Evidenced Based Practice

Question 1

Foundation of evidence-based practice

Answer 1

Question, experiment, analyze, record, repeat

Question 2

Evidence based practice and evidence based decision making is based on

Answer 2

External evidence (systematic reviews, randomized controlled trials, best practice, and clinical practice guidelines that support a change in clinical practice);
Internal evidence (healthcare provider expertise, quality improvement projects, outcome management initiatives);
Patient (preferences and values)

Question 3

Why use evidence based practice?

Answer 3

Leads to highest quality care & pt outcomes;
Reduces healthcare costs;
Increases reimbursement and decreases denials;
Reduces geographic variations in the delivery of care;
Increases clinician empowerment and role satisfaction;
Reduces healthcare provider turnover rate;
Meets expectations of an informed public

Question 4

Quantitative research

Answer 4

Intervention and outcome research based on scientific methods;
Uses experimental controls and manipulation of variables;
Uses instruments to test and measure data;
Uses statistics to interpret data;
Asks about relationship between/among defined measurable phenomena;
Statistical analysis;
“Numbers”

Question 5

Qualitative research

Answer 5

Used to understand human behavior;
Uses observations to assess group culture, beliefs, actions, and adaptations to life situations;
Data collection - direct observations, focus groups, key opinion leader interviews, contextual design;
Directional research - often done in with quantitative research or before it;
Focuses on meaning and interpretation of human phenomena;
“Relationships”

Question 6

Systematic review

Answer 6

Examines quantitative and qualitative evidence separately or together;
Based on peer-review protocol (2 or more people)

Question 7

FAME

Answer 7

Feasibility;
Appropriateness;
Meaningfulness;
Effectiveness;
Economic evidence;

Question 8

Evidence based methodology

Answer 8

Develop the research question;
Search for research or evidence;
Appraise the evidence;
Implement the evidence;
Evaluate practice changes and pt outcomes

Question 9

Biggest challenge faced by healthcare institutions

Answer 9

Providing evidenced-based, cost-effective, quality care that will improve practice and patient outcomes

Question 10

Evidenced-based practice

Answer 10

Integrate best current evidence with clinical expertise and pt/family preferences and values for delivery of optimal health care:
All health care professionals must understand and use the EBP approach to practice;
Incorporates expertise of clinician and pt’s values and preferences to make health care decisions;
Strategy for making clinical decisions about nursing practice, other health care professions

Question 11

Steps of Evidence-Based Practice

Answer 11

1) Ask “burning” clinical questions
2) Find the very best evidence available to try to answer those questions
3) Critically appraise and synthesize relevant evidence
4) Make recommendations for practice improvement
5) Implement accepted recommendations
6) Evaluate outcomes

Question 12

Evidence

Answer 12

Establishes benefit or harm
Best practices in context of health care
Supports or disputes the efficacy of treatment
Use of s diagnostic tool
Transmission of a disease, etc

Question 13

Scope of evidence is bidirectional

Answer 13

The focus of bench research is based on pt care;

The focus of pt care depends on bench research

Question 14

Level I research

Answer 14

Systematic reviews;
Integrative/meta-analyses;
CPGs based on systematic reviews;
Large multi-center clinical trials

Question 15

Level II research

Answer 15

Single experimental study (RTCs)

Question 16

Level III research

Answer 16

Quasi-experimental studies

Question 17

Level IV research

Answer 17

Non-experimental studies

Question 18

Level V research

Answer 18

Case report;
Program evaluation;
Narrative literature review

Question 19

Level VI

Answer 19

Opinions of respected authorities

Question 20

Qualitative research

Triangulation

Answer 20

Multiple perspectives offer a deeper understanding;

None of the data sources have the last word

Question 21

Ethnography

Answer 21

Thick description of everyday life and practice

Question 22

Evidence on the net

Answer 22

Determine the author and sponsor of the information;
Evaluate information with biases in mind;
Is it validated with evidence?
Is it current?
Does it have the Health on the Net seal?

Question 23

Consumer of evidence

Policies and procedures

Answer 23

Evidence is used to develop policies and procedures;
Policies and procedures are regularly updated to reflect current evidence;
Approved by a committee

Question 24

Consumer of evidence

Finding answers to practice questions or problems

Answer 24

Systematically approach a question of pt care:
Develop an answerable question;
Search the literature;
Evaluate the evidence;
Apply the evidence found; 
Evaluate the evidence

Question 25

Step 1: ask the burning question

Answer 25

P- population;
I- intervention;
C- comparison;
O- outcome;
T- time (when appropriate)

Question 26

Steps to defining the question

Answer 26

Identify the problem;
Clarify the problem;
Focus the question

Question 27

Background vs foreground question

We need a foreground question

Answer 27

Background question: asks for a fact, a statement on which authorities or experts would agree. The answers to these questions can usually be found in a textbook and are not controversial;
Foreground question: usually asks a question of relationship and may be controversial

Question 28

Define the practice context

Answer 28

What are the health, social, and ethnic characteristics of the population served?
Identify any characteristics specific to the group of people receiving nursing care.
What are the health care delivery characteristics of your setting?
Specify type of practice setting, economic constraints, type of health delivery system, existing policies and procedures, staffing patterns, administrative structures.
What are the motivators for, and barriers to, incorporating nursing research into practice?
Identify those who understand need for change in practice.
Identify those who played a part in the decision making process.
Identify those resistant to change.

Question 29

Step 2: Finding the best evidence

Answer 29

Preliminary search: clinical practice guidelines (www.guidelines.gov);
Search for best evidence: Cochrane, JBI, Medline, CINAHL (“the fantastic four”)

Question 30

Step 3

Answer 30

Critically appraising and synthesizing evidence

Question 31

Step 4

Answer 31

Making recommendations to improve practice

Question 32

Step 5

Answer 32

Implementing recommendations

Question 33

Step 6

Answer 33

Evaluating outcomes

Question 34

Evidence-based Practice Improvement model

Answer 34

Describe the problem;
Formulate the focused question;
Search for evidence;
Appraise and synthesize evidence;
Develop AIM statement;
PDSA;
Disseminate best practices

Question 35

Interrelated concepts: evidence

Answer 35

Health policy;
Health care economics;
Safety;
Technology & informatics

Question 36

Primary literature

Answer 36

Original research studies on which the secondary literature is based;
Includes quantitative and qualitative studies

Question 37

Secondary literature

Answer 37

Includes evidence summaries, systematic reviews/meta analyses, and practice guidelines

Question 38

Evidence summaries

Answer 38

Summarize original research studies

Evidence based nursing, world views on evidence based nursing, ACP journal club

Question 39

Systematic review

Answer 39

Collects the available evidence on a topic in the form of randomized controlled trials
(The fantastic four)

Question 40

Meta-analysis

Answer 40

Combines the statistical results of numerous randomized controlled trials and analyzes that evidence

Question 41

Practice guidelines

Answer 41

Summarize the findings of the research and advise practitioners in their care of pts