Class 5: evidence-based learning

Evidence-informed decision making

Evidence-informed decision making

Continuous process that involves explicit, conscientious and judicious consideration of the best available evidence to provide care. It is essential to optimize outcomes for individual clients, promote healthy communities and populations, improve clinical practice, achieve cost-effective nursing care and ensure accountability and transparency in decision-making within the healthcare system.

Nursing knowledge

The foundation of the profession of nursing. Constantly building.

Research.

What is a major source of nursing knowledge?

Learning from patient care, things that work, how other people do things (as long as it is within policy). It is still evidence if it is not written down or research.

Examples of non-research evidence that is another source of information to support practice:

1. Evidence from research, theories, clinical experts, opinion leaders

2. Evidence from assessment of patient’s history and physical and available health care resources. (patient research, charts, kardex)

3. Clinical expertise (non-research)

4. Information about patient preferences and values (applying to different patients)

Four sources that come together to support Evidence-Informed Clinical Decision Making:

Patient population of interest

Intervention: what are you doing?

Comparison: now vs. research

Objective: Goal, what and why you want to achieve

Time frame: for change to occur

PICOT Formulation of a clinical question:

Is the answer readily available in

1. Practice guidelines

2. literature

What to consider first before asking a clinical question: [2]

Research literacy

Being able to critique evidence. How up to date is it? Who wrote it (credibility)?

Determine it’s

1. value

2. feasibility

3. utility for changing practice

Why is it important to critique evidence?

1. Do articles together offer evidence to explain or answer PICOT question?

2. Do articles show that the evidence is true and reliable?

3. Can you use the evidence in practice?

After critiquing evidence, you will be able to answer these three questions:

1. Abstract

2. Introduction

3. Literature review

4. purpose statement

5. methods

6. results

7. clinical implications

Parts of a research article: [7]

Simply apply the research in your plan of care for a patient.

First step in integrating evidence:

Determine how effective the clinical decision was for the patient or practice setting.

How to evaluate a change after integrating evidence:

Florence Nightingale

First nursing researcher

1918

When were university nursing courses established?

1950s and 1970s

When were nursing master’s degree programs introduced?

1990s and 2000s

When were nursing PhD programs introduced?

ten years ago

When were nursing PhD programs at MUN introduced?

Nursing Papers (Later the Canadian Journal of Nursing Research, established at McGill in 1969)

First Nursing Research Journal

Quantitative nursing research

The investigation of nursing phenomena that can be precisely measured or quantified. Very objective.

pain severity, rates of wound healing, and body temperature changes.

Examples of quantitative research: [3]

Qualitative nursing research

Poses questions about nursing phenomena that cannot be quantified or measured. May choose one of many design strategies

1. Respect for human dignity

2. Respect for persons (autonomy)

3. Concern for welfare

4. Respect for privacy and confidentiality

5. Justice

ethical issues in research: