Chapter 11: Employ Evidence Based Practice

IOM Core Competency: Evidence-Based Practice

-EBM -Nursing Research -EBP and quality improvement -Tools for EBP success: Clinical guidelines, policies, and procedure -EBP and the students -EBP process models

Barriers to and Facilitators of Research

-Lack of funding -Lack of sufficient time -Lack of research compotencies -Lack of participants/subjects for the study -Inability to find the right setting -Lack of statistical expertise

The Research Process

-Plan or proposal -Research problem statement -Hypothesis -Research design -Research analysis

Ethics/Legal Issues in Research

-Right to self-determination (informed consent) -Right to privacy -Right to anonymity and confidentiality -Right to fair treatment -Right to protection from discomfort and harm

Randomized Controlled Trials (RCT)

-considered the gold standard in research design -a true experiment in which there is control over variables, randomization of the sample with a control group and an experimental group, and an intervention(s) (independent variable)

PICO(T)

-should be part of every search for evidence to improve practice -goal is to ask a searchable/answerable question to identify the best evidence to answer the question P: Patient/Population I : Intervention C: Comparison O: Outcome (T): Time

evidence-based practice (EBP)

-the integration of the best evidence into clinical practice, which includes research, the pts values and preferences, the pts history and exam data, and clinical expertise -connected to providing patient-centered care and interprofessional teams

5 Steps to the PICOT process

1. Identify a burning clinical issue/question 2. Collect the best evidence relevant to the question 3. Critically appraise that evidence before it is used 4. Integrate the evidence with the other parts of EBP: pt preferences/values, your clinical expertise, assessment info, etc 5. Evaluate the practice decision or change

Systematic Review

A summary of evidence typically conducted by an expert or a panel of experts on a particular topic; uses a rigorous process to minimize bias for identifying, appraising, and synthesizing studies to answer a specific clinical question and draw conclusions about the data gathered; different methods may be used depending on the type of review such as integrative review or meta analysis

Research

Investigation or experimentation aimed at the discovery and interpretation of facts about a particular subject

Three Types of Research Design

Manipulation of intervention -identify the effect of the independent variable (medication, intervention, etc) Control -uses a control group that does not receive the independent variable Randomization -participants are randomly assigned to either the control group or the experimental group

Basic Research

research designed to broaden the base of knowledge rather than solve an immediate problem

Applied Research

research designed to find a solution to a parrticular problem

Outcomes Research

research focused on determining the effectiveness of h/c services and pt outcomes

Evidence-Based Management (EBM)

use of evidence such as research to support management decisions