Week 1 - Intro to EBP Flashcards
What are the 3 pillars of EBP?
Best Research Evidence
Clinical Expertise
Patient Values and Preferences
Name 3 examples of research evidence?
Systematic reviews
Randomised control trials
Clinical practice guidelines
Name 3 examples of clinical expertise
Clinical experience
Quality improvement projects
Outcome management initiatives
What is EBP?
Basing practice on the highest possible quality evidence
Name some negative elements of nursing culture identified when EBP is not implemented
Lack of openness to criticism Lack of consideration for patients Defensiveness Looking inwards not outwards Secrecy Acceptance of poor standards Misplaced assumptions about the judgements and actions of others Failure to put patient first at all times
What is Clinical Governance?
Clinical governance is a system whereby what nurses and other care professionals do is able to come under scrutiny to ensure it is worthwhile, there are correct procedures and guidelines, auditing of practice is happening and money is being spent wisely.
Name the four principles of healthcare ethics:
Beneficence
Non-Maleficence
Autonomy
Justice
What is consequentialism in nursing?
Doing things that have the best outcomes. Nurses should select the path of care with the patient that has the highest possibility of achieving the desired outcome.
Name the epidemiologist who started EBP in the 1970’s
Archie Cochran
Name the university that developed EBP as we know it today
McMasters University, Canada
What is the number 1 challenge in healthcare?
Providing evidence based, cost effective, quality healthscare to improve practice and patient outcomes.
What percentage of healthcare is based on EBP?
20%
How many years does it take to get evidence into practice?
15-20 years
What is the purpose of EBP?
Providing evidence based, cost effective, quality healthcare to improve practice and patient outcomes.
What is the evidence pyramid?
Another version of the hierarchy of evidence
Name 3 resources of good evidence
Joanna Briggs Institute
National Health and Medical Research Council (NHMRC)
NHS
List the Hierarchy of Evidence
- Systematic Reviews, Meta-analyses
- Randomised Control Trials
- Case Controlled Studies
- Non- experimental designs
- Expert opinions
- Views of colleagues/peers
What would you would find on number 2 of the hierarchy of evidence?
Randomised Control Trials with definitive results
What do metanalyses do?
Gather all the statistics from various studies and reanalyse them.
List the 9 Key elements of nursing
Lifelong learning code of ethics Code of ethics Regulation Distinct body of knowledge Tertiary Education Accountability Autonomy Critical Reflection Evidence Based Practice
List some reasons that EBP is important
- Autonomy.
- Rapid progress.
- Correcting inaccurate Information.
- Providing best care.
- Social and political pressure to improve
- Moral & ethical imperatives
- Accountability to our professional body
- Professionalism of nursing
- Plan effective interventions
What is ADPIE and what does it stand for?
The nursing process.
Assessing Diagnosing Planning Implementing Evaluating
What are the 5 steps of the EBP Process?
- Ask question: Start with identifying a problem. Turn it into a question.
- Search Evidence: Find best available information on the topic.
- Appraise Evidence: Identify relevant supporting information. Best supports clinical decisions to meet needs for patient.
- Implement care.
- Evaluate: Assessing how effective the action has been. Future actions discerned.
What are some professional concepts associated with nursing?
Autonomy
Accountability
Regulation
Why do we have nursing standards?
Helps to guide our practice to ensure it is safe, ethical, competent and based on achieving the best outcomes for patients.
What does CPD stand for?
Continuing Professional Development
What are some negative aspects of nursing culture when EBP is not implemented?
Lack of openness to criticism Lack of consideration for patients Defensiveness Looking inwards not outwards Secrecy Acceptance of poor standards Misplaced assumptions about the judgements and actions of others Failure to put patient first at all times
What is clinical governance?
Clinical governance is a system whereby what nurses and other care professionals do is able to come under scrutiny to ensure it is worthwhile, there are correct procedures and guidelines, auditing of practice is happening and money is being spent wisely.
List the 4 principles of healthcare ethics
Beneficence
Non-Maleficence
Autonomy
Justice
What is consequentialism?
Doing things that have the best outcomes. Nurses should select the path of care with the patient that has the highest possibility of achieving the desired outcome.
What are the teo main questions associated with the CASP initiative?
How do I know research has been done properly? When information is conflicting, how do I know which to believe?
What does CASP stand for?
Critical Appraisal Skills Program
What does CASP do?
CASP helps:
Find the evidence
Appraise
Act
What is quantitative research?
Seeks to discover relationships between variables in a statistical way
What is qualitative research?
Explores attitudes, opinions, experiences or behaviours through interviews, focus groups or observation.
What are some common influences on nursing practice?
What have you been taught in your training? What research have you read? Personal experiences Experience of others you have listened to Local and national policies Pressure from managers Ethics Social norms
What is empirical knowledge?
Knowledge found in textbooks ot journal papers that is derived from research that is provable
What is aesthetic knowledge?
Subjective and unique knowledge that requires interpretation, creativity, empathy, understanding and valuing. It is knowledge that feels and looks right
What is ethical knowledge?
Knowledge based on systems of belief and moral codes of conduct.
What is personal knowledge?
Knowledge that arises out of experience as sympathy, empathy and understanding.
What are the 3 pillars of critical practice?
- Forging relationships
- Seeking to empower others
- Making a difference
What is supercomplexity?
When applied to professionalism and nursing means managing overwhelming data, theories and handling multiple frames of reference. Due to the nature of nursing, it becomes has become more complex. Nurses are required to pay attention to the realities of the patients illness but also all their types of knowledge, where beforehand it would have just been based on previous experience of dealing with the illness.
What are the 3 dimensions of being?
Knowledge
Working with others
Delivery of EB care
What are randomised control trials good for in terms of research?
Cause and effect
What are cohort studies good for in terms of research?
Comparing differences?
What is the main benefit of primary research?
It generates new, more evidence based research.
What are case-controlled studies good for in terms of research?
Assessing the relationship between outcomes.
What type of research studies are best for “therapy” related questions?
Randomised control trials
What type of research studies are best for “prevention” related questions, like how to prevent a disease or condition?
RCT’s
Cohort studies
Case control studies.
What type of research studies are best for “prognosis” related questions? (estimating the patients likely clinical course & complications)
Cohorts
Case controls
Case series
What type of research studies are best for “diagnosis” related questions?
Blind RCT’s
What type of research studies are best for “etiology/harm” related questions? (how to identify causes for disease)
RCT’s
Cohort studies
Case controlled
What type of research studies are best for “cost analysis” related questions?
Economic analysis studies
Define “autonomy”
To act for ones self independently
Why do we have NMBA standards of care?
Helps to guide our practice to ensure it is safe, ethical, competent and based on achieving the best outcomes for patients.
How many hours of professional development do registered nurses have to undertake per year?
20 hours
Name the 7 types of knowledge?
Trial and Error Personal Experience Intuition Reasoning Research Tradition/custom Authority
What are some benefits of knowledge by tradition/custom?
Some methods may be tried and true
Usually based on trial and error or personal experience
Can be the comfortable way of doing things
What are some negative aspects of using knowledge by tradition/custom?
Resistance to change
May be old and out of date
May not be culturally aware as the world has become globalised.
May not be based on evidence
What are some benefits of learning/knowledge by authority?
They often have more experience
Can learn by shadowing and immitation
Should be more familiar with the instiutional guidelines, etc.
What are some drawbacks of learning/knowledge by authority?
Everyone has a different way of doing certain things, eg. Their way may not be best for you.
They may not be aware of best practice
They may not be receptive to teaching.
Define “trail and error” knowledge/learning
An investigative form of learning/knowledge.
What are some benefits of learning/knowledge by trial and error?
Encourages critical thinking and creativity
Can learn a lot by what went wrong as well as what went right
What are some drawbacks of learning/knowledge by trial and error?
Can lead you outside your scope
Can be time consuming to reach a desired result
Not based on evidence
No real parameters
What are some benefits of learning/knowledge by personal experience?
Gaining experience
Ability to apply existing knowledge in different ways
What are some drawbacks of learning/knowledge by personal experience?
Your experiences are specific to you
May not always heed the same results
You need confidence in your knowledge to be able to apply it
What are some benefits of learning/knowledge by intuition?
Early interventions
Can pick up things that do not show on measureable charts
Can lead you on a new path of investigation
What are some drawbacks of learning/knowledge by intuition?
Can be seen as an overreaction
Not evidence based
Intangible
