Evidence-Based Nursing An Overview What’s It All About? Betty Ackley, RN, MSN, EdS Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Objectives  Identify the advantages of Evidence-Based Nursing  Explain the process of Evidence-Based Nursing

3 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. A portion of this presentation is adapted from the following text: Ackley B, Ladwig G, Swan B, Tucker S. (2008). Evidence-Based Nursing Care Guidelines: Medical-Surgical Interventions. Philadelphia: Mosby.

4 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Evidence-based nursing is a systematic process that utilizes current evidence in making decisions about the care of patients, including evaluation of quality and applicability of existing research, patient preferences, costs, clinical expertise, and clinical settings (Fineout-Overholt, 2005).

5 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. How Do You Give the Best Care Possible?  What interventions help prevent falls in the elderly?  What interventions help prevent or treat stomatitis for the chemotherapy patient?  How do you protect hospitalized patients from developing Clostridium difficile infection?

6 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. We answer these questions by referring to texts or expert nurses, and there is only beginning research. The nursing field is currently opinion or expert based. This does not allow nursing to meet the criterion of being a profession. Instead: The nursing field must become research based, building our practice on research and documenting better outcomes as a result. We will then be a profession, not an occupation.

7 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Critical Thinking Empowerment Excellence Growth EBN Critical Thinking Empowerment Excellence Growth

8 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. EBN Nursing’s Core

9 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. The EBN Nurse is Empowered The EBN nurse knows what needs to be done, how it should be done, and the evidence that supports her or his practice “Armed” with Evidence “Armed” with Evidence

10 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. EBN vs EBP EBP EBM EBN EB Psych

11 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. EBN: All Levels of Nursing Education All Nursing Specialties  Licensed Practical Nurse  Associate Degree Nurse  Baccalaureate Nurse  Master’s Degree Nurse  PhD (conduct research)

12 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. EBN vs Research Utilization Complex process Newer concept—developed 10 yrs ago Includes patient preference Includes a system to grade or level the quality of the research Includes evaluation of the evidence based on the clinical setting in which it will be applied Includes an evaluation of cost- effectiveness Includes evaluation of staffing and expertise of staff Less complex process Older concept—used in the 1970s to early 1990s Patient preference not included No defined system to evaluate research; may change practice based on one study Clinical setting is not considered Cost is not addressed Staffing and expertise are not addressed

13 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Levels of Evidence (Adapted from Melnyk & Fineout-Overholt, 2005) Level I Systematic review or meta-analysis, or evidence-based clinical practice guidelines based on systematic reviews of randomized controlled trials (RCTs) or three or more RCTs of good quality that have similar results Level II Evidence obtained from at least one well-designed RCT Level III Evidence obtained from well-designed controlled trials without randomization Level IV Evidence from well-designed case control or cohort studies Level V Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis) Level VI Evidence from a single descriptive or qualitative study Level VII Evidence from the opinion of authorities and/or reports of expert committees

14 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Steps of Evidence-Based Nursing Steps of Evidence-Based Nursing 1. Ask the burning clinical question. 2. Collect the best evidence available. 3. Critically appraise the evidence. 4. Integrate the available evidence with clinical expertise, client preference, and values in developing a practice decision or change. 5. Measure the “before and after” of outcomes. 6. Evaluate the EBN decision or change. (Adapted from Melnyk & Fineout-Overholt, 2005)

15 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. ASKMME! ©Copyright, The Betty Ackley LLC

16 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. A sk the burning question

17 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. S earch and collect the most relevant and best evidence available. S earch and collect the most relevant and best evidence available.

18 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. thin k

19 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. M easure the outcomes before instituting the change. Measure the outcomes after the change.

20 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. M ake it Happen! Rewrite a policy and procedure; write a clinical protocol; change a nursing supply.

21 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. E valuate the practice decision or change. Were there improved outcomes? Did it save money? Time? Is it realistic in the clinical setting?

22 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Why Do You Do It That Way?  The answer used to be:  That’s how I was taught in school.  That’s what it says in the textbook.  That’s the way we’ve always done it here.

23 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Now The Correct Answer Is:  Evidence-based nursing shows that...

24 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. We will show the world that nursing care that nursing care makes a difference! makes a difference!

25 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. References  Ackley B, Ladwig G, Swan B, Tucker S. (2008). Evidence-Based Nursing Care Guidelines: Medical-Surgical Interventions. Philadelphia: Mosby.  Fineout-Overholt, E & Melnyk, B. (2005). Building a culture of best practice. Nurse Leader 3(6):  Melnyk, B & Fineout-Overholt, E. (2005). Evidence-based Practice in Nursing and Health Care. Philadelphia: Lippincott Williams & Wilkins.