1. GEISINGER Supporting a Culture for Evidence Based Nursing Practice Adele Mattinat Spegman, PhD, RN Director, Institute on Nursing Excellence HEAL. TEACH. DISCOVER. SERVE.

2. Pravikoff DS, Tanner AB, Pierce ST. (2005). Readiness of U.S. Nurses for Evidence-Based Practice. American Journal of Nursing, 105 (9), 40-51. 70% nurses in practice graduated prior to 1990 70% nurses in practice graduated prior to 1990 RNs report lack of skills or resources to conduct searches RNs report lack of skills or resources to conduct searches 76% respondents never searched CINAL; 58% never searched MEDLINE 76% respondents never searched CINAL; 58% never searched MEDLINE 82% hadn’t used hospital library 82% hadn’t used hospital library 46% reported familiarity with term “EBP” 46% reported familiarity with term “EBP” HEAL. TEACH. DISCOVER. SERVE. GEISINGER

3. Why does EBNP seem so hard to implement? Misconceptions: Cookbook approach Misconceptions: Cookbook approach Limited ‘know how’ regarding EBP strategies Limited ‘know how’ regarding EBP strategies Issues of time, access, workload Issues of time, access, workload Attitudes Attitudes –Skepticism & lack of self-efficacy –Limited motivation –Trust in traditional practices –Lack of perceived reward HEAL. TEACH. DISCOVER. SERVE. GEISINGER

4. GMC’s approach to an EBNP educational program The learning needs of GMC nurses reflect diversity of US nurse workforce Pravikoff, Tanner, Pierce, (2005) The learning needs of GMC nurses reflect diversity of US nurse workforce Pravikoff, Tanner, Pierce, (2005) Encouraged, not mandatory Encouraged, not mandatory Accessible – on-line program Accessible – on-line program CEUs CEUs Novice-to-expert approach Novice-to-expert approach Modules transferred into resource: ppt → pdf Modules transferred into resource: ppt → pdf –links to eJournals, eBooks HEAL. TEACH. DISCOVER. SERVE. GEISINGER

5. 3-Part Series Introduction to EBNP Introduction to EBNP – –Definition & relevance Using EBNP – – Focus on 5 steps (identify, search, judge, implement, evaluate) – –Detailed descriptions, examples, strategies EBNP as template for research activities – –Focus on research methods: designs, variables, data collection, analysis HEAL. TEACH. DISCOVER. SERVE. GEISINGER

6. What is EBNP? EBP is the conscientious use of current best evidence in making decisions about patient care. EBP is the conscientious use of current best evidence in making decisions about patient care. (Sackett, Straus, Rickardson, Rosenberg & Haynes, 2000) A 3-component approach to solving problems, all with equal importance: A 3-component approach to solving problems, all with equal importance: – –Systematic search for and critical appraisal of most relevant evidence to answer a specific clinical question. – –Clinical expertise (skills, experience, insight, experience, etc) – –Patient/family preferences and values HEAL. TEACH. DISCOVER. SERVE. GEISINGER

7. Why is EBNP a priority? Knowledge explosion Knowledge explosion Need for time-effective process to critique Need for time-effective process to critique Focus on outcomes Focus on outcomes Consumer awareness Consumer awareness Professional, federal, & regulatory pressures Professional, federal, & regulatory pressures Professional responsibility Professional responsibility Keeping pace with other professions Keeping pace with other professions HEAL. TEACH. DISCOVER. SERVE. GEISINGER

8. How does EBNP differ from ‘traditional’ practices? Evolution of ‘research utilization’ Evolution of ‘research utilization’ –RU: utilization focuses on a single study without inclusion of clinician expertise or pt/family value –By definition, EBP is broader in scope (multiple sources of evidence, clinical expertise, pt/family). Extends the nursing process into the 21 st century: Extends the nursing process into the 21 st century: critical thinking caring synthesis systematic evaluation clinical decision-making autonomous practice responsive to pt/family values & needs (Mallock & Porter-O’Grady, 2006) HEAL. TEACH. DISCOVER. SERVE. GEISINGER

9. Using EBNP Asking answerable questions Asking answerable questions –Foreground, background, PICO format Searching for the best available evidence Searching for the best available evidence –Mosby Nurse Consult, Ovid, PubMed, Internet –Primary/secondary sources, systematic reviews, review processes Judging the evidence Judging the evidence –Hierarchy of evidence! –Participants, sample size, inclusion/exclusion –Local applicability Implementation and evaluation Implementation and evaluation HEAL. TEACH. DISCOVER. SERVE. GEISINGER

