evidence based practice - strategies to nursing practice
DESCRIPTION
Evidenced Based PracticeTRANSCRIPT
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Evidence Based PracticeStrategies to Nursing Practice
L Anand,
Lecturer,
College of Nursing,NEIGRIHMS,
Shillong
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“ARE YOU SURE NEW BATH TECHNIQUE WAS ON THE EVIDENCED BASED PRACTICE LIST?”
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EVIDENCE-BASED PRACTICE ?
Evidence-based practice is the integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making.
Evidence-based clinical decision making should incorporate consideration of the patient’s clinical state, the clinical setting, and clinical circumstances.
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The concept of EBP EBP is a problem-solving approach to
clinical decision making
EBP encourages critical thinking
EBP uses the latest research evidence to produce high quality health care.
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The value of EBP EBP ensures efficacy , efficiency and
effectiveness. EBP weighs risk, benefit, and cost
against a backdrop of patient preferences.
promote patient satisfaction and higher health-related quality of life.
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Models of EBP The Johns Hopkins Nursing Evidence-
Based Practice Model The Ace Star Model (Stevens, 2005) Lowa Model Rosswurm and Larrabee Model. Stetler Model.
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Models of EBP
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Models of EBP
Discovery Summary Translation Integration Evaluation
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Process of EBP
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N. MacIntyre, 2005
STEP 1: Identify an EBP question
The process of forming an EBP question often begins when one of the following questions arises:
1. What evidence is the basis for this treatment?
2. Is there a scientific basis for this treatment?
3. What was the rationale for making that decision?
4. What are the clinical implications of this practice?
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N. MacIntyre, 2005
STEP 1: Identify an EBP question
P Patient, population, or problem.
I Intervention or Interest
C Comparison intervention or status
O Outcome
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PICO A clinical question should incorporate at least
three elements
Patient Age, sex, ethnicity, etc. Condition, diseases, general health status
Intervention Education, diagnostics, treatment plan, self-care,
etc.
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PICO
Comparison Intervention Placebo, etc.
Outcome Expected and actual effects on patient
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PICO
Do nurse led tobacco cessation interventions result in decreased smoking rates after hospital admission for coronary heart disease?
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PICO
PATIENT (Adult) coronary heart patients Smokers Discharged from hospital
INTERVENTION Nurse led tobacco cessation programmes
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PICO
COMPARISON (Non-nurse led tobacco cessation programmes
Self-administered, non-nurse administered, etc.) No comparison
OUTCOME Lower rates of tobacco use among Patient group
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PICO
Not all questions are of a clinical nature
Intervention can be interpreted very broadly
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N. MacIntyre, 2005
Sources of Evidence-Based Practice Problems
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N. MacIntyre, 2005
Step 2: Define the scope of the practice question
The problem or question may relate to the care of
an individual patient,
a specific population of patients, or
the general patient population in the organization.
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N. MacIntyre, 2005
Step 3: Assign responsibility for leadership
Step 4: Recruit an interdisciplinary team
Step 5: Schedule a team conference
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N. MacIntyre, 2005
STEP 6: Conduct an internal and
external search for evidence Preprocessed resources - materials that
have been reviewed and chosen based on methodological standards for inclusion.
Primary evidence - usually data collected at the point of patient contact. This evidence can come from hospital-wide data, clinical trials, peer-reviewed research journals, conference reports, monographs, or summaries.
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N. MacIntyre, 2005
STEP 6: Conduct an internal and
external search for evidence Evidence summaries -
synthesized literature and provide broader foci on topics. (systematic reviews, integrative reviews, book chapters, and meta-analyses).
Translation literature - quality-filtered Internet and Intranet sources(practice guidelines, critical pathways, care plans, clinical innovations, protocols, standards).
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N. MacIntyre, 2005
STEP 6: Conduct an internal and
external search for evidence Evidence summaries -
synthesized literature and provide broader foci on topics. (systematic reviews, integrative reviews, book chapters, and meta-analyses).
Translation literature - quality-filtered Internet and Intranet sources(practice guidelines, critical pathways, care plans, clinical innovations, protocols, standards).
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N. MacIntyre, 2005
STEP 7: Appraise all types of evidence
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Claude Moore Health Sciences Library, 2003
Evidence Based Resources Models
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SUNY Downstate Medical Center, 2003
Evidence Pyramid
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Claude Moore Health Sciences Library, 2003
Evidence Based Resources Models
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N. MacIntyre, 2005
STEP 8 – 10 : EBPSTEP 8: Summarize the evidence
STEP 9: Rate the strength of the evidence
STEP 10: Develop recommendations for change in systems or processes
of care based on the strength of the evidence
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STEP 11: Determine the appropriateness and feasibility of translating recommendations into the specific practice setting
The practice guidelines development cycle
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N. MacIntyre, 2005
STEP 12 – 15 : EBP STEP 12: Create an action plan
STEP 13: Implement the change
STEP 14: Evaluate outcomes
STEP 15: Report the results of the preliminary evaluation to decision makers
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N. MacIntyre, 2005
STEP 12 – 18 : EBP
STEP 16: Secure support from decision makers to implement the recommended change internally STEP 17: Identify the next steps
STEP 18: Communicate the findings
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Questions?
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