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Chapter 5: Evidence-based Practice
Terms in this set (29)
Discuss the benefits of evidence-based practice
A problem solving approach that combines the deliberate and systematic use of the best evidence in combination with a clinicians expertise, patient preferences, and values, and available healthcare resources in making decisions in patient care.
EBP: enhances the patient experience, decreases cost, empowers clinicians and improves patient outcomes. It further improves the quality and consistency of healthcare
I'm plementing evidence-based practice in a reliable way is a feature of quality care and effective timely and appropriate clinical decisions.
Quality and safety education for nurses (QSEN): prepare nurses in preliscnesure and graduate programs with the knowledge skills and attitude necessary to continuously improve the quality and safety of HC systems.
Describe the steps of evidence-based practice
0. Cultivate a aspirin of inquiry within EBP culture and on iron net
1. Ask a clinical question in PICOT format
2. Search for the most relevant and best evidence
3. Critically appraise the evidence you gather
4. Integrate the best evidence with your clinical expertise and patient preferences and values to make the best clinical decision
5. Evaluate outcomes of practice changes based on evidence
6. Communicate the outcomes of EBP decision or changes
Develop a PICOT question
P=Patient population of interest
Identify pateints by age, gender, ethnicity, and disease or health problem
I= Intervention of interest
Which intervention is worthwhile to use in practice (treatment, diagnostic test, prognostic factor) ? What are of interest influences a desired outcome (complementary theory, motivational interviewing)
C=Comparison intervention or area of interest
What is the usual standard of care or current intervention used now in practice?
What result do you wish to achieve or observe as a result of an intervention (change in patient behavior, physical finding, or patient perception)
What amount of time is needed for an intervention to achieve an outcome (the amount of time needed to change quality of life or patient behavior)
Identify the components of a PICOT question
Explain the levels of evidence available in the literature
Level 1: systematic review or meta-analysis of randomized controlled trials (RCT) evidence based clinical practice guidelines based on systematic reviews
Level 2: a well designed RCT
Level 3: controlled trial without randomization (quasiexpiramental study)
Level 4: single non experimental study (case control, correlational, cohort studies)
Level 5: systematic reviews of descriptive qualitative study
Level 6: single descriptive or qualitative study
Level 7: option of authorities and/or reports of expert committees
Discuss how nurses apply evidence in practice
Use your clinical expertise and consider patients' values and preference to ensure that you will apply the evidence in practice both safely and appropriately
Explain how nursing research improves nursing practice
Nursing research helps improve the health and welfare of people who are undeserved.
Identify new knowledge, improve professional education and practice, and use nursing a healthcare resources effectively. Asks and answered questions to develop knowledge. It provides a basis for nursing practice and evaluates the effectiveness of nursing interventions.
It improves professional nursing education and practice and helps nurses use resources effectively. Provide safe and effective care.
Discuss the steps of the research process
Move from the research question to finding the answer.
The researching identifies and area of inquiry (identify a problem), which often results from clinical practice.
Review of the literature.
Forms a research team to design the study with the help of a nurse researcher. (Research team and research sample)
Before doing a study with human subjects the researcher obtains approvals from the human subjects committee or institutional review board.
- informed consent: research subjects are given full and complete information about the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; are capable of fully infer standing research and implications of participation; have the power of free choice to voluntarily consent or decline participation; and understands how the researcher maintains confidentiality and anonymity
-confidentiality: guarantees that any information a subject gives will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team.
Call left data on the study protocol, once all data is collected the team analyzes the data. Consider study limitations
-limitations: factors that affect study findings. These show how to refine or adapt the study in the future
Addresses the implications for nursing practice, helping apply these findings to HC.
Identify Area of Interest or Clinical Problem
formulate theoretical framework
Reflect on personal practice and/or discuss clinical issues with experts to better define the problem
Develop research questions(s)/hypothesis
Determine how study will be conducted
Select research design/methodology
Identify plan to recruit sample, taking into consideration population, number, and assignment groups
Identify study variables; specific interventions (independent variables) an d outcomes (dependent variables)
Select data collection methods
Select approach for measuring outcomes; questionnaires, surveys, psychological measures, interviews, observations
Formulate plan to analyze data; statistical methods to answer research questions/hypotheses
Conduct the study
Obtain necessary approvals
Recruit and enroll subjects
Implement the study protocol/collect data
Analyze results of the study and use of the findings
Continually analyze study methodology. Is study consistently carried out? Are all investigators following protocol ?
Interpret demographics of study population
Analyze data to answer each research question/hypotheses
Interpret results, including conclusions, limitations
Formulate recommendations for further research
Determine implications in nursing
Disseminate the findings: presentations, publications, need for further study, how to apply findings to practice
Explain the relationship among evidence-based practice, research, and performance
Although they are closely related, they are separate processes in nursing practice that all require the use of the best evidence to provide high-quality patient care
Evidence-based practice: use of information from research, professional experts, personal experience, and patient preferences, to determine safe and effective nursing interventions with the goal of improving patient outcomes
Research: systematic inquiry answer questions, solves problems, and contributes to the generalizable knowledge base of nursing; it may or may not improve patient care
Performance improvement: improves local work processes to improve patient outcomes and efficiency of healthcare systems; results usually not generalizable
EBP: implementation of evidence already known into practice
Research: new knowledge is generated to find answers for questions that are not known about nursing practice.
Performance improvement: measures effects of practice and/or practice change on specific patient population
EBP; multiple research studies, expert opinion, personal experience, patients
Research: subjects or participants have predefined characteristics that include or exclude them from a study; researcher collects and analyzes data from subjects
Performance improvement: data from patients records or pateints who are in specific area such as patient care unit or admitted to a particular hospital
Who conducts the activity?
EBP: practicing nurses and possibly of HC team members
Research: researches who may or may not be employed by HC agency and usually are not part of the clinical HC team
Performance improvement: employees of a HC agency such as nurses, physicians and pharmacists
Is activity part of regular clinical practice ?
Performance improvement: yes
Is IRB needed
Performance improvement: sometimes
EBP: internal, from HC agency
Research: funding is usually external, such as a government grant. However, larger HC facilities often have internal grants available form their foundations
Performance improvement: internal, from HC agency
Explain the difference between quantitative and qualitative research and their impact on nursing practice
Numeric and nonnumeric
measures and quantifies a study's variable
(1) a study dealing with a new pain therapy that quantitatively measures participants' pain severity
(2) a study testing different forms of surgical dressings to measure the extent of wound healing
is the precise, systematic, objective examination of specific concepts. It focuses on numerical data, statistical analysis, and controls to eliminate bias in findings
experimental, nonexperimental, survey, and evaluation research.
tightly controls conditions to eliminate bias with the goal of generalizing the results of the study Researchers test an intervention against the usual standard of care.
assign subjects to either a control or a treatment group.
Controlled trials without randomization test interventions, but researchers have not randomized the subjects into control or treatment groups In a nonrandomized controlled trial, the way in which subjects fall into the control or treatment group sometimes influences the results.
describe, explain, or predict phenomena
(1) a study examining factors that lead to an adolescent's decision to smoke cigarettes
(2) a study determining factors that lead patients with dementia to fall in a hospital setting.
of subjects with
In a case-control study researchers study one group a certain condition (e.g., asthma) at the same time as another group of subjects who do not have the condition.
determines whether there is an association between one or more predictor variables and the condition
case control study is conducted retrospectively, or after the fact. look back in time and review available data about the two groups of subjects to understand which variables explain the condition.
These small number of subjects, creating a risk of bias.
Correlational studies describe the relationship between two vari- ables (e.g., the age of the adolescents and whether the adolescents smoke). determines whether the two variables are correlated or associated with one another and to what extent.
Quantitative research often uses surveys to obtain information regarding the frequency, distribution, and interrelation of variables among subjects in the study
obtain information about practices, perceptions, education, experience, opinions, and other characteristics of people.
The most basic function of a survey is description.
gather a large amount of data to describe the population and the topic of study.
population sampled is large enough to keep sampling error at a minimum.
determines how well a program, practice, procedure, or policy is working
determines why a program is successful or unsuccessful.
problems and the contexts in which the experiences occur.
Patients tell their stories and share their experiences in these studies.
(1) patients' perceptions of nurses' caring in a palliative care unit
(2) the perceptions of stress by family members of critically ill patients.
involves inductive reasoning
Qualitative research involves the discovery and understanding of important behavioral characteristics or phenomena.
qualitative research methods: ethnography, phenomenology, and grounded theory.
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