Week 3: Evidences Based Practice

What are the scopes of nursing research?

-scientific approach

-applied approach

3 Interrelated concepts in nursing research

research utilization, knowledge translation, EBP

Goals of the interrelated concepts in nursing practice

Identify, utilize, and apply the scientific knowledge from research to clinical practice

Research utilization

Use of study findings in a practical application in specific clinical area unrelated to the original research

(aims to impact/change nursing practice)

Knowledge Translation

Synthesizing, disseminating, and using of research knowledge

(aims to bridge gap between research and healthcare)

EBP aim

Integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care

(aims to have best clinical decision making)

History of RU

1975- noticed gaps in practice.

1970-80s- tried to address gaps (CURN project)

1990- EBP took over

Archie Cochrane

Made research summaries about interventions available to healthcare providers. Led to Cochrane center and Cochrane Collaboration

David Sackett

Developed EBP, which has broadened use of best evidence by all healthcare workers

What does EBP Integrate

External evidence (search, critical appriasal, synthesis of research).

Internal evidence (clinical experience, quality improvement projects, evaluation).

pt preferences and values.

Best Evidence

Findings of quantitative research studies

Clinical experience

Expert panels, Consensus statements, Practice groups, Practitioner experience

Pt preferneces

Satisfaction, QOL, Treatment burden, Qualitative studies

5 Steps in EBP (As)

Ask, Acquire, Appraise, Apply, Assess

Step 1: Ask (EBP)

Ask a well-worded clinical question that can be answered with research evidence.

Step 2: Acquire (EBP)

Search for and retrieve the best evidence to answer the clinical question.

Step 3: Appraise

Critically appraise the evidence for validity and applicability to the problem and situation.

Step 4: Apply

After integrating the evidence with clinical expertise, patient preferences, and local context, apply it to clinical practice.

Step 5: Assess

Evaluate the outcome of the practice change.

Step 0 of EBP

Cultivate a spirit of inquiry

Knowledge Focused triggers

Begins with an innovation or research finding (e.g., might emerge in a journal club)

Problem Focused Triggers

Begins with a perplexing or troubling clinical situation (bedside problem, in the moment)

Asking the question happens in _____ format

PICO

PICO

Patient population

Intervention or issue of interest

Comparison intervention or group

Outcome

Time frame

Components of qualitative evidence

population, situation (processes, experiences, cultures, history, condition of interest)

Where is the best website to search for evidence

cochrane collaboration

Step 3: Appraise the Evidence

Does not look for if the study works or not.

Quality, magnitude, quantity, consistency, applicability

Quality (Step 3: Appraise)

To what extent is the evidence valid—how serious is the risk of biases?

Magnitude (Step 3: Appraise)

How large is the effect of the intervention or influence (I) on the outcome (O) in the population of interest (P)? Are the effects clinically significant?

Quantity (Step 3: Appraise)

How much evidence is there? How many studies have been conducted, and did those studies involve a large number of participants?

Consistency (Step 3: Appraise)

How consistent are the findings across various studies?

Applicability (Step 3: Appraise)

To what extent is the evidence relevant to my clinical situation and patients?

1st level of evidence

Systematic reviews of RCTs

2nd level of evidence

Individual RCT

3rd level of evidence

Systematic reviews non-experimental studies (correlational)

4th level of evidence

Individual correlational studies

5th level of evidence

Systematic reviews of descriptive studies

6th level of evidence

Individual descriptive studies

7th level of evidence

Expert opinion of respected authorities or expert panels

High level study does not necessarily mean..

high quality study

What are the 3 domains that grade the strength of a body of evidence

quality, quantity, consistency

Quality

The extent to which a study's design, conduct, and analysis has minimized selection, measurement, and confounding biases (internal validity)

Quantiity

The number of studies that have evaluated the question, overall sample size across all studies, magnitude of the treatment effect, strength from causality assessment, such as relative risk or odds ratio

Consistency

Whether investigations with both similar and different study designs report similar findings (requires numerous studies)

Step 4: Apply Evidence

Evidence gets ingrained into clinical experience. Can provide insight to how pts experience a problem or about barriers with tx

Integrating evidence

Implementation step, pt hx and circumstances have big effect on nurse choice of intervention, availability of resources must also be considered

Stelter Model of EBP

promotes EBP

IOWA model of EBP

promotes quality care

Step 5: Assess the outcomes of the practice change

Did you achieve the desired outcomes? Were patients satisfied with the results?

Additional Step 6: Disseminate

share the info

Nursing research knowledge to practice gap

17 years

Barriers to EBP

research related (scarcity of published replications), nurse related barriers (insufficient skills in location/appraising evidence), organizational barriers (lack of finance and staff release time)

Barriers to Nursing

Lack of knowledge

Information overload

Lack of role models

Lack of time or money

Resistance to change

Misperceptions - require education