1. Evidenced Based Practice; Systematic Reviews; Critiquing Research
CNL Exam Review

2. Evidence-Based Practice
Conscientious integration of best research evidence with clinical expertise and patient values and needs in the delivery of high-quality, cost-effective health care
Synthesis of knowledge for development of guidelines, standards, protocols, or policies to direct nursing interventions and practice

3. Evidence-Based Practice
Hospital Priorities
Pressure Ulcers
Falls
Hospital Acquired Infections
Reducing costs
Improving patient and staff satisfaction
Reducing errors
communication

4. Evidenced-Based Practice
Masters prepared
Innovators
Early adopters
Application
Evaluate Merit
Clinical Relevance
Sufficiency of research base
Pilot change
Monitor Outcomes
Innovators-bring new ideas
Early adopters-embrace new ideas.
Communication of new ideas through media and books, journal but most effective in 1:1 or face-to face to increase utilization
Barriers/Facilitators-practitioners uncomfortable and lack knowledge to critique or understand researcher. 2) lack support from administration. 3) poor quality of research findings. To improve increase in dissemination of research, publish more literature reviews and meta-Analysis., Develop evidenced based guidelines for practitioners. Clinicians need to publish implementation and outcomes of implemented EBP.
Magnet Status-must have EBP protocol
Evaluate Merit-valid study pooled studies. Large sample size, rigor of methods, representative sample. Strength of findings.
Clinical Relevance-need everyone on board
Sufficiency of research base-Meta-Analysis and literature clustering or review. Meta-analysis is a methodology that scientifically pools results from previous studies into a single quantitative analysis
Pilot change-need to be flexible. Watch resistors. Give extra time.
Monitor Outcomes-have to consider nurse, system and client outcomes.

5. Creating an EBP Culture
Value Reflection
Develop rituals
Ask why
Is there evidence to support it?
Is it best for patients?
Are there better ways?
Share concerns-multidisciplinary
Gather information

6. Intellectual Research Critique
A careful examination of all aspects of a study to judge:
Merits
Limitations
Meaning
Significance
Bias
Bias-any influence or action in a study that distorts the findings or slants them away from the true or expected

7. Critique Skills Critical thinking Logical reasoning
Knowledge of research methodology
Attention to details
Recognition of strengths and weaknesses

9. Levels of Evidence

10. Rigor in Random Control Studies
P < .05
Sample size
Reliability of measures
Control confounding variables
Replication

11. Types of Systematic Reviews
Meta-Analysis-random control trials
Systematic Review-other quantitative studies
narrative findings
Meta-Synthesis
Pitfalls
Literature reviews

12. Common Threads Problem Formation Comprehensive Search
Clearly identified problem and variables
Identified prior to searching the literature
Inclusion and exclusion criteria
Comprehensive Search
Published and unpublished work
Networking
Conferences
Dissertations
Two independent selectors
How the literature was searched should be clearly identified in the article
Bias in published work is that many times only studies with significant findings are accepted in refereed journals

13. Common Threads (con’t)
Data Evaluation
Primary studies evaluated for rigor
Reliability and validity coding
Two independent evaluators to establish inter-rater reliability
Quality scores
Data Analysis/Findings
Thorough interpretation of studies
Visual aides to describe studies
Identification of potential threats and bias

14. Systematic Review Summarize findings regarding a clinical problem
Studies have related or identical hypotheses
Quantitative designs
Narrative findings

15. Meta-Analysis Randomized control studies
Testing interventions
Studies have related or identical hypotheses
Statistical Findings
Measure the magnitude of a common effect
Test for homogeneity
Explain heterogeneity
High level of evidence
Homogeneity is the similarity between studies. If heterogeneous then need to explain. Look for differences in sample and quality of studies.
If done correctly-high level of evidence

16. Meta-Synthesis Qualitative studies Related phenomena Develop theory
Rigor
Participants and/or primary authors agree with interpretations
Used for enhancing the experience
Moderate level of evidence
Qualitative critique for having many studies in isolation.
Can you combine phenomenology, grounded theory and ethnographic philosophies

17. Levels of Evidence