302 Midterm Blueprint

Evidence-Based Practice (EBP)

use of current best evidence in decision making for care of patients

Three Components of EBP

Best research evidence, clinical expertise, patient values and preferences

Examples of Best Research Evidence

CPGs with rigorous research, randomised controlled trials, systemic reviews, meta-analyses

Examples of clinical expertise

nurse’s clinical judgement and experience with similar patients, skills in physical assessment and patient monitoring

Examples of Patient Values and Preferences

cultural beliefs about treatment options, personal goals and quality of life priorities

Importance of EBP

improves patient outcomes and quality of care, reduces variation in practice and unnecessary interventions, increases healthcare efficiency and cost-effectiveness, empowers nurses to make informed evidence based decisions, bridges the gap between research and practice, promotes professional accountability and lifelong learning

“Quadruple Aim” of EBP

improve population health

enhance patient experiences,

educe costs

improve clinician well-being

Background questions

broad, foundational questions about a condition, disease, or intervention (who?, what?, when?, why?, how?)

Foreground questions

Specific, focuses clinical questions about patient care (PICOT format)

PICOT Format

P - population/patient

I - intervention

C - comparison

O - outcome (desired)

T - time

Clinical Practice Guideline (CPG)

systemically developed statements to assist practitioner and patient decisions that are based on rigorous evidence

How do CPGs guide nursing practice?

standardized care and reduced unwarranted variation, provide evidence based recommendations for common clinical scenarios, support clinical decision making at the point of care, enhance patient safety and quality outcomes, serve as educational tools for students and new practitioners, provide legal protection when followed appropriately

PhD Focus

research and scientific discovery

DNP Focus

clinical practuce and translation of evidence

PhD Goal

generate new knowledge

DNP Goal

apply evidence to improve practice

PhD career path

Academic/research roles

DNP career path

advanced clinical practice/leadership

PhD capstone

dissertation

DNP capstone

practice improvement project

PhD degree type

research doctorate

DNP degree type

practice doctorate

PhD emphasis

research methodology, statistics

DNP emphasis

clinical outcomes, systems leadership

Morbis Artificum Diatriba

“discourse on the diseases of workers",” refers to study of occupational diseases and workplace health hazards

Ex: miners developing respiratory diseases from inhaling coal dust

Case Control Study

an observational study that compares patients who have a disease/outcome with those who don’t

When to use case control study

when studying rare disease, when outcomes take a long time to develop, when it would be unethical to randomly assign subjects, as initial investiation to identify potential risk factors

Hierarchy of Evidence

system that organizes evidence by strength and quality

Level 1 evidence

systemic reviews, meta-analyses of RCTs

Level 2 evidence

randomized controlled trials

Level 3 Evidence

Controlled trials without randomization (Quasi-experimental)

Level 4 Evidence

case control and cohort studies

Level 5 Evidence

Systemic reviews of descriptive/qualitative study

Level 6 Evidence

single descriptive or qualitative study

Level 7 Evidence

expert opinion, case reports, animal studies

“Igniting the Spirit of Inquiry”

promotes a culture where questioning current practices is values, cultivates curiosity about clinical practices and identifying gaps between current practice and evidence

Initiatives for Enhancing EBP

Magnet Recognition Program, EBP Mentorship Programs, Academic-Practice Partnerships, EBP Champions/Change Agents, Research Councils, EBP Fellowship

Magnet Status

designation assigned by American Nurses Credentialing Center (ANCC) to recognize healthcare organizations for nursing excellence, quality patient outcomes, and innovation

Magnet Status Requirements

transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovations, and improvements, empirical quality outcomes

Mental Status Benefits

attracts and retains nurses, improves patient outcomes, creates positive work environment

Florence Nightingale Contributions

data collection and statistical analysis to improve patient outcomes, analyzed mortality rates during crimean war, discovered poor sanitation is associated with increased death, disseminated findings with graphs and charts, led to EBP changes in hygiene, sanitation, and hospital processes, demonstrated systemic observation and documentation can improve patient care, established nursing as a profession based on scientific principles

Nursing theory

structured set of ideas of concepts used to explain, predict, or understand a phenomenon

Importance of Nursing Theory

explains why something happens, guide care plan and delivery, study relationships of phenomenons in healthcare, serve as basis for deductive reasoning, provides framework for research and practice

Diffusion of Innovation Theory

how new ideas/practices spread within a group

Adoption occurs in stages: knowledge > persuasion > decision > implementation > confirmation

Adopter groups: innovators, early adopters, early majority, late majority, laggards

helps nurses implement evidence based practices

Health Belief Model

Explains how beliefs influence health behaviors

Key concepts: percieved susceptibility, perceived severity, perceived benefits vs. barriers, cues to action

Promotes prevention and patient adherence

Lewin’s Change Theory

3 stages: unfreezing, changing, refreezing

emphasizes overcoming resistance

Promotes practice change and quality improvement

Orem’s Self-Care Theory

focuses on patient’s ability to perform self-care

Components: self-care, self-care deficit, nursing systems

Promotes patient independence and autonomy

Transition Shock Theory

explains reality shock experienced by new nurses

occurs in first 3-4 months of practice

Characterized by emtional stress, physcial exhaustion, intellectual overwhelm

Promotes orientation, mentorship, and support

Quantitative Research

standardized experimental design, hypotheses are tests, measurable variables and outcomes, uses statistical analyses, seeks to measure and quantify, uses numerical data

