chapter 5 evidence base practice

All magnet-designated hospitals maintain the

National Database of Nursing Quality Improvement (NDNQI) (see Chapter 2).

To collect the best evidence ask experts for help

Nursing faculty, advanced practice nurses, staff educators, risk managers, and librarians.

is the study of nursing phenomena that offers precise measurement and quantification

Quantitative nursing research

Act of keeping information private or secret; in health care the nurse only shares information about a patient with other nurses or health care providers who need to know private information about a patient to provide care for him or her; information can only be shared with the patient's consent.

Confidentiality

is a form of quantitative research that determines how well a program, practice, procedure, or policy is working

Evaluation research

Study that tests how well a program, practice, or policy is working. Example: Study measuring the outcomes of an informational campaign designed to improve parents' ability to follow immunization schedules for their children.

Evaluation research:

Melnyk and Fineout-Overholt (2014) suggest using a PICOT format to state your question. Box 5-1 summarizes the five elements of a PICOT question. The more focused your question is, the easier it becomes to search for evidence in the scientific literature

For example, Rick is a member of the evidence-based council committee of his unit. The nurses on the committee develop the following PICOT question: Do patients (P) who listen to music (I) achieve better control of their anxiety and pain (O) after surgery (T) when compared with patients who receive standard nursing care following surgery (C)? Another example is: Is an adult patient's (P) blood pressure more accurate (O) when measuring with the patient's legs crossed (I) versus with the patient's feet flat on the floor (C)?

Collect the best evidence (cont)

Systematic reviews and meta analysis of RCT's One well-designed RCT Well-designed controlled trials without randomization Well-designed case control studies Systemic reviews of descriptive or qualitative studies Single descriptive or qualitative studies Opinion of authorities or expert committees

Act of keeping information private or secret; in health care the nurse only shares information about a patient with other nurses or health care providers who need to know private information about a patient to provide care for him or her; information can only be shared with the patient's consent.

confidentiality

Critiquing evidence involves

evaluating it, which includes determining the value, feasibility, and usefulness of evidence for making a practice change (ONS, n.d.).

Use of current best evidence from nursing research, clinical expertise, practice trends, and patient preferences to guide nursing decisions about care provided to patients. evisceration Protrusion of visceral organs through a surgical wound.

evidence-based practice

An RCT is a true ________ that tightly controls conditions to eliminate bias with the goal of generalizing the results of the study to similar groups of subjects

experimental study

The database includes information on

falls, falls with injuries, pressure ulcer incidence, and nurse satisfaction

When critiquing evidence,

first evaluate the scientific merit and clinical applicability of the findings of each study. Then with a group of studies and expert opinion determine which findings have a strong enough basis for use in practice.

Process of obtaining permission from a patient to perform a specific test or procedure after describing all risks, side effects, and benefits.

informed consent

Thus implementing evidence-based practice (EBP) helps you

make effective, timely, and appropriate clinical decisions in response to the broad political, professional, and societal forces present in today's health care environment (Peterson

is a way to identify new knowledge, improve professional education and practice, and use nursing and health care resources effectively. Research means to search again or to examine carefully.

nursing research

article is reviewed for accuracy, validity, and rigor and approved for publication by experts before it is published. MEDLINE and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) are among the best-known online databases to search for scientific knowledge in health care (Melnyk and Fineout-Overholt, 2014).

peer reviewed

EBP is a systematic,

problem-solving process that facilitates achievement of best practices. Consistently following a step-by-step approach ensures that you obtain the strongest available evidence to apply in patient care.

Evidence-based care improves

quality, safety, patient outcomes, and nurse satisfaction while reducing costs

predictions made about the relationship or difference among study variables (concepts, characteristics, or traits that vary within or among subjects).

questions or hypotheses

is an orderly series of steps that allow a researcher to move from asking the research question to finding the answer. Usually the answer to the initial research question leads to new questions and other areas of study.

research process

Codified sequence of steps used in the formulation, testing, evaluation, and reporting of scientific ideas

scientific method

To be an effective change agent and foster optimal patient care, you need to have a never-ending

spirit of inquiry

Researchers gather empirical data

through the use of observations and assessments and use the data to discover new knowledge

There are seven steps of EBP, which are numbered from zero to six (Melnyk and Fineout-Overholt, 2014):

0. Cultivate a spirit of inquiry. 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 all evidence with your clinical expertise and patient preferences and values. 5. Evaluate the outcomes of practice decisions or changes using evidence. 6. Share the outcomes of EBP changes with others

A medical librarian can

Identify the databases that are available to you, identify key words that will provide the best answer to your PICOT question

which are systematically developed statements about a plan of care for a specific set of clinical circumstances involving a specific patient population.

It contains clinical guidelines

Developing a PICOT Question

P = Patient population of interest Identify patients by age, gender, ethnicity, and disease or health problem. I = Intervention of interest Which intervention is worthwhile to use in practice (e.g., a treatment, diagnostic test, prognostic factor) C = Comparison of interest What is the usual standard of care or current intervention used now in practice? O = Outcome What result do you wish to achieve or observe as a result of an intervention (e.g., change in patient behavior, physical finding, or patient perception)? T = Time What amount of time is needed for an intervention to achieve an outcome (e.g., the amount of time needed to change quality of life or patient behavior)?

Beliefs and attitudes associating negative permanent characteristics to people who are perceived as different from oneself.

biases and prejudices

Examples of clinical guidelines on NGC include care of

children and adolescents with type 1 diabetes and practice guidelines for the treatment of adults with low back pain. The NGC is invaluable when developing a plan of care for a patient (see Chapter 18