1. Evidence-Based Practice Back to the Basics Anne Burnett, RN-BC, MSN, CRRN Veterans Healthcare System of the Ozarks April 4, 2011

2. Learning Objectives Evidence-Based Practice History EBP Process An Example of Using EBP ABC Mnemonic

3. Florence Nightingale “The most important practical lesson that can be given to nurses is to teach them what to observe – how to observe – what symptoms indicate improvement – what the reverse – which are of importance – which are of none”. (Nightingale, 1860)

4. Translation Teach nurses what is important to monitor How to monitor it What trends show improvement What trends show negative change Which indications are important Which indications don’t matter

5. Professional Nursing Information –Collecting –Interpreting –Evaluating

6. EBP Defined Combines –Research –Data Collection –Nurse experience –Patient wishes and needs

7. DATA Nursing Assessment Observations Collecting Care improvement Evaluating Sharing

8. Academic & Publishing Landmarks 1860 1873 1900 1907 1912 1923 1929 1952 Nightingale Hospital RN Programs in US American Journal of Nursing Teacher’s college of Columbia National League of Nursing Education 1 st Doctoral Program in Nursing Education Goldmark Report 1 st Master of Nursing Nursing Research Journal

9. Key Drivers for the 20 th Century Nursing Research Conferences – 1960’s –American Nurse’s Association Building Foundations –Developing Academic Programs Frameworks and understanding research –The Practice of Nursing Research –Burns & Grove, 1980’s

10. Key Drivers for the 21 st Century Formalizing five steps of EBP –Melnyk & Fineout-Overholt; Evidence-Based Practice in Nursing & Healthcare Nursing developing a researched body of knowledge –Boswell & Cannon; Introduction to Nursing Research Incorporating Evidence-Based Practice EBP Conferences –Locally, Regionally, Nationally

11. Veterans Healthcare System of the Ozarks EBP Council Made up of nurses from diverse care delivery areas: –Acute care –Surgery –Outpatient areas –Psychiatric care (Boswell & Cannon, Ch.1; Hockenberry, et al; Mantzoukas; Titler; Turkel, et al)

12. Challenges & Solutions Challenges –Culture Changes –Introducing EBP –Implementing EBP –Educational Gaps –Prior Experience Solutions –Education for staff & the council –Poster Presentations –Developing Nursing Projects –Research Critiques

13. EBP Council Serves as resource –Developing Change Strategies Share information –How to access research Guiding staff to other change venues –Appropriate change process –Example the Watson Theory Project

14. Integrating EBP Studies on how to integrate EBP Culture of change Recent research developments Nurse Empowerment

15. Skills Developing skills Overcoming resistance to change Engaging staff

16. Mnemonic Development Mnemonics have been used by nurses for years Tool to integrate multiple step processes ADPIE

17. Mnemonic Reduce volumes of information Helps sequence –Complex information Building Blocks for EBP

18. The ABCs of EBP = Ask = Consider = Facilitate = Books = Develop = Evaluate

19. A = Ask the Question A is the essence of EBP Melnyk & Fineout-Overholt –“BURNING QUESTION” Right Question Right way Key to using EBP A has a secondary mnemonic: –PICOT

20. PICOT Format P = Population. I = Intervention. C = Comparison. O = Outcome. T = Time.

21. Secondary Mnemonic PICOT Filtering Project Goals Focus the research

22. Goals for PICOT Application of the collected evidence Narrow focus End product Application

23. PRACTICE PICOT So this sample question reads: Does this diabetic teaching tool help my diabetic patients reduce their A1c in six months compared to the current process we use?

24. Example of the PICOT P opulation: Diabetic patients I ntervention: Diabetic teaching tools C omparison: A1c prior to the education O utcomes: A1c after the education T ime: 3 months, 6 months, Ongoing

25. ABCs of EBP = Ask = Books = Consider = Develop = Evaluate = Facilitate

26. B = Books B stands for books; meaning research Use the question to narrow the search to manageable amounts Internet search engines & research sites http://www.ahrq.gov http://www.cdc.gov (Boswell & Cannon, Ch.7; Burns & Grove, Ch.2; Melnyk & Fineout-Overholt, Ch.3)

27. B = Books Using Search engines & sites Nursing Organizations On-line libraries at work or school

28. Caution!!!! CINAHL Full Search under EBSCO Host First run: Diabetes –57,163 results Second run: narrow dates –35,672 Third run: add ‘education’ –1,623 Fourth run: add ‘tool’ –1 study

