1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 2 Evidence-Based Practice

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Definitions Variety of definitions, interpretations –Definition according to David Sackett –Definition by Sigma Theta Tau International Use of term best practice by industries –Association with “benchmarking” –Now one of the less scientific forms of evidence used

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Definitions (cont.) Goal: provide optimal patient care –Enhancement of nursing practice –Improvement of patient or system outcomes

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Use of Evidence-Based Practice Why? –Control of health care costs: early stimulus –Provision of highest quality patient care: selection of optimal interventions for patients –Patient satisfaction

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Use of Evidence-Based Practice (cont.) When and Where? –Priority across nursing specialties (see Table 2.1) –Valued across nursing roles and responsibilities Preparation of nurse leaders and administrators Incorporation into curricula Expectation of staff nurses to participate in or lead initiatives

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Use of Evidence-Based Practice (cont.) Around the World –Worldwide commitment –Australia (the Joanna Briggs Institute) –Canada (Registered Nurses’ Association of Ontario) –Nursing Knowledge International (NKI): international clearinghouse, facilitator

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? The term evidence-based practice was first defined during the time of Florence Nightingale.

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Evidence-based practice emerged as a term in response to the ongoing expansion and demanding changes in health care. –It evolved when discussions of evidence-based medicine were expanded to include an interdisciplinary audience. –David Sackett, one of the leaders of the movement, defined evidence-based medicine. –Sigma Theta Tau expanded the definition to address nursing

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Determination of Evidence-Based Practice Questions arising in practice settings Nurses empowered to ask critical questions (see Box 2.1) Questions leading to decision making to affect outcomes Best answers, decisions from informed, evidence- based analysis of each situation

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Sources of Evidence Tradition-based –Consultation with more experienced, educated, higher-authority-level nurse –Institutional standards, procedure manuals –Coworkers, other health care providers

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Sources of Evidence (cont.) Evidence-based –Research Randomized controlled trial (RCT): considered the gold standard of clinical evidence Integrative review Meta-analysis –Practice-based evidence for continuous process improvement (PBE-CPI)

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Additional Sources of Evidence (cont.) Benchmarking data Clinical expertise Cost-effectiveness analyses Infection control data Medical record review data National standards of care Pathophysiologic data Quality improvement data Patient and family preferences

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Institutional standards are considered evidence-based.

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Institutional standards and procedure manuals are typically considered sources for tradition-based evidence rather than evidence-based information.

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Support Mechanisms for Best Evidence Garner administrative support Collaborate with research mentor (see Box 2.3) Seek assistance from professional librarians Search already reviewed or summarized research (journals, Cochrane Collaboration, AHRQ) Access resources from professional organizations (AACN, AWHONN, AORN, ONS) Benchmark with high-performing teams, units, institutions

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Mechanisms for Incorporation Into Practice Development, refinement of research-based policies, procedures Protocols, algorithms, decision trees, standards of care, critical pathways, care maps, institutional clinical practice guidelines Consensus of interdisciplinary team Patient, family support

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Challenges to Implementation Accessibility of research findings Anticipated outcomes of using research Support from others Lack of organizational support (Funk et al., 1991; Retsas, 2000)

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Challenges to Implementation (cont.) Lack of time or ability for effective research review Lack of authority to make changes to practice Difficulty accessing research articles Information overload Insufficient resources Preference for knowledge from co-workers and practice experience (Solomons & Spross, 2011)

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following would a nurse most likely need to address as the greatest obstacle when planning to implement evidence-based practice? A. Accessibility of research findings B. Support from others C. Setting D. Organizational support

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Based on research about barriers to implementing evidence-based practice, lack of organizational support was perceived to be the most significant limitation.

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation