Chapter 11 Employ Evidence-Based Practice

IOM definitions of evidence-based practice:

"integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible"

EBM is

"systemic application of the best available evidence to the evaluation of managerial strategies for improving the performance of health services organizations"

systemic review: (key point in EBP literature)

"the consolidation of research evidence that incorporates a critical question using methods designed to reduce the likelihood of bias"

Outcomes research

(*a newer approach*) is a type of research that focuses on determining the effectiveness of healthcare services and patient outcomes

research is

a systemic investigation that includes research development, testing, and evaluation. (it is designed to develop or contribute to generalizable knowledge)

Randomized controlled trials (RCTs) *refereed to as gold standard in research design*

involve a true experiment; there is control over variables, randomization of the sample, use of a control group and an experimental group, and manipulation of an intervention or interventions (independent variable)

Basic research

is designed to broaden the base of knowledge, rather than solve and immediate problem, and is typically done in a laboratory setting.

Applied research

is designed to find a solution to a practical problem. (non-laboratory setting)

Nurses become apart of this (EBP) process by?

obtaining or collecting the evidence, understanding the evidence, and applying it appropriately to patient care

PICOT stands for

patient intervention comparison outcome time

Healthcare teams rely on EBP to?

provide optimal care to patients

Continuous quality improvement (CQI)

the process that aims to ensure patients receive the best care when they need it and outcomes are met on an ongoing basis

Qualitative studies

the research question focuses on *feelings* or *experiences*

Quantitative studies

the research question focuses on *how many* or *how much*

In the research proposal

the researcher describes *what will be done*, and in the research report or published article, poster, or presentation after the study is completed, the researcher describes what *was* done.

The institute of Medicine (IOM) identifies evidence-based practice as?

the third core competency for healthcare professionals, including nurses, to employ

Some priority areas of research include: (6)

-health promotion -disease prevention -quality of life improvement -improvement of palliative and end-of-life care -innovation in science and practice -development of the next generation of nurse scientists

Vulnerable populations in ethical/legal conducted research:

-neonates (new borns) -children -pregnant women -person w/ mental illness -person w/ cognitive impairment -terminally ill patient -person who is confined to institutions (prison etc.)

ANA research agenda focuses on: (5)

-the value of nursing contributions to safety, reliability, quality, and efficiency - factors that increase the impact of nurses on quality and efficiency -use of National Database of Nursing Quality Indicators to enhance patient safety, quality care, and efficiency -nurse workforce issues -population health issues

Funding sources for research:

-universities -private donations -foundations and organizations -local and state government -federal government

2 types of research approaches:

1) Basic research 2) Applied research

3 approaches research might take to obtain funding:

1) Identify a problem and develop a proposal. This proposal is sent to funding sources that might have an interest in the particular problem 2) Develop a research proposal that specifically addresses a problem area that a funding source has identified as critical need area. This is called a request for proposal or request for applications, and in this case, the researcher must carefully follow all the requirements for the proposal 3) Sometimes funding sources require the researcher to conduct a pilot study or have data that indicate greater need for research about a particular problem. Indeed, in many cases, having some data to support the research is critical to getting funding for a study

(*NOT ALL RESEARCH STUDIES ARE EXPERIMENTAL STUDIES*) To be experimental, a study must meet 3 things:

1) Manipulation of intervention 2) Control 3) Randomization

PICOT process: (5)

1) identify a burning clinical issue of question 2) collect the best evidence relevant to the question 3) critically appraise that evidence before it is used 4) integrate the evidence w/ the other parts of EBP: patient preferences and values, your clinical expertise, assessment info about the patient and the patients history 5) evaluate the practice decision or change

Barriers need to be turned to facilitators for research to become successful. These barrier issues include: (6)

1) lack of funding 2) lack of sufficient time 3) lack of research competencies 4) lack of participants/subjects for the sample 5) inability to find the right setting 6) lack of statistical expertise

four major concerns with ethical and legal research:

1) protection of the rights of human participants 2) balance of benefits and risk/harms 3) informed consent 4) Institutional review

Research study designs are developed into two broad categories:

1) quantitative studies 2) qualitative studies

Transitional research is described in 2 ways:

1) the application of discoveries generated in the laboratory and in preclinical studies to the development of trials and studies in humans 2) research aimed at enhancing the adoption of best practices in the community

EBP literature database (3)

1. The Cochrane Database of Systemic Reviews 2. Joanna Briggs Institutes EBP Database 3. *less used* NCGs

The steps for a research proposal follow: (8)

1. research problem statement 2. research questions and hypothesis 3. research purpose 4. review the literature 5. provide and theoretical framework 6. describe ethical considerations 7. describe the research design and methods 8. develop a budget

Manipulation of intervention:

The research administers and intervention to the participants/subjects (sample). This intervention represents the independent variable(s). The researcher wants to identify the effect of the independent variables on the dependent variable or determine if the independent variable causes the dependent variables

Randomization:

The researcher assigns participants/subjects in the sample to be experimental and to the control group using systemic methods, ideally randomization.

Control:

The researcher controls some of the experimental situation and uses a control group from the sample, which does not experience the intervention (independent variable). Total control is not usually possible, but efforts must be made to have as much control of the situation as possible. This is easier to do in a laboratory setting as compared to applied or clinical research where there are many factors, many unknown, that affect the patient or the sample

The National Institute of Nursing Research (NINR) is responsible for?

conducting research that applies to and impacts the nursing discipline

Who sets the NIH's budget?

congress

The Institutional research board (IRB)

reviews research before it is conducted to ensure that the study is conducted ethically *MUST REVIEW HUMAN SUBJECTS* in institutions that receive federal funds

The research process is important to EBP because?

some of the best evidential facts comes from research results