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

2. 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. 

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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)

10. 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)

11. 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

12. 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

13. 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.

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

16. Models to Use Evidence in Practice

17. 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

18. 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

19. 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?

20. 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.

21. The Grove Model for Implementing Evidence-Based Practice

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

23. 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

24. 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

25. 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.

26. 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

27. 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

28. 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

29. 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

30. The End!
Questions? Comments?