10. Using EBNP Asking answerable questions Asking answerable questions –Foreground, background, PICO format Question templates: Etiology: Are __ who have __ at __ risk for __ compared with ___? Prevention: For __, does the use of __ reduce the future risk of __ compared with __? Meaning: How do __ diagnosed with __ perceive __? (Melnek & Fineout-Overholt, 2005, p. 31) (Melnek & Fineout-Overholt, 2005, p. 31) http://www.nursingconsult.com/das/book/82671869-2/view/1323 http://www.uicomp.uic.edu/IntMedRes/teach/question.htm HEAL. TEACH. DISCOVER. SERVE. GEISINGER http://www.nursingconsult.com/das/book/82671869-2/view/1323 http://www.uicomp.uic.edu/IntMedRes/teach/question.htm http://http://www.nursingconsult.com/das/book/82946866-4/view/1323 http://http://www.nursingconsult.com/das/book/82946866-4/view/1323 chapter 2, ‘background & foreground Qs’

11. Using EBNP Searching for the best available evidence Searching for the best available evidence –Mosby Nurse Consult, Ovid, PubMed, Internet –Primary/secondary sources, systematic reviews, review processes –Search strategies for OVID www.nursingconsult.com/das/book/82671869-2/view/1323 http://www.nursingconsult.com/das/book/82671869-2/view/1323 http://www.uicomp.uic.edu/IntMedRes/teach/srchovid.htm HEAL. TEACH. DISCOVER. SERVE. GEISINGER

12. Joanna Briggs Institute, Royal Adelaide Hospital, Australia Registered Nurses’ Association of Ontario Registered Nurses’ Association of Ontario Nursing Best Practice Guidelines EBNP resources on the Internet Western Australia Centre for EBN and Midwifery (systematic reviews & best practices) Western Australia Centre for EBN and Midwifery (systematic reviews & best practices) Evidence Based Public Health Nursing, UI at Chicago Evidence Based Public Health Nursing, UI at Chicago Academic Center for Evidence-Based Practice The University of Texas Health Science Center at San Antonio School of Nursing Academic Center for Evidence-Based Practice The University of Texas Health Science Center at San Antonio School of Nursing AHRQ: Agency for Healthcare Research and Quality AHRQ: Agency for Healthcare Research and Quality HEAL. TEACH. DISCOVER. SERVE. GEISINGER

13. CJNR - Canadian J of Nursing Research CJNR - Canadian J of Nursing Research Evidence-Based Nursing Journals http://www.biomedcentral.com/bmcnurs/ Evidence-based Child Health: A Cochran Review Journal Evidence-based Child Health: A Cochran Review Journal Evidence-based Child Health: A Cochran Review Journal Evidence-based Child Health: A Cochran Review Journal (GMC-HSL) 03/01/06 to present Evidence-based nursing Evidence-based nursing Evidence-based healthcare Evidence-based healthcare HEAL. TEACH. DISCOVER. SERVE. GEISINGER

14. Using EBNP Judging the evidence –Hierarchy of evidence! –Participants, sample size, inclusion/exclusion –Local applicability How is evidence rated? What factors increase the strength – value – of researched evidence? How strong are best practice guidelines? Aren’t best practices based on clinical evidence? Implementation and evaluation Implementation and evaluation http://www.nlm.nih.gov/nichsr/ihcm/hsrceval.html HEAL. TEACH. DISCOVER. SERVE. GEISINGER

15. EBNP as template for research activities Are the results valid? – –Bias, confounding variables – –How does the study design impact the value of the evidence? What are the results? – –Reliability issues: sample size, attrition – –Inclusion, exclusion criteria – –Statistical significance – –Clinical significance Will the results help locally? – –Similarities of participants with pt/families – –Research ‘control’ issues O’Rourke & Booth, 2000 HEAL. TEACH. DISCOVER. SERVE. GEISINGER

16. Thank you. HEAL. TEACH. DISCOVER. SERVE. GEISINGER

17. Assess = describe/formulate problem Assess = describe/formulate problem Performance improvement audits = data collection Performance improvement audits = data collection Revising protocols, standards = intervention Revising protocols, standards = intervention Evaluation of care = analysis Evaluation of care = analysis Nursing scholarship = examinations of actual practice and current literature to support new understandings about nursing care. Nursing scholarship = examinations of actual practice and current literature to support new understandings about nursing care. HEAL. TEACH. DISCOVER. SERVE. GEISINGER