EVIDENCE BASED PRACTICE STUDY GUIDE

research

Systematic, rigorous, critical investigation to support and generate NEW knowledge

• aims to answer questions about nursing phenomena

• Researchers follow the steps of the scientific process.

what do research nurses do

study questions relevant to nursing practice

what is evidence based practice

collection, interpretation, and integration of valid research evidence combined with clinical expertise

What will an EBP nurse need to understand to inform clinical decision making

patient and family values and preferences

EBP steps

ask→ gather→ assess appraise→ act→ evaluate

what is quality improvement

Systematic use of data to monitor the outcomes of care processes

what do we use in quality improvement

improvement methods to design and test changes in practice Specific to population, unit, or facility

what is the goal of quality improvement

continuously improve the quality and safety of health care systems

quality improvement steps/ QI nurses roles

• Conducting an assessment

• Setting specific goals for improvement

• Identifying ideas for changing current practice

• Deciding how improvements in care will be measured

• Rapidly testing practice changes

• Measuring improvements in care

• Adopting the practice change as a new standard of care

what evidence does QI primarily reley on

internal evidence

what does QI NOT INVOLVE

the scientific process and critical appraisal

what evidence is EBP focused on

both internal and external evidence in decision making about a practice change to be implemented to improve an important clinical outcome

All QI should be

EVIDENCE BASED

what does research do

test or generates new knowledge

What does research ask

what is true and what new knowledge can we generate

what does quality improvement ask

how can we make care better in this setting

what does EBP ask

what should we do for the patient or population using the best evidence, clinical expertise and patient values

what does EBP integrate

research into practice

levels of evidence

a tool to help determine the strengths and weaknesses of a research study. This hierarchy of evidence provides a rating scales based on the type of article and methodology of the research. Using this scale is a piece of evidence when critiquing research and the reliability and validity of the findings.

Level 1 LOE

systematic review of meta-analysis of randomized controlled trials (RCTs), evidence based clincial pratice guidelines based on systematic reveiws of RCTs or 3 or more RCTs of good quality that have similar results

Level 2 LOE

randomized controlled trials

Level 3 LOE

evidence obtained from well- designed controlled trials with out randomization

• quasi-experiemental

Level 4 LOE

evidence from well designed case control, cohort, or cross sectional studies

• nonexperimental studies

Level 5 LOE

evidence from systematic reviews of descriptive and qualitative studies

• Meta-synthesis

Level 6 LOE

evidence from a single descriptive or qualitative study

• qualitative studies

Level 7 LOE

opinions of experts and authorities, expert committee reports or organizations, NOT BASED ON RESEARCH

what do clinical guidelines do

• Assist in bridging practice and research

• Provide clinicians with an algorithm for clinical management, or decision making, for specific diseases (e.g., colon cancer) or treatments (e.g., pain management)

clincial guidelines serve as what

guides for providers/practitioners and are statments or recommendations

where do we use clinical guidelines in our paper

significance section

what do the clinical guidelines also adresss

who cares about the problem

types of clinical guidelines

• Consensus (expert developed) and Evidence-based

• They May or may not be based on research findings

qualitative research

Seeks to understand the meaning of human experience

• Describe EXPERIENCES and interpret meaning

• subjective approach

• THEORY GENERATING

where is qualitative research usually conducted

in natural settings

quantitative research

-Seeks to test relationships or answer a question

-Explains cause-and-effect relationships

-Tests intervention effectiveness

• objectivity is important

• THEORY TESTING

what methods do quantitative research use

specific statistical methods

what is important in quantitative research

objectivity

What does critically reading involove

actively and intellectually engaging in reading to the point where you as a reader participate in inner dialogue

what will critical reading allow

reader to objectively and critically evaluate a research reports content for scientific merit and application to practice

to critical read, what will the reader need

• General knowledge of the subject matter

• Knowledge of how to critically read

• Use critiquing criteria

critical reading steps

preliminary

comprehensive

analysis

synthesis

critical reading steps: preliminary

Familiarize yourself with the content (skim the article)

critical reading steps: comprehensive

Understand the author’s purpose or intent

critical reading steps: analysis

Understand the parts of the study

critical reading steps: synthesis

Understand the whole article and each step of the research process

research article format layout

abstract

background

lit review and theoretical framwork

methods

data anaylysis and results

discussion

references

disseminations/ communicating results

abstract

short summary that outlines the pain points of the whole paper

background/introduction

• Describes the clinical problem (Risk factors, Morbidity, Mortality, Socioeconomic)

• Definition of purpose

• Hypothesis/research question

literature review

evaluates existing research on a topic

theoretical framework

provides foundational lens used to guide the studys analysis and design

methods

• Research Design (Type of study: Quant, Qual, Mixed Methods)

