1. Created by Terran Mathers, PhD, RN There is no conflict of interest in the creation of this education program.

2. Objectives  Explain the importance of Evidence Based Practice (EBP) in nephrology nursing.  List the steps of EBP.  Identify four internet resources/databases where previous research or guidelines may be located.  Recognize potential barriers to EBP within an organization so that strategies may be planned to overcome them.

3. Introduction Historical Background of EBP  1837: Pierre Louis  1970’s: Cochran Collaboration  1972: Briggs Report (DHSS)  2004: ANNA Nursing Research Committee Survey

4. What is Evidence-Based Research?  EBR defined: Clinically relevant research based on medical science; this research is patient-centered.  Research Utilization: Use of the knowledge found from research, usually based on a single study.  Cochrane Center (meta-analysis reviews) (Melnyk & Fineout-Overholt, 2005; Sackett et al, 2000)

5. What Is Evidence-Based Practice? Patient Preferences & Values Clinical Experience And Expertise Assessment Search and Appraisal Of Evidence Evidence Based Practice ** Clinical Decision Making Sackett et al, 2000; Melnyk & Fineout-Overholt, 2005

6. Why Evidence-Based Practice? Quality Care Positive Patient Outcomes Enhance Professional Environment Cost Containment

7. Centers for Evidence-Based Practice  Blue Cross and Blue Shield Association  Duke University  ECRI  John Hopkins University  McMaster University  Oregon Health & Science University  RTI International – University of North Carolina  Southern California  Stanford University – University of California, San Francisco  Tufts University – New England Medical Center  University of Alberta, Edmonton, Alberta, Canada  University of Minnesota, Minneapolis, MN  University of Ottawa, Ottawa, Canada www.ahrq.gov/clinic/epc/epcenters.htm

8. Steps of Evidence-Based Practice Step 1: Melnyk & Fineout-Overholt, 2005 What is the clinical question?

9. P=Patient Population / Disorder I=Intervention or Interest Area C=Comparison O=Outcome Ask the clinical question in the “PICO” format

10. PICO P=Elderly nephrology patients I= Psychosocial issues C=Effect on compliance O=Patient will be able to adapt to changes related to diagnosis and treatment Example:

11. Steps of Evidenced-Based Practice Step 2: Find the best evidence to answer the question  Systematic review of the literature  Meta-analysis or clinical practice guidelines  Rigorous process  Preset criteria  Overcomes bias  Valid / credible results

12. Guideline Databases  National Guideline Clearinghouse (NGC) http://www.guideline.gov http://www.guideline.gov  National Institute for Clinical Excellence (NICE) http://www.nice.org.uk/catcg2.asp?c=20034 http://www.nice.org.uk/catcg2.asp?c=20034  National Kidney Foundation K/DOQI Guidelines: http://www.kidney.org/professionals/doqi/guidelineindex.cfm http://www.kidney.org/professionals/doqi/guidelineindex.cfm

13. Steps of Evidence-Based Practice Step 3: Appraise the evidence 1. What were the results of the study? 2. Are the results valid? 3. Will the results facilitate patient care? Critical Questions to Ask:

14. Step 4: Steps of Evidence-Based Practice Integrate the evidence, patient assessment information, clinical expertise, patient preferences and values.

15. Steps of Evidence-Based Practice Evaluate the change in the clinical area. Step 5:

16. Implementing EBP: The Barriers  Translating the meaning and relevance of EBP  Knowledge deficit  Being overwhelmed by the evidence  The need for dedicated time  Negative views about research  Organizational constraints VanBuskirk, 2005; Melnyk & Fineout-Overholt, 2005

17. Facilitation of EBP Promote Acceptance  Access with surveys; focus groups  Identify baseline knowledge  Identify real case scenarios  Analyze the culture of the environment

18. Facilitation of EBP Correct Misperceptions  Have key leaders attend nursing centers  Teach the basics of EBP (Online Tutorials)  Expose to useful databases

19. EBP Online Tutorials  Evidence-Based Clinical Practice Tutorial http://www.urmc.rochester.edu/hslt/miner/digital_library/eviden ce_based_resources.cfm  Texas Health Science Center: Academic Center for Evidence-Based Nursing http://www.acestar.uthscsa.edu/  Evidence-Based Nursing http://www.hsl.unc.edu/Services/Tutorials/EBN/index.htm

20. Facilitation of EBP Question Clinical Practices  Prioritize problems  Utilize clinical practice guidelines and research  Promote a culture of organizational acceptance for EBP

22. References  Honor Society of Nursing, Sigma Theta Tau International (2005). Honor Society of Nursing, Sigma Theta Tau International: Position statement on evidence-based nursing. Indianapolis: Sigma Theta Tau International.  Cowan, P. (2004). Advancing evidence-based practice through meta-analysis. Nephrology Nursing Journal, 31(3), 343-345.  Gagan, M., & Hewitt-Taylor, J. (2004). The issues for nurses involved in implementing evidence in practice. British Journal of Nursing, 13(20), 1216-1220.

23. References  Gillis, A., & Jackson, W. (2002). Research for nurses: Methods and interpretation. Philadelphia: F.A. Davis.  Larrabee, J. (2004). Advancing quality improvement through using the best evidence to change practice. Journal of Nursing Care Quality, 19(1). 10-14.  Malloch, K., & Porter-O’Grady, T. (2006). Introduction to evidence-based practice in nursing and health care. Boston: Jones and Bartlett.  Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott, Williams, & Wilkins.

24. References  Pape, T. (2003). Evidence-based nursing practice: To infinity and beyond. The Journal of Continuing Education in Nursing, 34(4), 154-164.  Paramonczyk, A. (2005). Barriers to implementing research in clinical practice. The Canadian Nurse, 101(3), 12-18.  Portney, L. (2004). Evidence-based practice and clinical decision making: It’s not just the research course anymore. Journal of Physical Therapy Education, 18(3), 46-51.

25. References  Tod, A., Palfreyman, S., & Burke, L. (2004). Evidence- based practice is a time of opportunity for nursing. British Journal of Nursing, 13(4), 211-216.  VanBuskirk, S. (2005). The value of evidence-based practice in nephrology nursing. Nephrology Nursing Journal, 32(2), 134-135.  Sackett, D. L., Straus, S. E., Richardson, W. S. et al. (2000). Evidence-based medicine: how to practice and teach EBM. London: Churchill, Livingstone.