evidence based practice

evidence based practice combines...

the best available research, clinical expertise, and patient preferences to guide healthcare decisions

EBP in community setting focuses on 3 things...

1. using evidence to address health needs for communities rather than individual patients- such as promoting wellness or disease prevention

2. partnering with community members, leaders, and stakeholders to implement health strategies tailored to community dynamics

3. educating populations on topics like nutrition, exercise and preventative care to improve collective health outcomes

EBP does the following (3)

1. improves client outcomes by ensuring care decisions are based on current credible research

2. enhances efficiency and quality of healthcare + reducing cost and increasing nurse and client satisfaction

3. encourages client centered care and keeps nursing practice up to date with new protocol and technology

7 steps of EBP in community

1. ASK

- focused PICOT ?

2. COLLECT

- gather evidence

3. ANALYZE

- critically examine evidence

4. INTEGRATE

- combine nursing experience, community input, and best evidence

5. CHANGE/IMPLEMENT

- make practice changes if permitted, based on evidence

6. EVALUATE

- assess effectiveness

7. DISSEMINATE

- share findings

which steps of the 7 step sof EBP are here novice nurses disengage?

steps 6 and 7 (breaking things breaks the cycle)

PICOT question

Population

- whose community of interest

intervention?

- what action or exposure considered?

Comparison/implementing intervention

- what is the alternative or control condition?

Outcome

- what measurable result did we expect?

Time/Type

- over what period or what study type?

PICOT HTN example: in adults w/HTN (__), does pharmacist led home BP monitoring (__) compared to standard clinic follow up (__) reduce systolic BP (__) ove r6 months (__)

P, I, C, O, T

Levels of evidence: level 1

Systematic Review & Meta Analysis

- strongest b/c analyze many studies

- always start here

Levels of evidence: level 2, 3 & 4

Randomized controlled trials, controlled trials w/o randomization, and case control/cohort studies

-provide storng data but not as comprehensive

Levels of evidence: level 5, 6, 7

systemic reviews of qualitative studies, single descriptive, expert opinions

-just opinions

- but sometimes necessary with newer issues

AHRQ (Agency for Healthcare Research and Quality)

3 components to help w/appraisal of evidence: Quality, Quantity, Consistency

AHRQ- Quality ?s to ask

what is the strength of the evidence?

what level evidence?

qualitative (weaker) or quantitative (stronger)?

is it biased?

methods used?

AHRQ- Quantity ?s to ask

how many studies currently exist related to the topic?

what are the population sizes?

was this a good sample size?

how many in a synthesis?

what are the affects of the treatments?

AHRQ- Consistency

are findings similar between studies or synthesis?

do the studies align?

are there any conflicts and are they explained?

Barriers to EBP

Lack of Knowledge- unsure about databases, dont know how to evaluate, lack application of EBP (cant implement)

Limited resources/time+ no organizational support+ dont want change

The national agenda: healthy people 2030

if u dont know where to start start here great EBP

- offers a vision, mission, and core objectives to guide EBP

cochrane

provides systemic reviews and high quality summaries of health research +evidence+ guidelines to support EBP

NHSPI

provides data and tools to see how prepared states are for health emergencies

county health rankings

see how health varies per county

quality assurance

makes sure care meets standards

- watching and evaluating services

- reactive process

- focuses on fixing problems found, gov led

quality improvement (QI)

focuses on continuously improving processes

- proactive process

- uses PDSA framework

PDSA

Plan- define a change

Do- implement

Study- analyze

Act- adopt, adapt, or abandon change

CBPR: wilders model of community power

guides community roles, advisors, collaborators, or leaders making research more meaningful and sustainable

CBPR: wilders model defines how individuals ________, __________, & _______ in a healthy community

mature, form attachments, function

CBPR: in wilders _____ and _____ share equal decision making power

community and researcher (everyone equal input)

flawed tradition

treating the community as purely a study site

CBPR: example round table homelessness

ppl @ round table to help: homeless shelter rep, food bank rep, law enforcement, ER nurse, EMT, goodwill rep, school rep, mayor, VIP HOMELESS

***ALWAYS ATTEMPT TO INVITE GATEKEEPER- has ALOOOTTTTT OF INFLUECNE AND RESOURCES

---- they're ALWAYS a faith based leader

12-16 ppl max- EVERYONE W/EQUAL VOICE

CBPR (community based participatory research) when trying to implement change on a _____ scale

large