• Sampling & Data Collection

• Population from where the sample was obtained

• Procedures and data-collection measures (Inclusion/Exclusion criteria, Intervention implemented (if applicable), Tools used to collect data Human Protection (Ethical considerations))

data analysis and results

Statistical tests

Results

discussion

• Implications for practice

• Recommendations for further research

• Strengths and Limitations

what do research questions focus on

• Describing variables

• Specifying the population being studied

• Examining testable and measurable relationships among variables

• Define a specific question/topic area

• Reflect the literature review

• Identify the significance to nursing and/or healthcare

• Reflect the feasibility of studying this topic

when is a research question fully developed

• Variables are clearly identified:Independent (X) and Dependent (Y)

• Population is specified (Setting may also be described)

• Empirical testing is implied (Measurement)

what are research questions influenced/ initiated by

practical experience

critical appraisal of literature

identifying gaps in the literature

interest in a theory

research hypothesis does what

Predicts the expected outcome

what is a research hypothesis often based on

specific theory

when is a research hypothesis formualted

before the study is started because it determines how data are collected, analyzed, and interpreted

a research hypothesis flows from

the research question, literature review, and theoretical framework

another name for research hypothesis

scientific hypothesis

research hypothesis may be

directional or nondirectional

what is a statistical hypothesis also called

a null hypothesis

what does a null/ statistical hypothesis state

that there is no relationship between X (ind) and Y (dep) variables

a good hypothesis compoents

A declarative statement that identifies a predicted relationship between X and Y

The nature of the relationship is implied

Testable: the variables can be observed or measured

Theory based: consistent with existing theory and research fiindings

a hypothesis is NEVER

proven

• the findings either support or do not support the hypothesis

study purpose/aim is

what the invesigator hopes to achieve

what does the study purpose/aims suggest

the level of evidence to be obtained

the study aim/purpose use verbs like

discover, explore, or describe OR test or compare

the study purpose/aim is a

defining feature of the study itself but it can be changed throughout the planning of a study

what is the EBP/QI clinical question

PICO

PICO components

P: population/problem (individual pt or group of pt with a particular condition or health care problem)

I: intervention (the particular aspect of healthcare that is of interest to the nurse or health team→ could be therapeutic preventative, diagnostic, organizational, and interventon)

C: comparison (standard care or no intervention, comparison of 2 treatment settings

O: outcome (more effective outcome)

T: time

Independent variable

the mainpulated or controlled variable. it stands alone and doesnt change because of other variables in the study

• X

dependent variable

the measure outcome or responding variable, its value depends on changes in the independent variable

• Y

Primary source

articles or books by the original author

secondary source

articles or books that are written by persons other than the independent who conducted the study or developed the theory

summarizing literature

condenses a single source to explain what the author found

synthesizing literature

integrates multple sources to reveal patterns, debates and a new meaning across the collective evidence

what is the interconnectedness of research, theory, and pratice

Theory guides

Pratice tests

Research builds

Theory guides

help shapes research questions and nursong pratice

pratice test

real clincial care reveals weather ideas work and what questions remain

research builds

generates test, and refines knowledge that informs guidelines

Grand theory

most abstract, describes nursing broadly, often includes person, health, environment, and nursing.

-developed to describe the disciple of nursing as a whole

• wide angle

Grand theory example

Orem self car deficit nursing theory

Roy adaptation model

middle range theory

more focused limited number of concepts, often easier to use in research

• focused lens

middle range thoery exaple

penders health promotion model

situation specific theory

most specific, explains are narrow phenomeon in a specific pipulation or context

• clincial close us

situation specific example

heart failure self care

QI model/framework

EBP model/framework

conceptual defintion

conveys the general meaning of the concept but defines/ explainsthe concept as it is rooted in theoretical literature

operational definition

specifies how the concept will be measured→ defines what instruments will be used to assess the presence of the concept

key characteristics of quality improvement

QI emphasizes: customer satisfaction, teams and teamwork, & the continuous improvement of work processes.

Use of transformational leadership for performance goal

Use of data to make decisions

Standardization of work processes to reduce variation across providers and service encounters

IOM goals for health care quality

STEEEP

STEEEP acronym

Safe: avoid harm

Timely: reduce waits and delays

Effective: use evidence and avoid under or overuse

Efficient: reduce waste

Equitable: quality of care should not vary by personal characterisitcs

Patient- centered: honot patient perspectives, needs, and values

common ways QI and EBP data is analyze and presented

frequencies, run charts, stratification, STD deviation, means, range

what do run charts help with

answer if the change lead to improvement

benchmarking

comparing your performance with an agreed standard or best pratice

benchmarking is a…

systematic approach to gathering info about process or product performance and analyzing why performace differs

what is the benchmark in benchmarking

a reference point for judging current performance

what does benchmarking help with

helps the team locate their performace gaps