Evidence Based Practice

Community Health

evidence-based practice

the application of the best available research findings, nursing expertise, and client values and preferences to improve care and outcomes

three components of EBP

• research evidence

• clinical experience

• client needs

primary purpose of EBP

to translate the best available research evidence into direct client care to improve outcomes

what are the benefits of EBP?

• improved client outcomes

• standardized care

• increased safety

• better quality of care

• greater efficiency

• decreased healthcare costs

The 7 steps of EBP

• ask → the nurse develops a focused clinical question

• collect → the nurse gathers relevant research evidence

• analyze → the nurse investigates, evaluates, and categorizes the collected evidence

• integrate → the nurse combines clinical experience with new research findings

• implement → the nurse changes clinical practice based on research findings

• evaluation → the nurse assesses the changes made in clinical practice

• disseminate → the nurse shares newly acquired knowledge and findings with others

what does PICOT stand for?

• P → Patient/Population

• I → Intervention/Indicator

• C → Comare/Control

• O → Outcome

• T → Time/Type

case report

an in-depth analysis of an individual client, often completed by a clinician

case series

an in-depth analysis of one or more clients with similar clinical presentations or illnesses

cross-sectional study

exploring relationships between risk factors and public health concerns

case-control study

comparing individuals with disease (cases) to similar individuals without the disease (controls)

cohort study

a prospective study that follows groups of individuals over time

what is the primary difference between a cohort and case-control study?

cohort studies follow groups over time, while case-control studies compare individuals with and without a disease

Farminghan Heart Study

a cohort study that followed participants over time to identify risk factors for coronary heart disease

what cardiovascular risk factors were identified through the Framingham Heart Study?

• Increased blood pressure

• elevated cholesterol

• smoking

randomized controlled trial

an experimental study in which participants are randomly assigned to treatment or control groups

why are randomized controlled trials considered the gold standard for evaluating interventions?

they use random assignment to evaluate treatment effectiveness and establish cause-and-effect relationships

quasi-experimental study

similar to a randomized control trail but without random assignment

common quasi-experimental designs

• non-equivalent group designs

• pretest-posttest design

level 1 evidence

strongest level of evidence; systematic reviews or meta-analyses

level 2 evidence

evidence from at least one randomized controlled trail

level 3 evidence

evidence from controlled trials without randomization

level 4 evidence

evidence from case-control or cohort studies

level 5 evidence

systematic reviews of descriptive or qualitative studies

level 6 evidence

evidence from a single descriptive or qualitative study

level 7 evidence

weakest level of evidence; expert opinions

what is quality when evaluating evidence?

the strength of evidence and the degree to which bias is minimized

• interview bias → bias when interviews are conducted inconsistently such as without a standardized script

• selection bias → bias that occurs when participants are selected in a way that skews research results

• generalizing where not applicable

what is quantity when evaluating research evidence?

the number of studies, sample size, and magnitude of effect

what is consistency when evaluating evidence?

the degree to which findings are similar across different studies

validity

the accuracy of research findings or measurements

reliability

the consistency of research findings or measurements

systematic review

a structured method of identifying, appraising, and synthesizing available research relevant to a specific question

meta-analysis

method of systematic review that quantitatively combines and summarizes results from multiple studies

a nurse searches multiple databases and critically analyzes research on barriers to healthcare access. What type of review is this?

systematic review

what resources can provide Level 1 evidence and systematic reviews?

• Cochrane Library

• Community Prevention Service Task Force

• US Preventative Services Task Force

government. resources for EBP

• CDC → promotes overall health of public and provides evidence for guidelines for practice

• NIH → addresses research needs and gaps

• State and Local Health Departments → provides resources and statistics for best practice

what is the purpose of county health rankings?

to provide publicly available community information that can guide health improvements

quality improvement

implementing processes with less variation to improve client outcomes and healthcare systems

quality assurance

monitoring and evaluating services or agencies to ensure established quality standards are met

what does PDSA stand for in quality improvement framework?

P → plan the change

D → do (carry out the proposal)

S → study the new outcomes

A → act (make the change sustainable)

what is the purpose of accreditation in healthcare?

to implement national standards of care and improve the quality of services provided

community-engaged research

research that investigates community health issues while involving community members in the research process

first step in community-engaged research

conducting a thorough assessment of the community