Week 12 Flashcards
moving from evidence to practice change is about.. (2)
- transdisciplinary HCP collaborations w pts/families in decision-making
- combining external evidence w pt preferences & clinical expertise
the competent clinician (CC) is expected to…
- deliver the best care possible supported by evidence that can be demonstrated by pt outcomes
the context of caring is…
- the integration of pt preferences, values, and clinical expertise w evidence from well-conducted studies
- should be everyday practice
why is evidence in healthcare considered complex?
- as HCP we seek info across a wide range of interventioned and situations calling for different research designs
clinicians rely on …..for nursing practice
- both internal and external evidence that needs to be understood within the context of the pt’s unique situation/context
evidence in healthcare is more than research but _________ is central in decision making
- external evidence
clinical judgement focuses on…
- weighing risks and benefits based on your assessment, clinical data, research, and pt preference
define: experiential learning
- learning from past or present experiences that help us to examine evidence to consider practice changes – the heart of EBP!
what does clinical expertise require? how is this acquired?
- Continuous self-improvement via application of: external evidence, experiential clinical learning (consists of use of internal evidence and clinical expertise)
clinical expertise consists of: (4)
- specialized body of knowledge or skill
- extensive experience in the field of practice
- highly developed lvls of pattern recognition
- and then uses the above w external evidence in specific clinical contexts
describe clinical expertise over times
- develops over time
what are the characteristics of pt centered care (3)
- intentional focus by clinicians on pt values
- including pt values in shared decision-making
- pt engagement resulting in better perceived care outcomes
“talk less, listen more… no decision for them without them”
what are some barriers to pt centered care (5)
- time constraints
- competing care obligations
- range of discharge communication strategies (eg. instruction to shared decision making, different nurses may provide diff education, can miss details which might have been useful to pt)
- pts not feeling prepared for discharge, non-individualized
- discharge process influenced by pressure for use of available beds
what can clinicians ask to provide pt-centered care
- “Is there anything at all that could have gone better today from your point of view in the care your experienced?”
EBP nursing practice is more than “helping people” it is….
- It is big picture thinking = integrating research, clinical expertise, and patient preferences in decisions.
describe what is meant by “EBP nursing practice is intentional”
- evidence needs to be sought out and appraised to provide best possible care
what are the 4 components to an EBP clinical enviro
- vision
- engagement
- integration
- evaluation
describe the “vision” component of an EBP enviro (5)
create a vision for EBP:
- what are the goals & shared mental framework (goals & values r/t pt care should be similar on a unit)
- small group of passionate people
- early involvement of clinical experts and EBP mentors
- knowledge of change strategies (change theory?)
- administrative support (ex. if doing research on a topic and find that the unit strategy is not best practice = need support from management)
describe the “engagement” component of the EBP enviro model (5)
- involve all staff in high priority clinical issues including admin (ownership)
- assess/eliminate barriers (assess strengths, weaknesses, threats, opportunities to change)
- prioritize clinical issues (focus on how steps for change “fit” routine clinical practice, cost, staffing, time)
- evaluate infrastructure (time to do the 5 A’s?, access to a library/clinical research database?)
- develop or seek experts in the EBP process
describe the “engagement” component of the EBP enviro model (5)
- involve all staff in high priority clinical issues including admin (ownership)
- assess/eliminate barriers (assess strengths, weaknesses, threats, opportunities to change)
- prioritize clinical issues (focus on how steps for change “fit” routine clinical practice, cost, staffing, time)
- evaluate infrastructure (time to do the 5 A’s?, access to a library/clinical research database?)
- develop or seek experts in the EBP process
what are common barriers to EBP implementation (7)
- Resistence to change: Breaking traditional practice, not knowing how evidence improves outcomes, misconceptions about time and effort for change
- Inadequate knowledge and skill about EBP process
- Weak beliefs about the value of EBP
- Poor attitudes toward EBP
- Lack of EBP mentors
- Organizational and social influences
- Economic restrictions
describe the “integration” component of the EBP enviro model (8)
- establish formal integration teams
- build excitement, create compelling case, create discomfort w status quo
- disseminate evidence (tailored and multi-faceted approaches)
- develop clinical tools (ex. summaries, CPGs, pathways, “up to date” search question)
- pilot the test EBP change in practice (trialing a new intervention on your unit for a small period of time)
- preserve energy (small phased projects, patients, perseverance, persistance –> massive changes are rarely retained as they overwhelm people and make them closed to implementing it = intro small things at a time)
- setting timelines (be aware of enviro issues)
- celebrate success (early ones too)
- leadership plays imp role
what are 3 key factors to successful integration of EBP
- evidence is robust (reliable and valid)
- physical enviro is receptive to change
- change process is appropriately facilitated
describe the “evaluate” component of the EBP enviro model (3)
- at all lvls: pt, clinician, and organization/system
- often overlooked step in the EBP practice
- ask if the findings from research are the same when translated into your “real world” of practice
what are the 6 areas of EBP evaluation indicators
- outcome measures
- quality care improvement
- pt-centered quality care
- efficiency of processes
- enviro changes
- professional expertise
describe the “outcome measures” area of EBP evaluation indicators
- measureable medical outcomes
ex. health status, death, disability, etc.
describe the “quality care improvement” area of EBP evaluation indicators
- managing common systems like pain, fatigue caused by diseases but have direct impact on pts/families
- enhancing QOL
describe the “pt centered quality care” area of EBP evaluation indicators
- reflect the value placed on health care received by pts and families
ex. effective communication, open discussion about illness, sensitivity to pain & distress, consideration of religious beliefs, being respectful, nonavoidance of specific issues, empathy, patience, equitable access, caring attitude
see page 285, exam question
describe the “pt centered quality care” area of EBP evaluation indicators
- reflect the value placed on health care received by pts and families
ex. communication, options for care, etc.
see page 285, exam question
describe the “efficiency of processes” area of EBP evaluation indicators
- about health care delivery methods in the organization
ex. appropriate timing of interventions, effective discharge plannig, efficient utilization of hospital beds, elimination of waste such as duplication of tests
*** know this
describe the “environmental changes” area of EBP evaluation indicators
- a culture that promotes EBP throughout the organization
ex. evaluate policy and procedure adherence, unit resource availability, use of supplies and materials essential to implement EBP
describe the “professional expertise” area of EBP evaluation indicators
- staff knowledge and expertise helps w setting expectations for adhere to accepted standards of care for best practice
know the pressure injury stuff?
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