Building an Evidence-Based Nursing Practice The Pennsylvania state university college of nursing Nursing 200w

Objectives ˜Identify the benefits and barriers related to evidence-based practice in nursing ˜Interpret systematic reviews, meta-analyses, meta-syntheses, and mixed-methods systematic reviews of current research evidence. ˜Describe the models used to promote evidence-based practice in nursing such as the Iowa Module of Evidence-Based Practice and The John Hopkins Nursing Evidence-Based Practice Model.  Describe the significance of evidence-based practice and translational research in developing evidence-based health care. 

Evidence-Based Practice Integration of all of the following to promote high-quality, cost-effective patient care with good outcomes: Best research evidence Clinical expertise Patient values and needs

Evidence-Based Practice Evidence-based practice is not always incorporated due to the following barriers: Practicality of implementing changes ‘Cookie-cutter’ or ‘cookbook’ approach to care

Evidence-Based Practice EBP is used because of benefits such as improved patient, family and caregiver outcomes. EBP can also improve provider (i.e., nurse, physician, etc.) and hospital outcomes. EBP leads to the ‘gold standard’ or best treatments

Sources for Evidence-Based Practice Systematic reviews Meta-analyses Integrative reviews Meta-syntheses

What are integrative reviews? Identify, analyze, and synthesize results from independent quantitative and qualitative studies to determine current knowledge Include multiple types of research designs and literature types Complicated review, but give breadth and depth to conclusions

What are systematic reviews? A narrowly focused synthesis of research findings from quantitative studies Looks at studies of similar methodology Has same standards of clarity, rigor, and replication as primary research studies

Steps in a Systematic Review Formulate purpose and identify scope. Develop specific questions or hypotheses. Establish criteria for inclusion/exclusion of studies. Conduct extensive literature search of all sources. (Melnyk & Fineout-Overholt, 2010; Whittemore, 2005)

Steps in a Systematic Review Develop questionnaire and contact authors to gather data. Critique studies for scientific merit and data analysis. Analyze and interpret data. Report the review. (Melnyk & Fineout-Overholt, 2010; Whittemore, 2005)

What is a meta-analysis? Statistically pools results from previous studies into single quantitative analysis Allows for application of scientific criteria For example, sample size, level of significance, variables

What results are reported in a meta-analysis? A large, diverse sample that is more representative of target population Determination of overall significance of probability of pooled data Indication of the efficacy of the intervention from the average effect size determined from several quality studies Strength of relationship between variables

What is the best evidence for use in practice? The strength of the evidence is on a continuum from high-quality results to lower quality results. Evidence-based guidelines are essential in developing evidence-based practice for nursing.

What is strong versus weak evidence? Strongest Weaker Meta-analysis Integrative reviews Experimental studies Descriptive surveys Qualitative studies Correlational studies Quasi-experimental studies

Models to Use Evidence in Practice

The Stetler Model of Research Utilization Phase I: Preparation Phase II: Validation Phase III: Comparative Evaluation/Decision Making Phase IV: Translation/Application Phase V: Evaluation

The Iowa Model of Evidence-Based Practice Provides direction for development of evidence-based practice in an agency Looks at triggers for change, such as: Risk management data Financial data Organizational standards Philosophy of care

Example Questions for Application of Iowa Model What are effective strategies for implementation? What are outcomes from using the research findings? Do the data support the change? Is the proposed change an agency priority?

The Grove Model for Implementing Evidence-Based Practice Nurses identify a practice problem Search for the best research evidence to manage the problem in their practice Note that an evidence-based guideline has been developed.

The Grove Model for Implementing Evidence-Based Practice

Factors to Consider when Implementing Change Time Support or Resources Needed Money Institutional or Other Barriers

Barriers at the Administrative Level Lack of Emphasis Placed on Research Limited Resources to Make Changes Based on Research Previous Changes Not Based on Research

Barriers at the Clinician/Nurse Level Lack of Knowledge of Research Process Do Not Keep Up to date with Research Do Not Believe or Trust in Research Findings Inability to Implement Findings into Daily Practice

How are Guidelines for Evidence-Based Practice developed? The Agency for Healthcare Research and Quality's (AHRQ) helps with guidelines through development of an expert panel. The group designates the scope of the guidelines. They synthesize the findings to develop recommendations for practice. Guidelines developed are presented at meetings and published.

Examples of AHRQ Practice Guidelines Pain management Decubiti prediction/prevention Cataract treatment in adults Depression treatment Screening, diagnosis, management of sickle cell disease in newborns and infants Otitis media treatment in children Availability of cardiac rehabilitation services

Where to Find Evidence-Based Guidelines Agency for Healthcare Research and Quality (AHRQ) National Guideline Clearinghouse (NGC) Academic Center for Evidence-Based Nursing American College of Physicians American Academy of Pediatrics

Implementing EBP in the ‘Real-World’ Identify practice problem. Search for best research evidence. Determine quality of guideline by assessing: Authors Significance of problem Strength of evidence Link to national standards Cost-effectiveness of guideline

What is translational research? The next frontier! And where you will be! An evolving concept defined by the NIH as the translation of basic scientific discoveries into practical application Encouraged by nursing and medicine to increase the implementation of evidence-based interventions in practice and determine if these interventions are effective

The End! Questions? Comments?