Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 2 Evidence-Based Nursing: Translating Research Evidence Into Practice

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: The use of study findings in a practical application unrelated to the original research is evidence-based practice.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Research utilization is the use of study findings in a practical application unrelated to the original research. Evidence-based practice is basing clinical decisions on best possible evidence.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Research Utilization (RU) Versus Evidence-Based Practice (EBP) Research utilization (RU) The use of study findings in a practical application unrelated to the original research Evidence-based practice (EBP) Basing clinical decisions on best possible evidence—especially high- quality research

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Underpinning for Evidence-Based Nursing Cochrane Collaboration McMaster Medical School: evidence-based medicine

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question What may be used to rank study findings according to the strength of evidence provided? A.Evidence hierarchy B.Systematic review C.Randomized controlled trials D.Electronic databases

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A An evidence hierarchy may be used to rank study findings according to the strength of evidence provided. Systematic reviews, randomized controlled trials, and electronic databases are resources that are used.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Resources for Evidence-Based Practice Systematic reviews Clinical practice guidelines Care bundles Other preappraised evidence

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Barriers to Using Research in Nursing Practice Quality and nature of the research Characteristics of nurses Organizational factors

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: Systematic reviews can involve quantitative meta-analysis methods that integrate findings statistically.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Systematic reviews can involve either qualitative, narrative approaches to integration including metasynthesis of qualitative studies, or quantitative methods meta-analysis that integrate findings statistically.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Research Integration and Synthesis Forms of integrative reviews: Narrative, qualitative integration (traditional review of quantitative or qualitative results) Meta-analysis (statistical integration of results) Metasynthesis (theoretical integration of qualitative findings)

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Care Bundles Set of interventions Treat or prevent cluster of symptoms

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Two Models for Evidence-Based Nursing Practice The Stetler Model of research utilization to promote evidence-based practice The Iowa Model of evidence-based practice to promote quality care

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Five Sequential Phases of the Stetler Model Phase I: Preparation Phase II:Validation Phase III:Comparative Evaluation and Decision Making Phase IV:Translation/Application Phase V:Evaluation

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Iowa Model of Evidence-Based Practice to Promote Quality Care The Iowa Model outlines a series of activities with three critical decision points: Decide whether problem is a sufficient priority for the organization exploring possible changes Decide whether there is a sufficient research base Decide whether change is appropriate for adoption in practice

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Individual nurses can put research into practice. What is the first step? A.Searching for relevant research evidence B.Appraising and synthesizing the evidence C.Framing an answerable clinical question D.Assessing effectiveness

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C The correct order of steps is (1) framing an answerable clinical question; (2) searching for relevant research evidence; (3) appraising and synthesizing the evidence; (4) integrating evidence with other factors; and (5) assessing effectiveness.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of Individual EBP 1.Framing an answerable clinical question 2.Searching for relevant research-based evidence 3.Appraising and synthesizing the evidence 4.Integrating evidence with other factors 5.Assessing effectiveness

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Appraisal of Evidence Validity of study findings Clinical importance of findings Precision of estimates of effects Associated costs and risks Utility in a particular clinical situation

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins EBP in Organizational Context More formalized than individual EBP Must take organizational and interpersonal factors into account “Triggers” include both pressing clinical problems and existing knowledge

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Organizational (Team-Based) EBP Projects Involve the development or adaptation of clinical practice guidelines or clinical protocols Assessment of implementation potential of the innovation Transferability Feasibility Cost–benefit ratio

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementing and Evaluating the Innovation Pilot Test Develop an evaluation plan Collect information on outcomes Train staff in the use of the new guideline and, if necessary, “market” the innovation Try the guideline out on one or more units or with a group of clients Evaluate the pilot project

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nurses’ Role in Using Research Evidence Read widely and critically Attend professional conferences Learn to expect evidence that a procedure is effective Become involved in a journal club Pursue and participate in RU/EBP projects