week 1 and 2 of ebp

What is the Evidence in EBP

Collection of facts thought to be true, generated through external evidence and internal evidence

Quality improvement

Making healthcare better by finding problems and fixing them

Purpose of QI

Improve healthcare and pt outcomes

EBP

Try out and check new ways to improve healthcare based on research

Process of Translational research

investigtion sourced from evidence or previous research

Purpose of transtional research

Turn research into real reatments and solutions

Final product of translational research

New knowledge to explain or improve clinical practices

Final product of resarch

New knowledge

Final product of ebp

Systems change

Final product of QI

information

Year EBP become part of healthcare

1970s

Melnyk’s 7 step approach

A framework created to describe EBP

NYP PEACE Model

Problem identification, Evidence Search, Appraise the Evidence, Conduct Research/Change Practice, Evaluate Outcome.

P in NYP PEACE MODEL

Problem identification

E in NYP PEACE MODEL

Evidence search

A in NYP PEACE MODEL

Appraise the evidence

C in NYP PEACE MODEL

Conduct research/change in practice

E in NYP PEACE MODEL

Evaluate outcomes

Research

Rigorous and systematic process that generates new knowledge through the application of basic scientific principles and theory development.

External Evidence

Evidence generated from research.

Internal Evidence

Evidence generated internally within a clinical setting, such as patient assessment data, outcomes management, and quality improvement data.

PICOT

Patient population; Intervention or area of interest; Comparison intervention or group; Outcome; Time.

Dr. Archie Cochrane

Criticized the medical field in the 1970s for not using research evidence to help guide best practice. The Cochrane collaboration was founded in the 1990s.

Step ZERO of EBP

Spirit of inquiry. Reflecting on your own clinical practice.

Step ONE of EBP

Formulate a PICOT question.

Step TWO of EBP

Search for the evidence.

Step THREE of EBP

appraise the evidence, including validity, reliability, and applicability.

Step FOUR of EBP

Integrate the evidence with clinical experience and patient/family preferences.

Step FIVE of EBP

Evaluate the outcomes of practice change.

Step SIX of EBP

Disseminate outcomes of the EBP change

Barriers to EBP

Lack of knowledge, time, and resources.

Facilitators of EBP implementation

Incorporating EBP in curriculum, creating positive beliefs about EBP, mentorship, and commitment to EBP among nurse leaders.

Quadruple AIM

enhance healthcare quality, improve pt outcomes, reduce costs, empower clinicians

Who uses EBP

all healthcare providers

CEBM Levels of evidence

Ranks evidence based on reliability and strength for clinical decision making

Level 1 cebm

systematic review, meta analysis of RCTs

Level 2 cebm

Randomized controlled trials

Level 3 cebm

Non-randomized controlled cohort/follow up studies

Level 4 cebm

Case series, case control studie

Level 5 cebm

Expert opinion

Strongest evidence

Level 1, systemic reviews

Weakest evidence

Level 5, expert opinion

Research

The systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions.

Master of Science in Nursing (MSN) Research Competencies

Critically appraise and synthesize studies to develop protocols, clinical algorithms, and policies; collaborate in research projects and provide clinical expertise for research.

Doctor of Nursing Practice (DNP) Research Competencies

Participate in EBP guideline development, develop, implement, evaluate, and revise protocols, policies, and EBP guidelines; conduct clinical trials in conjunction with nurse researchers.

Doctor of Philosophy (PhD) Research Competencies

Assume major scientific role in conducting research to generate empirical knowledge, obtain research funding and lead research teams.

Descriptive Quantitative Research

describes whats happening in a group sithout testing cause and effect. Examples: survey

Correlational Quantitative Research

uses numbers and datas to see if two things are related without changing anything

Quasi-experimental Quantitative Research

tests cause and effect relationships using numbers and data; no randomization.

Experimental Quantitative Research

researchers test a hypothesis by changing the independent variable and seeing how it affects the dependent variable

Research Hypothesis

States an expectation of what will be uncovered, a predicted answer to the research question.

Study Population

People in a defined setting.

Sample

Subset of people in the defined setting.

Inference

Reasoned judgment that the characteristics of the sample resemble patient population.

Independent Variable

you can control or change to see how it affects something else

Dependent Variable

Outcome variable.

Validity

Extent to which a tool measures the actual condition it is meant to measure.

Reliability

Consistency of measures over time.

Bias

Systematic error that can distort the results in a non-random way.

Null Hypothesis

Assume no relationship.

p-values

Likelihood of results due to chance.

Confidence Intervals

Contains range of true value; measure of precision.

Covariate variables

Other variables associated with the outcome – should be included in statistical models when associated with outcomes to account for their influence on the outcome (age, prior instrument playing experience)

Confounding variables

hidden facter that mixes up the results of a study – should be included in statistical models to obtain the adjusted odds of the predictor’s impact on an outcome

Measurement

The assignment of numbers or categories to represent the amount, frequency or degree of an attribute or phenomenon/occurrence; used to operationalize or measure variables in a study

Nominal level data

used to label or name categories but doesnt rank them

Ordinal level data

arranged in order or ranking but difference ist exactly equal or measureable

Interval level data

data is numerical and ordered and difference between values are equal, but there is no true zero point.

Ratio level data

You can categorize, rank, and infer equal intervals between neighboring data points, and there is a true zero point.

Face Validity

how much a test or tool looks like it measures what its supposed to

Content validity

covers everything it is supposed to measure

Construct Validity

the instrument performs as expected between similar and dissimilar constructs

Convergent Validity

how closely a test is related to other tests that measure the same (or similar) constructs

Discriminant Validity

Unlike-constructs do not have similar scores

Instrument Reliability

How consistently an instrument measures the target attribute.

Internal consistency

The extent to which all the items/questions on an instrument are measuring the same attribute.

Bias

Introduced at any point in study.

Hypotheses

Stated expectations, a predicted answer to the research question.

Directional hypothesis

Predicts the direction of a relationship

Non-directional hypothesis

Predicts the existence of a relationship, not its direction

Type I error

Rejecting the null hypothesis when it is actually true

Type II error

false negative, when a test says there’s nothing there but there actually is. You fail to reject the null hypothesis

Appraisal

Determines the usefulness of a study to patient care.

Abstract

Brief study overview

Methods

Details study procedures, e.g. study design, study setting, participants, instruments, analyses, etc.

Results

Reports study findings

Discussion

Places study findings in context with existing literature; describes study limitations

Purpose Statement

provides the objective of the study