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EBP CHAPTER 1, 2

Terms in this set (13)

Evidenced Based Practice
A systematic search for as well as critical appraisal and synthesis of the most relevant and best research (external evidence) generated from outcomes. One's own clinical expertise, which includes internal evidence generated from outcomes management or quality improvement projects, a thourough patient assessment and evaluation and use of available resources necessary to achieve desired patient outcomes. Patients preverences and values.
EBP
Unlike research utilization, which has been frequently operationalized as the use of knowledge typically based on a single study, EBP takes into consideration a synthesis of evidence from multiple studies and combines it with expertise of the practioner as well as patient preferences and values.
RCT
Randomized Clinical Trials also known as cohort studies.
RCTs
Strongest level of evidence (Level 1 evidence) should be included along with a) clinical judgement b) internal evidence generated from quality improvement or outcomes management projects c) clinical reasoning (i.e. ability to apply the improvement or outcomes management projects and d) evaluation and use of available healthcare resources needed to implement the chosen treatments and achieve the expected outcome.
Origins of EBP
Founderd by Dr. Archie Cochrane, a British epidemiologist, who struggled with the efficacy of healthcare and challanged the public to pay only for the care that had been empiracally supported as effective.
Box 1.1
The level of the evidence + Quality of the evidence=strength of the evidence--> confidence to act upon the evidence and change practice!
Cochrane died in 1988
As a result of his influence and call for updates of systemic RCTs, the Cochrane center was launced in Oxford England in 1992 and the Cochrane collaboration a year later. The major purpose of the center and the international collaboration is to assist individuals in making well-informed decisions about healthcare by developing, maintaining and updating systematic reviews of healthcare interventions and ensuring that these reviews are accessible to the public.
EBP, WHY?
Leads to the highest quality of care and the best patient outcomes. In addition, EBP reduces healthcare costs and geographic variation in the delvery of care. EBP keeps turnover low and employees keep from burning out.
Progress
The gap betwen the publishing of research evidence and its translation into practice to improve patient care often takes 17 years and continues to be a major concern for healthcare organizations as well as federal agencies.
Magnet hospitals
The program evaluates quality indicatiors and standards of nursing practice as defined in the ANA scope and standards for nursing administrators. Conducting research and using EBP are critical for attaining Magnet status. Hospitals are appraised on EBP: quality. The Magnet program is based on a model with five key components a) transformational leadership, b) stuctural empowerment c) exemplary professional practice d) new knowledge, innovation and improvements which emphazsize new models of care, application of existing evidence, new evidence and visible contributions to the science of nursing and e) empirical quality results, which focus on measuring outcomes to demonstrate the benefits of high-quality care.
Seven steps of evidence-based practice
0. cultivate a spirit of Inquiry
1 Ask the burning clinical questio in the format that will yield the most relevant and best evidence (ie. PICOT format.
2. Search for and collect the most relevant and best evidence to answer the clinical question
3. Critically appraise the evidence that has be collected for its validity, reliability, and applicability, then synthesize that evidence.
4. Integrate the evidence with one's clinical expertise and the patient's preferences and values to implement a clinical decision.
5. Evaluate outcomes of the practice decision a r change based on evidence.
6. Disseminate the outcomes of the EBP decision or change.
Rating System for the Hiearchy of Evidence for intervention/tratment questions.
I Evidence from a sytemic review or meta analysis of all relevant RCT;s
II Evidence obtained from well designed RCT
III Evidence obtained from well-designed controlled trials without randomization.
IV Evidence from well-designed case-control cohort studies
V Evidence from systematic reviews of decriptive and qualitative studies.
VI Evidence from single desriptive or qualitative studies.
VII Evidence from the opinion of authorities and or reports of expert committees.
Meta analysis
Systematic reviews incorporating quantitative methods to summarize the results from multiple studies. Thus systematic reviews and Meta analysis yield the strongestlevel of evidence on which to base practice decisions.
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