T2 Mod 4 Flashcards
Societal Factors Influencing the Use of Research
Rising cost of health care Quality improvement initiatives Pressures to avoid errors Research about the costs of not implementing evidence Publicity about research findings \_\_\_\_\_\_\_\_\_
This slide illustrates factors influencing the use of research.
Rising cost of health care
In 2013, 14% of the population was over 65.
Over 30 million Americans still do not have health insurance.
Employee-sponsored health insurance has risen at a rate 5 times faster than wages.
Poverty: 15.4% live below poverty level.
Quality improvement initiatives
National Quality Forum: www.qualityforum.org
See the 30 measures that healthcare organizations can take to improve quality.
Agency on Healthcare Research and Quality: www.ahrq.gov
National Database of Nursing’s Quality Indicators: www.nursingworld.org/quality
Unit-based repository of quality indicators designed to assist hospitals to make improvements in quality
American Nurses Credentialing Center (ANCC): Magnet Recognition ProgramTM
Nursing Research impacting in the Foundation for Practice Improvement
Preoperative teaching Pain management Assessment of children’s behavior Prevention of falls Pressure ulcer risk detection Incontinence care Family-centered care in intensive care
This slide illustrates exemplars of research where nurses have made considerable progress in the improvement of nursing practice.
Preoperative teaching (early work of Jean Johnson, meta-analyses done by Cook & Devine)
Pain management (work of Sandra Ward and colleagues at the University of Wisconsin in facilitating the adoption of the pain management standard by JCAHO)
Assessment of children’s behavior (work of Kathryn Barnard with NCAST, a child assessment program that saw widespread use by more than 20,000 nurses at any single given time)
Falls prevention (numerous programs by teams of experts across the country) (Link to http://www.guideline.gov for list of guidelines related to falls prevention [e.g., University of Iowa, Registered Nurse Association of Ontario])
Pressure ulcer risk detection (work of Nancy Bergstrom and Barbara Braden in development of the Braden Scale)
Incontinence care (see the AJN monograph on incontinence prevention: The State of the Science on Urinary Incontinence, March 2003
Family-centered care in intensive care (work of Melnyk et al., 2004)
Steps In evidence based practice
Asking the relevant clinical question
Searching for the best evidence
Critically appraising evidence
Integrating evidence with clinical expertise, patient preferences, and values in making a practice decision or change
Evaluating the practice decision or change
Asking the right question
Patient population
Intervention/interest area
Comparison
Outcome
PICO
Stages of diffusion’s of innovations
It provides a useful model in planning for the integration of evidence into practice over time. According to Rogers, the diffusion of innovations occurs in stages:
Knowledge
Exposure to information
Persuasion
Attitude development
Decision
Commitment to adoption
Implementation
Application to practice
Confirmation
Stage of innovation (change)
Information dissemination Journals Conferences Educational programs Media Literature review
Knowledge
Informal communication networks
Use of a champion
Attitudes may be positive or negative.
Persuasion
Attitude development
Commitment to adoption
Innovation might be adopted.
Innovation might be rejected.
Decision stage
Direct application
Exactly as it was done in previous research
Exactly as recommended in a guideline
Reinvention
Modified to suit the environment
Indirect application
Modified according to the needs and values of the staff
Implementation stage
Phases of EBP
Preparation Validation Evaluation/decision making Translation/application Evaluation
How can nurses make a difference using EBP
Individually
Keep up to date on EBP in our field. Bring forward to your manager.
Volunteer for committees and taskforces
Identify challenges in providing care.
How can we use the concept of forming a PICO question to identify important clinical problems?
What are research priorities?
How are agency policies and procedures updated? What EBP have we incorporated?
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Identify challenges in providing care.
[Refer students back to slide 15 to review the PICO format in identifying important clinical problems.]
Ask questions about agency practices.
Ask for evidence underlying practices.
[Ask students to find out how agency policies and procedures are updated and whether an effort is made to incorporate the latest evidence.
Suggest to students that they can volunteer for opportunities to take part in committees and task forces that examine practice problems.]
Identify clinical practice problems.
[Again, refer students to slide 15 for the PICO format.
Refer students to specialty organizations and the National Institute of Nursing Research for information about research priorities.]
steps in collaboration to implement evidence-based practice.
1.Identify key stakeholders.
[
Ask students to identify the key stakeholders who would be involved in implementing a practice change. Using the PICO question developed earlier would help to focus the discussion in this arena.]
Does the stakeholder list identified by students include nurse managers and executive leadership, members of other disciplines, access to top levels of management in the organization, community representatives?
2.Involve as many people as possible in the process.
How can many people be involved?
What different roles can be assumed by staff members, students, faculty, organizational leaders, and informal leaders?
3.Partner with researchers.
Identify researchers and their expertise.
Describe existing partnerships and future possibilities.
4.Partner with faculty and nursing students to gather evidence
What are the benefits to partnering with a local college/university?
- Publicize nursing research to nurses, healthcare professionals, and the public.
- Publicize your successes.
Evaluating the innovation Make a decision Continue. Discontinue. Modify.
How should the innovation be evaluated?
Patient perspectives
Nurse perspectives
Outcomes
Confirmation stage
Characteristics of Innovation Adopters
See Box 20-3.
Innovators: Active in seeking new information. Organization’s visionaries.
- Organization’s opinion leaders who learn about an innovation and apply it to their practice. Can be effective in communicating the value of an innovation.
- Won’t bring forth an innovation but will readily adopt it when brought forth by others.
- Skeptics who don’t adopt something unless pressure is applied. May be part of a backlash.
- Most secure in holding on to the past. Most comfortable when an idea can’t fail.
Early adopters: Organization’s opinion leaders who learn about an innovation and apply it to their practice. Can be effective in communicating the value of an innovation.
Early majority: Won’t bring forth an innovation but will readily adopt it when brought forth by others.
Late majority: Skeptics who don’t adopt something unless pressure is applied. May be part of a backlash.
Laggards: Most secure in holding on to the past. Most comfortable when an idea can’t fail.
Active in seeking new information. Organization’s visionaries.
Innovators:
