EBP & Critical Thinking

What does EBP integrate?

• Clinical expertise

• Patient values & preferences

• Best evidence

Reasons for using EBP

• Better pt outcomes

• Promotes research rather than tradition

  • Increased pt care experience

  • Increased nurse satisfaction

  • Increased quality of care and decreases healthcare costs

• Engages nurses in research

• Contributes to evolution of nursing

Steps in implementing EBP

1. Ask a question

2. Collect best evidence

3. Critically appraise the evidence

4. Integrate evidence w/ clinical expertise, pt preferences & values

5. Evaluate the practice decision or change

QSEN

Quality and safety education for nurses

• Knowledge, skills, attitude (KSA)

EBP examples

• Handwashing

• Turn and position

• Use ROM

• Standard precautions

Quantitative Research Methods

Produced data in the form of numbers

• Basic research: generate and refine theory; not directly useful in practice; “what if”

• Applied research: practical research; useful in practice

Qualitative research methods

Research conducted to gain insight by finding meanings and in-depth understanding of human behavior

• Impossible to accurately measure

• Ex: What are the pt’s perception of nurses or healthcare

PICO format

A relevant question

• P: pt, population, problem of interest

• I: intervention of interest

• C: comparison of interest (to usual standard of care)

• O: outcome of interest

• may add T: timeframe

Critical thinking in nursing

• Purposeful, outcome-directed

• Essential to safe, competent, skillful nursing practice

• Based on principles of nursing process and the scientific method

• Requires specific knowledge, skills, and experience

• New nurses must question

• Guided by professional standards and ethic codes

• Requires strategies that maximize potential and compensate for problems

Critical reasoning

Ways of thinking about pt issues

• What is the problem?

• What could happen if I don’t take care of this right away?

Clinical judgement

Conclusions, decisions, or opinion

• Prioritizing

3 questions of critical thinking

• What do I really know?

• How do I know it?

• What opinions are available?

Levels of critical thinking

• Basic critical thinking

• Complex critical thinking

• Commitment

Basic critical thinking

Nurse trusts the experts and rules; limited nursing knowledge/experience

Complex critical thinking

• Nurse begins to express autonomy by analyzing and examining data to determine the best alternative

  • Results from knowledge, experience, intuition, and more flexible attitudes

Commitment

• Expect to make decision with or without help

• Take responsibility

Components of critical thinking

• Knowledge

• Experience

• Competence

• Attitudes

• Standards

Attitudes of a critical thinker

• Confidence

• Independence

• Fairness

• Responsbility

• Discipline

• Perserverance

• Creativity

• Integrity

• Humility

Nursing process- assessment an critical thinking

Observe, collect data, differntiate date, organize, validate, interpret

Nursing process - nursing diagnosis and critical thinking

• Custer, Id, recognize actual/potential problems

• Avoid making judgement

• Prioritize

Nursing process - planning and critical thinking

ID goals, determine strategies, set priorities, take knowledge, apply

Nursing process - implementation and critical thinking

Use knowledge, use skills, test theories, delegate, supervise, communicate

Nursing process - evaluation and critical thinking

Determine accuracy, evaluate outcome, based on scientific criteria