An important theme defined as the conscientious integration of best research evidence with clinical expertise and patient values and needs in the delivery of quality, cost-effective health care.
Best research evidence
Produced by the conduct and synthesis of numerous, high-quality studies in a health-related area. The best research evidence is generated in the areas of health promotion; illness prevention; and the assessment, diagnosis, and management of acute and chronic illnesses.
What are some barriers to evidence-based nursing practice?
Nursing lacks the research evidence for the implementation of an EBP in many areas. The development of EBP has lead to a "cookbook" approach to nursing care. General evidence is generated based on population data and then is applied in practice to individual patients.
Barriers to evidence based nursing practice cont.
Difficulties in translating basic research knowledge generated in a lab with animals to human beings. Some healthcare agencies and administrators do not provide the resources to support the implementation of EBP by nurses
What are some of the benefits to evidence-based nursing practice?
Improved outcomes for patients, providers, and healthcare agencies. Easy access to assist healthcare providers in making the best clinical decisions..
benefits of evidence based nursing practice continued.
Many health care agencies are supportive of EBP because it promotes the delivery of quality, cost-effective care to patients and families and meets accreditation requirements
How is research evidence synthesized?
Systematic review, meta-analysis, integrative review, metasummary, and metasynthesis.
is a structured, comprehensive synthesis of quantitative studies in a particular healthcare area to determine the best research evidence available for expert clinicians to use to promote and EBP.
Cummulative Index to Nursing and Allied Health Literature (CINAHL)
Authoritative resource covering the English language journal literature for nursing and allied health. The database was developed in the United States and includes published sources from 1982 forward..
PubMed-National Library of Medicine (MEDLINE)
Database developed by the National Library of Medicine in the United States and provides access to more than 11 million MEDLINE citations back to the mid-1060s and additional life science journals
MEDLINE with MeSH
Database provides authoritative medical information on medicine, nursing, dentistry, veterinary medicine, the healthcare systems, preclinical services and more.
Database that includes professional and academic literature for psychology and related disciplines from 1887 forward. This database was developed by the American Psychological Association
Database of information on cancer that was developed by the United States National Cancer Institute.
Provides high-quality evidence to inform people providing and receiving health care and those responsible for research, teaching, funding and administration of health care at all levels. Included is the Cochrane Collaboration that has many systematic reviews of research.
National Library of Health (NLH)
Located in the United Kingdom and can search for evidence-based sources.
National Guideline Clearinghouse (NGC)
Agency for Healthcare research and Quality developed in 1998. The NGC to house the thousands of evidence-based guidelines that have been developed for use in clinical practice. Initiated by the Agency for Healthcare Research and Quality (AHRQ).
National Institute for Health and Clinical Excellence (NICF)
organized in the united kingdom to provide access to the evidenced-based guidelines that have been developed.
What does the quality of research syntheses determine?
The best research evidence in a selected area and the quality of the research evidence available for practice.
What two models have been developed to promote EBP in nursing?
The Stetler Model of Research Utilization to Facilitate EBP and the Iowa Model of Evidence-Based Practice to Promote Quality of Care.
What are the phases of the revised Stetler model?
Preparation, validation, comparative evaluation/decision making, translation/application, and evaluation
Iowa Model of Evidence-Based Practice
Provides guidelines for implementing patient care based on the best research evidence and monitoring changes in practice to ensure quality care.
What was used to implement the EBP protocol for using saline flush to integrate intravenous catheters in adults?
Iowa Model of Evidence-based practice
format developed to promote implementation of the best research evidence in practice. Elements: Population or participants of interest; Intervention needed for practice; Comparisons of interventions to determine the best for practice; and Outcomes needed for practice.
What was used to demonstrate the EB delivery of IM injections by nurses?
The Grove Model for Implementing Evidence-Based Guidelines in Practice
provided to assist nurses in determining quality of evidence-based guidelines and the steps for using these guidelines in practice.
Evidence-based practice centers (EPCs)
Created by the AHRQ in 1997. Important role in the conduct of research, development of systematic reviews, and formulation of evidence-based guidelines in selected practice areas.
Evolving concept that is defined by the NIH as the translation of basic scientific discoveries into practical applications.
