Implementing EBP Flashcards
Research
- research is a formal, systematic , and diligent inquiry or study that seeks to validate or refine existing knowledge or develop new knowledge.
- it answers a question…
EBR
integration of the best available research into our practice as nurses, and into the care we give to our patients
Nursing is built on what concept?
EBP
Significance of Clinical decision making
helps us make informed decisions regarding our practice
Significance of Patient centered-care
respect the patients
-right to effect care based on best practice
Significance of quality improvement
nursing care is constantly evolving to be safer, more effective and more efficient
Significance of professionalism
nursing as a discipline has a responsibility to utilize EBP
To succeed as a nurse….
you must have a familiarity with the research process
As a nurse you must be able to interpret and evaluate…
nursing research to some degree
Not all research is…
created equal and understanding the differences and limitations in research will make you a better nurse
difference between background and foreground questions
- background: deals with knowledge and information
- foreground: deals with direct patient care
If you have a question about a disease process or medication and you look it up in your text or resource
background question
-deals with knowledge and information
you want to compare something or see how a certain intervention affects a patient outcome?
foreground
-deals with direct patient care
Inclusion/Exclusion criteria
- qualifiers about selecting participants that the author of the study includes or excludes
- inclusion criteria are acceptable and exclusion are not accepted
- inclusion criteria are NOT just the opposite of your exclusion
Population
who is your patient/s?
Intervention
what are you gonna do for them? whats the treatment?
Comparison
whats the alternative? often just no tx or a diff one
Outcome
whats the goal you have in mind? what will you be measuring
time
whats the time frame? not always
In adults over the age of 70 is cranberry juice or water more effective in preventing UTIs?
P-70
I-cranberry
water-C
O-more effective in preventing recurring
Are diabetics who perform daily foot exams less likely to experience ulceration compared to those who do weekly exams
P-diabetics
I-daily foot exams
O-less likely to exp ulceration
C-weekly exams
Finding the evidence
- involves literature review
- searching academic databases for journal articles or other published research which seek to answer the research question
Database search strategies
- have a search statement or PICOT in mind
- use database appropriate to topic
- use keywords or specific language
- identify other possible vocab or synonyms
- boolean search uses “and, or not”
- change approach or change your research statement/question
Evaluating the evidence
- not all research is the same
- there are different types of research that gives us different information
- we want to evaluate out research based on its:
- validity and reliability
validitiy
did the study actually measure what it intended to measure
reliability
are these results consistent if the study was repeated?
qualititative
asks a question focused on narrative data that seeks to explore subjective info
quantitative
uses measures data and statistical analyzes to summarize or describe findings or to test relationships among variables
meta-analyses
combining results from different studies with similar topics or research questions
-strongest evidence
case study
analyzing a specific case or event
cohort study
gather data on a group/s over a long period of time
case-control study
compares individual cases with or without a specific condition to identify predictive factors
randomized control trial
measures a control group vs. an experimental group
When reading an article…
first consider what the question the researcher asked was
- what is it trying to do/answer?
- next look at the journal/source it was published in
- is it relable and peer reviews?
- how is it organized?
Abstract
brief summary of the research
background/intro/significance
develops why the research is important
review of lit
summarizes previous research in the field
When examining research there are a few values to pay attention to…
p-value
- confidence interval
- standard deviation
- mean, medium, mode
methods
describes the methodology used to frame the study and to collect the results
results
details the results of the research
-may use visuals to aid
recommendations/conclusion
makes recommendations for practice and further based on the results of the study
p value
- likelihood of getting results you got if the null hypothesis were true
- basically its how likely you would be to get the results you got if there was no correlation between your variables
- lower the better
p less than 0.05 is the gold standard
confidence interval
2 numbers written as something like (95%CI: 1.2,1.5)
- means the author is 95 percent sure that the avg of their results is somewhere between those numbers
- generally the CI should not “cross the 1”
standard deviation
number used to measure the extent that individual data points deviate from the average
-higher number means greater deviation, lower means less deviation
thin curve - standard deviation
means that your winrates remain close to the mean average
fat curve - standard deviation
means that there is a wider spread of your winrates
mean, median, mode
all convey “average”
- mean=all data points added together and divided by total number of data points
- median=number in the middle
- mode=most recurring data point
Why do these values matter?
- not enough just to read the abstract and conclusion
- helps you evaluate if the methods were appropriate
- helps you evaluate whether the conclusion and recommendations follow logically from the findings
Applying the evidence
- once best practice is identified through review of the literature, implement the new practice
- during this step, evaluation continues to ensure any changes in practice have the desired effect
- we evaluate and then either accept, modify, or reject the changes based on how they affect patient outcomes
whats your role?
- you are where the rubber meets the road
- identify issues related to care
- bring concerns/issues you’ve identified up to staff, colleagues, and supervisors
- explore the available body of research on the issue
- take part in unit task forces, committees
- continue evaluating
EBP Committees
- serve as a hub for EBP and research activities at the facility
- helps coordinate and faciliate the use of best practice procedures, standards, etc
- helps disseminate research through the organization
- helps provide opportunities for involvement in research
funding
grants from corporations, nursing orgs, state, federal gov, schools
participants
inclusion/exclusion criteria
ethics/legal
must have informed consent from study participants/must appropriately cite any other works used in creating research
barriers and challenges
- extra work
- patient preferences that conflict with BP
- lack of access to research
- lack of experience/knowledge regarding EBP
- resistance to change
- attitudes from individual staff
- lack of organizational support
