Nursing Research Evidence Base Practice (EBP)

Steps of EBP

1. Identify clinical question using PICO(T) 2. Searching evidence 3. Evaluating/Appraising evidence 4. Integrating with practice issues 5. Implementing into practice 6. Assessing practice change 7. Disseminating the outcome

Research Utilization

-Applying research findings into clinical settings -Finding practical applications for research findings -May take up to years for it to become standard practice

Level of appraisal for research (highest to lowest)

1.Clinical Guidelines 2.Systematic Review 3.Individual Research Studies 4.Non-research materials

Medium Evidence Quality

Credible but some applicability issues

High Evidence Quality

Definitely credible and applicable

Comparative Evaluation/Decision-Making

Determines if the study findings are applicable to the patient

Integrative Research Reviews (IRR)

Narrative summary of past research findings

PICO(T): Intervention or Interest (New status)

New intervention that you are thinking of applying

Low Evidence Quality

Issues with credibility and/or applicability

Collecting Evidence: Define and Refine Topic

Know key concepts to narrow search parameters

Systematic review

Locates, critically appraises, and integrates available research

What are the results of integrating into practice?

Protocols Resources Meetings Plans for adoption

Collecting Evidence: Selecting Appropriate Resources

Starts with a general search (Google) then using more appropriate sources

PICO(T): Population

The population that is affected by the intervention

What is the goal of systematic review?

To use precise and methodological approach to search for, compile and analyze the findings from a number of research studies

Weaknesses

-Not up to date -Only 1 year since publication date -Individual patient views can be lost

PICO(T)

-Population -Intervention or Interest -Comparison intervention -Outcome -Timeframe

Clinical Practice Guidelines

-Provides specific recommendations for clinical practice -Develop by an expert panel who work together to develop the guidelines -Useful decision-making tool -Based on systematic review

What is Evidence?

-Research -Patient Preferences -Clinical Experience

Differences between EBP and Research Utilization

-Research utilization starts with the research and moves to seeking practical application -EBP begins with a clinical problem and seeks research-based evidence to confirm clinical decision-making

Metasynthesis

-Search for QUALITATIVE research studies asking the same research question -Integrates all information found and offers a fresh interpretation

Meta-Analysis

-Searches for QUANTITATIVE research asking the same research question and using a similar research design -Uses a statistical analysis technique to treat the findings from all the studies as if they came from one large study -Allows for greater generalizability

PICO(T): Timeframe

-Time it takes for an intervention to achieve desired outcome -OPTIONAL b/c it may not be appropriate in all questions

Collecting Evidence: Define Search Parameters and Run Search

-Use keywords to search -Allows for discovery of additional info that guides decision making

Research Utilization: Conceptual

-Use of research results to alter our perspectives without any specific change in our practice behavior -Use of findings to expand our knowledge base -Use of findings to confirm what we already know -Provides rational to support clinical protocols -DOES NOT lead to specific change in patient intervention

Evidence Hierarchies

-Used in Step 3: Evaluating/Appraising evidence -Allows us to organize and rank evidence

PICO(T): Outcome

-What might happen -Consequences of intervention

What are the major sources from where problems arises?

-When a clinician is presented with a problem which needs a solution in the course of clinical practice -A problem is uncovered in the course of reading the literature or viewing a newly issued clinical guideline

Levels of evidence hierarchies

1.Clinical Practice Guidelines based on evidence drawn from a comprehensive review and rating of available research studies & systematic reviews 2.Sytematic Reviews including Integrating Literature Reviews and Meta-analysis 3.Single experimentally designed research studies 4.Sytematic Reviews including Integrating Literature Reviews, Meta-analysis & Metasynthesis of non-experimental/qualitative studies 5.Single non-experimental /qualitative research studies 6.Non-research driven expert opinion or committee reports

Clinical Problem

A situation encountered in nursing practice that requires a solution

Similarities between EBP and Research Utilization

-All models provide a specific process to follow in producing evidence-base change in practice -All identify a problem -All critically examine the evidence -All design, implement, and evaluate the substantiated change

Categorizes of Research Utilization

-Conceptual -Instrumental -Persuasive

Research Utilization: Instrumental

-Concrete application of the research finding -A particular research study is used as the basis to change nursing intervention -Change comes as a direct result of the research findings

Steps to collecting evidence by searching Literature

-Define and Refine the Topic -Select appropriate resources -Chose appropriate database -Define Search Parameters and Run Search -Examine Search Results -Collect Resources from Search

Collect Evidence: Collect Resources from Search

-Downloading full text to a computer file -Review and print only those that are relevant

PICO(T): Comparison Intervention

Seeing if another intervention could be used

Key features of Evidence Based Practice

-Emphasis on deliberate and systematic problem solving approach -Uses research-based material as a base for decision -Considers how the decisions fit individual patient needs and preferences Acknowledges that clinical expertise is key to integrating decisions into a specific care setting

Collect Evidence: Examine Search Results

-Examines the types of articles found in the search -Prioritize the articles requiring follow-up evaluation to determine usefulness to the project

Systematic Research Reviews (SRR)

-Findings focused on specific clinical problems rather than broader clinical topics -Focus and scope of SRR is narrow (IRR can broad or narrow)

Strengths

-Identify all studies on a particular topic -Full view of what is known -Less biased -Critical appraised of studies -Valid and ease of use

Evidence Based Practice

-Integration of patient, nurse, and research into clinical practice for optimal patient outcome -Begins with a clinical problem followed by a searchable question followed by a process

Summary of the forms the findings can take in a systematic review

-Integrative Research Review (IRR) -Systematic Research Review(SRR) -Meta-Analysis -Metsynthesis

Evidence-Based model

Graphic representation of a defined process for collecting, evaluating and using evidence

Research Utilization: Persuasive

Research findings are used as tools to advocate for certain practice or intervention

Evidence Appraisal

Systematically evaluating literature and guidelines found that are relevant to a selected nursing problem

Purpose of PICO(T)

Template for formulating a clinical question