Evidence Based Practice

What is considered nursing literature?

A professional publication with at least one author being a nurse within in the last 5 years

How can you help get better at EBP

Being active in a nursing organization.

How do you begin critical thinking

By asking 3 Questions What do I really know? How do I know it? What options are available to me? Look at the big picture and important pieces Problem solving, sometimes via trial and error or by intuitive problem solving

Critical thinking in Nursing Diagnosis

Cluster, identify, recognize actual or potential problems Avoid making judgements

Clinical Judgement

Conclusions, decisions or opinion

Quantitative Research Methods

Dealing with numbers that can be accurately measured Includes: Basic Research Applied Research

Critical thinking in Evaluation

Determine accuracy, evaluate outcome, based on scientific criteria

Qualitative Research Methods

Discovering meaning and experiences - not numbers

Identify a relevant question

Narrow down search terms PICO(T) P = patient ,population, or problem of interest I = intervention of interest C = comparison of interest (control) O = outcome of interest T = timebound - under what circumstances

Is equal the same as fair?

No

Knowledge Discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preferences

Skills Consult with clinical experts before deciding to deviate from evidence-based protocols Attitudes Acknowledge own limitations in knowledge and clinical expertise before determining when to deviate from evidence-based best practices

Critical Reasoning

Ways of thinking about patient issues

Rational for using EBP

Yields better patient outcomes Promotes care practices based on research rather than tradition Improves patient care experience Provides higher level of satisfaction among nurses Increases quality of care while decreasing healthcare costs Engages nurses in the research process Contributes to the evolution of nursing practice

Methods of conducting nursing research

quantitative and qualitative

Critical thinking in Implementation

Use knowledge, use appropriate skill, test theories, delegate, supervise, communicate

Components of critical thinking

-knowledge -experience -competence -attitudes -standards

Steps in Implementing EBP

1. ask a question about a clinical area of interest or an intervention 2. collect the most relevant and best evidence 3. critically appraise the evidence 4. integrate the evidence with clinical expertise, patient preferences and values in making a decision to change 5. evaluate the practice decision or change

EBP we have learned

Hand hygiene NG placement / checking

Quality and Safety Education for Nurses (QSEN)

Identified Knowledge, Skills and Attitudes (KSAs) essential for safe nursing practice Six areas of competency are required Patient-Centered Care Teamwork & Collaboration Evidence Based Practice : Leads to safe & effective care Quality Improvement Safety Informatics Prelicensure KSAs

Critical thinking in Planning

Identify goals and outcomes, determine appropriate strategies, set priorities, take knowledge and apply,

Critical Thinking

Includes both reasoning and judgement Helps choose solutions or identify options for patient care situations Use when you want to make the best choice Guided by law and standards

EVIDENCE-BASED PRACTICE (EBP) Definition

Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.

Application of research to practice

It takes approximately 10 years since research has been published to be come standard practice

Basic Research

Lab research - theory

Critical thinking in Assessment

Observe, collect data, differentiate data, organize, validate, interpret

Evidence Based Practice is?

Problem-solving approach to making clinical decisions using the best evidence available 1. Critical thinking and appraisal of research 2. One's clinical expertise - education / experience / exposure 3. Client preferences and values - may override other evidence Blends both the science and the art of nursing so that the best patient outcomes are achieved May consist of specific nursing interventions The use of EBP mandates the analysis and systemic review of research findings

Critical Thinking in Nursing

Purposeful, outcome-directed Essential to safe, competent, skillful nursing practice Based on principles of nursing process and the scientific method Requires specific knowledge, skills, and experience New nurses must question what they are experiencing and validate Guided by professional standards and ethic codes Requires strategies that maximize potential and compensate for problems Always think - What could go wrong? Nursing is not Black and white

Example Using PICO(T) Format

Question: Do Rocking chairs promote peristalsis and prevent paralytic ileus postoperatively???? P= Patients who have had abdominal surgery I= and who rock in a rocking chair post- operatively C= When compared with patients who receive standard nursing care following surgery (sitting in chair with no rocking) O = reduced incidents of postoperative ileus

The three "Legs" of EBP

Research evidence Clinical Expertise Patient / family values

Knowledge Demonstrate knowledge of basic scientific methods and processes Describe EBP to include the components of research evidence, clinical expertise and patient/family values.

Skills Participate effectively in appropriate data collection and other research activities Adhere to Institutional Review Board (IRB) guidelines Base individualized care plan on patient values, clinical expertise and evidence Attitudes Appreciate strengths and weaknesses of scientific bases for practice Value the need for ethical conduct of research and quality improvement Value the concept of EBP as integral to determining best clinical practice

Knowledge Explain the role of evidence in determining best clinical practice Describe how the strength and relevance of available evidence influences the choice of interventions in provision of patient-centered care

Skills Participate in structuring the work environment to facilitate integration of new evidence into standards of practice Question rationale for routine approaches to care that result in less-than-desired outcomes or adverse events Attitudes Value the need for continuous improvement in clinical practice based on new knowledge

Knowledge Differentiate clinical opinion from research and evidence summaries Describe reliable sources for locating evidence reports and clinical practice guidelines

Skills Read original research and evidence reports related to area of practice Locate evidence reports related to clinical practice topics and guidelines Attitudes Appreciate the importance of regularly reading relevant professional journals

Attitudes of critical thinking

confidence independence fairness responsibility discipline perseverance creativity curiosity integrity humility

Applied research

scientific study that aims to solve practical problems