability
Look for technical and stylistic flaws, novelty of study, make recommendations for acceptance, rejection, or revision
Pre-appraised evidence (secondary research)
Systems, summaries, synopses of syntheses, syntheses, and synopses of studies
Data has undergone a filtering process to include only research of higher quality
These resources are regularly updated so that the evidence is current
Systems
Computer decision support systems which would match information from individual patients with the best evidence from research that applies to the clinical situation
Ideal system would summarize all relevant research evidence about a clinical problem and link to the individual patient’s situation through an electronic health record
Summaries
Provide a critical appraisal synthesis of research evidence eon a specific topic, so that practitioners can easily determine validity and reliability
Integrate best available evidence from the lower levels of the pyramid
Gather from systematic reviews to provide a comprehensive rename of evidence concerning management options for a given health problem
Synopses of syntheses
Edited, short, structured descriptions and critical commentaries of systematic reviews
Usually accompanied by a commentary on quality of the synthesis and clinical applicability of findings
Comprehensive summary of research evidence to focused clinical question
Syntheses
Systematic reviews that summarize scientific studies
Comprehensive literature searches with critical appraisal
Synopses of single studies
Brief summary of high quality study with commentary
Summary is brief and detailed to inform practice
Has screened study for quality