Qualitative research

looks at qualities of human experience, no variable manipulation, experience is described and interpreted, uses data coding and thematic analyses, seeks to understand meaning, uses narrative data

Research

systematic investigation of phenomena, intended to be generizable, results can be used for broader group, follows religious scientific process, generates new knowledge

problem solving

quick temporary fix, often based on trial and error, results are specific to the immediate situation, may not follow a structured process, solves immediate issues

Inductive reasoning

begins with specific observations/experiences and then generalizations

Specific → General

may lead to more research

Deductive reasoning

starts from general case and applies to specific case

General → Specific

conclusions are validated but not necessarily true for all

Cumulative Index to Nursing and allied Health Literature (CINAHL)

comprehensive database for nursing and allied health literature, includes nursing journals, research articles, and EBP resources

PubMed

free database from National Library of Medicine

biomedical literature from medline, life science ournals, and online books

covers broader medical and scientific literature

Boolean Operators

used in database searching to combine or exclude search terms

Boolean Operators: “AND”

narrows search, finds articles containing both terms

Boolean Operators: “OR”

broadens search, finds articles containing either term

Boolean Operators: “NOT”

excludes terms

Search Strategies

• Use Boolean operators (AND, OR)

• Use MeSH terms (Medical Subject Headings)

• Use truncation () to find variations of words (e.g., nurs finds nurse, nurses, nursing)

• Use quotation marks for exact phrases

• Use limiters/filters (date, language, age group, publication type)

• Combine multiple search terms

• Search multiple databases

• Use CINAHL and PubMed

MeSH

standardized controlled vocabulary used by PubMed for indexing

U.S. Preventative Services Task Force (USPSTF) Grading System

grades recomendations

USPSTF Grade A

Recommends the service; high certainty that net benefit is substantial

USPSTF Grade B

Recommends the service; high certainty that net benefit is moderate OR moderate certainty that net benefit is moderate to substantial

USPSTF Grade C

Recommends selectively offering service based on professional judgment and patient preferences

USPSTF Grade D

Recommends against the service. Moderate or high certainty; there is no net benefit or harms outweigh benefits

USPSTF Grade I

Current evidence is insufficient to assess balance between benefits and harm

EBP Step 0

Ignite spirit of inquiry

EBP Step 1

create PICOT question

EBP Step 2

find the evidence

EBP Step 3

appraise the evidence

EBP Step 4

synthesize findings

EBP Step 5

implement change

EBP Step 6

measure outcomes

EBP Step 7

disseminate results

Experimental Designs (Levels 1-3)

randomized controlled trials (RCT) - gold standard, tests casuality, randomize participants

quasi-experimental - do not randomize, participants can self-select, may not have control group, manipulate variables

*Features - researcher manipulates independent variables and controls for confoundign variables

Non-experimental designs (Levels 4-7)

case control - retrospective, compares cases to controls

cohort - follows a group over time (prospective or retrospective)

qualitative - explores experiences, no variable manipulation

descriptive studies - describe characteristics of a population

Independent variable (IV)

something that can cause a change in other study variables

this is what the researcher manipulates of observes as the cause

Dependent Variable (DV)

variable being measured of tested; the outcome

Confounding variable

an extraneous variable that may affect the relationship between the independent and dependent variables

Design methods to reduce potentioal confounding variables

randomization, matching, statistical control, restriction, stratification, multivariate analysis, crossover design, inclusion/exclusion criteria

3 questions to guide critical appraisal

validity - is the study believable

reliability - would we get similar results again

applicability - can i use this with my patients

Internal Validity

extent to which the study’s design supports cause-and-effect conclusions and addresses whether observed effects are due to intervention, not other factors

Methods that strengthen validity

randomized control trial with intervention and control groups, pre/post valid and reliable measures, comparable groups, control for confounding variable

External Validity

extent to which research findings can be applied or extended beyond the specific study sample or setting to a broader population, context, or situation

Instrument validity

degree to which an instrument measures what it is supposed to measure

content - does the instrument cover all aspects of the concept

construct - does the instrument measure the theoretical concept

criterion - does the instrument correlate with other measures of the same concept

Study reliability

Would repeating the study provide similar results?

Concerns: exercise, class, diet, participant motivation were not fully controlled

Instrument Reliability

consistency of a measurement tool

Selection Bias

systemic differences in how participants are selected or assigned

Sample Bias

when the sample is not representative of the population

Recall bias

inaccurate recall of past events

Social/Desirability Bias

Tendency to underreport socially undesirable attitudes/behaviors and overreport desirable ones

Measurement Bias

systemic error in measuring outcomes

Reporting bias

selective reporting of results

Confounding bias

third variable affects the relationship being studied

Publishing bias

studies with positive results are more likely to be published

APA Title Page Requirements

Title of Paper, Author’s name, course information, due date

format: centered, double spaced

Parenthetical Citation Format

(Author, Year, Page Number)

Et al. usage

used when citing work with 3 or more authors

“First Author, et al.”