Clinical and Translational Science Awards (CTSA) Consortium
Developed by the NIH in October 2006, to encourage researchers to conduct transitional research
What are the steps in the Grove Model
Examine the following: the authors of the guideline, significance of the healthcare problem, strength of the research evidence, the link to national standards, cost-effectiveness of using the guidelines in practice.
Integrative review of research
Conducted to identify, analyze, and synthesize the results from independent studies to determine the current knowledge (what is known and not known) in a particular area
Performing statistical analyses to integrate and synthesize findings from completed studies to determine what is known and not known about a particular research area.
Qualitative research synthesis
process and product of systematically reviewing and formally integrating the findings from qualitative studies.
the synthesis or summing of the findings across qualitative reports to determine the current knowledge in an area.
a fully integrated, novel, description or explanation of a target event or experience versus a summary view of that event or experience.
What are the five phases of Stetler's Models of Research Utilization to Facilitate Evidence-Based Practice?
Preparation, validation, comparative evaluation/decision making, translation/application, and evaluation.
Phase I: Preparation
determining the purpose, focus and potential outcomes of making an evidenced based change in a clinical agency.
Phase II: Validation
Research reports are critically appraised to determine their scientific soundness. If the studies are limited in number or are weak, or both, the findings and conclusions are considered inadequate for use in practice and the process stops.
Phase III: Comparative Evaluation/decision making
Includes four parts: Substantiation of the evidence; fit of the evidence with the healthcare setting; feasibility of using research findings; and concerns with current practice.
Decision-making aspect of phase III
Three decisions are possible: to use the research evidence; to consider using the evidence; and to not use the research evidence.
What does the decision to use research knowledge in practice rely on?
The strength of the evidence.
Phase IV: Translation/Application
Involves the planning for and actual use of the research evidence in practice. Determining exactly what knowledge will be used and how that knowledge will be applied to practice.
What are the steps for planned change in the application stage?
Assess the situation to be changed; develop a plan for change; implement the plan
Phase V: Evaluation
Is used to evaluate the impact of the research-based change on the healthcare agency, personnel, and patients. Includes both formal and informal activities.
include case studies, audits, quality assurance and translational or outcomes research projects
Self-monitoring, discussions with patients, families, peers and other professionals.
What is the goal of Stetler's model?
to increase the use of research evidence in nursing to facilitate ERP.
How does Stetler's model encourage nurses?
It provides detailed steps to encourage nurses to become change agents to make the necessary improvements in practice based on research evidence.
Iowa Model of Evidence-Based Practice
Provides direction for the development of EBP in a clinical agency. In a healthcare agency, there are triggers that initiate the need for change and the focus should always be to make changes base don the best research evidence.
Research based protocols
Document providing clearly developed steps from implementing treatment or intervention in practice that is based on findings from studies.
Critical appraisal for scientific merit
Determine the scientific merit of nursing studies by critically appraising the following aspects of study: the conceptualization and internal consistency, or the logical lings of a study; methodological rigor, or strength; generalizability of the findings; the number of replications.
Evaluation for clinical relevance
A practitioner desiring to implement a research-based intervention must be able to assure the agency that the benefits of the intervention outweigh the cost in time,, energy, and money and any real or potential risks.
Synthesis or research evidence
Is the evidence strong enough to support making a change in practice? Process for synthesizing quantitative research evidence includes: systematic review, meta-analysis, and integrative review.
Patient care guidelines that are based on synthesized research findings from meta-analyses, integrative reviews of research, and extensive clinical trials supported by consensus form recognized national experts and affirmed by outcomes obtained by clinicians.
What were some of the first guidelines from the AHRQ focused on?
Acute pain management in infants, children, and adolescents; prediction and prevention of pressure ulcers in adults; urinary incontinence in adults; management of functional impairments with cataracts; detection, diagnosis and treatment of depression;
first guidelines from AHRQ continued..
screening, diagnosis, management and counseling about sickle cell disease; management of cancer pain; diagnosis and treatment of heart failure; low back pain; otitis media diagnosis and management in children
Nursing Research & Evidence-Based Practice44 terms