Evidenced Based Practice Flashcards
Foundation of evidence-based practice
Question, experiment, analyze, record, repeat
Evidence based practice and evidence based decision making is based on
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)
Why use evidence based practice?
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
Quantitative research
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”
Qualitative research
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”
Systematic review
Examines quantitative and qualitative evidence separately or together;
Based on peer-review protocol (2 or more people)
FAME
Feasibility; Appropriateness; Meaningfulness; Effectiveness; Economic evidence;
Evidence based methodology
Develop the research question; Search for research or evidence; Appraise the evidence; Implement the evidence; Evaluate practice changes and pt outcomes
Biggest challenge faced by healthcare institutions
Providing evidenced-based, cost-effective, quality care that will improve practice and patient outcomes
Evidenced-based practice
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
Steps of Evidence-Based Practice
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
Evidence
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
Scope of evidence is bidirectional
The focus of bench research is based on pt care;
The focus of pt care depends on bench research
Level I research
Systematic reviews;
Integrative/meta-analyses;
CPGs based on systematic reviews;
Large multi-center clinical trials
Level II research
Single experimental study (RTCs)
Level III research
Quasi-experimental studies
Level IV research
Non-experimental studies
Level V research
Case report;
Program evaluation;
Narrative literature review
Level VI
Opinions of respected authorities
Qualitative research
Triangulation
Multiple perspectives offer a deeper understanding;
None of the data sources have the last word
Ethnography
Thick description of everyday life and practice
Evidence on the net
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?
Consumer of evidence
Policies and procedures
Evidence is used to develop policies and procedures;
Policies and procedures are regularly updated to reflect current evidence;
Approved by a committee
Consumer of evidence
Finding answers to practice questions or problems
Systematically approach a question of pt care: Develop an answerable question; Search the literature; Evaluate the evidence; Apply the evidence found; Evaluate the evidence
Step 1: ask the burning question
P- population; I- intervention; C- comparison; O- outcome; T- time (when appropriate)
Steps to defining the question
Identify the problem;
Clarify the problem;
Focus the question
Background vs foreground question
We need a foreground question
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
Define the practice context
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.
Step 2: Finding the best evidence
Preliminary search: clinical practice guidelines (www.guidelines.gov);
Search for best evidence: Cochrane, JBI, Medline, CINAHL (“the fantastic four”)
Step 3
Critically appraising and synthesizing evidence
Step 4
Making recommendations to improve practice
Step 5
Implementing recommendations
Step 6
Evaluating outcomes
Evidence-based Practice Improvement model
Describe the problem; Formulate the focused question; Search for evidence; Appraise and synthesize evidence; Develop AIM statement; PDSA; Disseminate best practices
Interrelated concepts: evidence
Health policy;
Health care economics;
Safety;
Technology & informatics
Primary literature
Original research studies on which the secondary literature is based;
Includes quantitative and qualitative studies
Secondary literature
Includes evidence summaries, systematic reviews/meta analyses, and practice guidelines
Evidence summaries
Summarize original research studies
Evidence based nursing, world views on evidence based nursing, ACP journal club
Systematic review
Collects the available evidence on a topic in the form of randomized controlled trials
(The fantastic four)
Meta-analysis
Combines the statistical results of numerous randomized controlled trials and analyzes that evidence
Practice guidelines
Summarize the findings of the research and advise practitioners in their care of pts