29. ABCs of EBP = Ask = Books = Consider = Develop = Evaluate = Facilitate

30. C = Consider Evaluate the research Tool developed Using the tool (Boswell & Cannon, Ch.5, Burns & Grove, Ch.2 4; Mantzoukas; Melnyck & Fineout-Overholt, 2005, Ch. 5)

31. Research Evaluation Tool Article Title Target Population/is it applicable here? What was tested/ is it applicable DatesStrengths of Study Weaknesses of study Other comments/ citation if indicated Dick & Jane look for Spot. 2 children looking for dog. N/A we don’t have pediatrics here. Ф Tested methods to look for dogs. N/A we don’t have dogs here. Ф This study is not dated. I would guess 1940’s. Ф In-depth case study. Ф Only 2 subjects. Needs larger sample size. Ф Citation if the study is going to be used to build a paper, or develop further research. Comments if the study might be used for something in the future. Ф Any other brief memory joggers you want to add. Boswell & Cannon, p.108; Mantzoukas) You might get ideas for other search parameters Use them as a pilot study

32. ABCs of EBP = Books = Ask = Consider = Develop = Evaluate = Facilitate

33. D = Develop & Apply Develop and apply the intervention being considered Use specific steps, specific details in order to make the project manageable Specific to your patient population (Melnyk & Fineout-Overholt, Ch.10)

34. Develop the EBP Project Does this tool help my diabetic patients reduce their A1c in six months compared to the current process we use? –Tool adjusted for your patient population –Instructions for staff –Instructions for patients

35. ABCs of EBP = Ask = Books = Consider = Develop = Evaluate = Facilitate

36. E = Evaluate Evaluating care delivery should be second nature for nurses Familiar from the nursing process Collecting data to drive the evaluation Statistical analysis may be necessary Decide what is going to be measured (Boswell & Cannon, Ch.9; Melnyk & Fineout-Overholt, Ch.10 & 11)

37. Chocolate

38. Evaluate Results of the Project Does this tool help my diabetic patients reduce their A1c in six months compared to the current process? –Run A1c –Count –Pre/Post Test –Questionnaires

39. Note Research Ethics Privacy Institutional Review Board

40. ABCs of EBP = Ask = Books = Consider = Develop = Evaluate = Facilitate

41. F = Facilitate Facilitate EBP Academic Growth Professional Growth Skills Development Share Project Findings (Melnyk & Fineout-Overholt, Ch.14)

42. Evidence at Work in Practice Fact sheets for nurses Publish research article reviews Share findings Attend conferences Support other staff development Culture changes

43. Getting EBP to the Staff Power Point Presentation New employee orientation Introduces new staff to our cultural environment EBP not in original curricula

44. Thank You “Let whoever is in charge keep this simple question in her head: – Not how can I always do this right thing myself, but how can I provide for this right thing to be always done?” –Florence Nightingale, 1860

45. The Answer is EBP!

46. Questions?

47. References Boswell, C. & Cannon, S. (Eds.) (2007). Introduction to nursing research: Incorporating evidence-based practice, p.108. Sudbury, MA: Jones & Bartlett. Burns, N., & Grove, S. (2005) The practice of nursing research ch.2, (5 th ed.), Elsevier. Bradshaw, W. (2010). Importance of nursing leadership in advancing evidence-based practice. Neonatal Network, 29(2), 117-122. Dontje, K. (2008). Evidence-based practice: Understanding the process. Topics in Advanced Practice Nursing eJournal, 7(4). Retrieved May 13, 2010 from http:www.medscape.com/viewarticle/567786. Hockenberry, M., Walaen, M., Brown, T., Barrera, P. (2008). Creating an evidence-based practice environment: One hospital’s journey. Journal of trauma nursing, 15(3) p.136-142. Ireland, M. (2008) Assisting students to use evidence as a part of reflection on practice. Nursing Education Perspectives, 29(2) p.90-93.

48. References Melnyk, B, & Fineout-Overholt, E. (Eds.). (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. (Ch1) Philadelphia:Lippincott Williams & Wilkins Nightingale, F. (1860). Notes on nursing: What it is and what it is not. Dover edition, NY, 1969 (original work published by D. Appleton and company, 1860). Seben, S., March, K., Pugh, L. (2010). Evidence-based practice: The forum approach. American Nurse Today, 5(11) p.32-34. Titler, M. (2010). Chapter 7, The evidence for evidence-based practice implementation. Retrieved Sep. 29, 2010 from http://wwwahrq.gov/qual/nurseshdbk/docs/TitlerM_EEBPI.pdf