Intro to Nursing Unit 3

Prof. Atkinson

Why evidence based practice?

Evidence based practice provides a strategy to ensure that nursing care reflects the most up to date knowledge available

According to the American Associate of Colleges (AACN)

Professional nursing practice is grounded in the translation of current evidence into practice

Why is EBP relevant in nursing?

• Helps resolve problems in the clinical setting

• Results in effective patient care and better outcomes

• Contribute to the science of nursing through the introduction of innovation to practice

• Keeps practice current and relevant by helping nurses deliver care based on current best research

• Decreases variations in nursing care and increases confidence in decision making 

• Supports the Joint Commission on Accreditation of Healthcare Organization (JCAHO) readiness because policies and procedures are current and include the latest research

• Supports high quality patient care and achievement of Magnet status

• It enhances practice by encouraging reflection about what we know

• It is applicable to virtually every area of nursing practice, including patient assessment, diagnosis of patient problems, planning, patient care interventions, and evaluation of patient responses.

7 Steps in the EBP process…How to begin

1. Cultivate a spirit of inquiry and culture of EBP among nurses and within the organization

2. Identify an issue and ask the question

3. Search for and collect the most relevant * best evidence to answer the clinical question

4. Critically appraise and and synthesize the evidence

5. Integrate evidence with clinical expertise and patient preferences to make the best clinical decision

6. Evaluate the outcome of any EBP change

7. Disseminate the outcomes of the change

Common barriers to implementing EBP in nursing

• Lack of value for research in practice
• Difficulty in changing practice
• Lack of administrative support
• Lack of knowledgeable mentors
• Insufficient time
• Lack of education about the research
process
• Lack of awareness about research or EBP
• Research reports/articles not readily
available
• Difficulty accessing research reports &
articles
• No time on the job to read research
• Complexity of research reports
• Lack of knowledge about how to critique
articles
• Feeling overwhelmed by the process
• Lack of a sense of control over practice
• Lack of confidence to implement change
• Lack of leadership, motivation, vision,
strategy or direction among managers 

PICO(T)

P= Patient, population, or problem

I= Intervention, exposure, or topic of interest

C= Comparison or alternative interventions (if appropriate)

O= Outcome

T= Time or Timeframe

Examples of PICO(T) Questions

• In (patient or population), what is the effect of (intervention or exposure) on (outcome) compared with (comparison or alternate invention)

• For (aging adult), does the introduction of (yoga) reduce the risk of (falls) compared with (daily walking only)?

Basic Research

• Used to broaden the base of knowledge

Example: gathering and learning information to include in a paper about STIs among adolescents aged 14-19 years old

• Research is important due to the acquisition of knowlede, aiding in problem solving, and providing curren information

Competency

1970s

Research was built as part of the nursing curriculum

Accreditation

1970s

National League of Nursing (NLN) required research for accreditation in BSN and masters

Quantitative

• The research question focuses on how many or how much. This research gives us descriptive data demonstrating associations between variables It also demonstrates causality established through experimental research.

Qualitative

• The research questions focuses on the experience, feelings, or attitudes. Goal is to understand the issue. Use of non-numerical and subjective data to understand responses

Institutional Review Board

Revies research before its conducted to ensure study is ethical

Protect vulnerable populations

Neonates, children, pregnant women/fetus, mental illness, cognitive impairment, terminally ill, and persons confined to institutions.

Nuremburg Code

1st international code of ethics for research on human subjects

How do we determine if a person is healthy

The WHO constitutions states: “health is a state of complete physical, mental and well being and not merely the absence of disease or infirmity.”

How do we determine if a person is ill

Absence of the state of health

How do you define a family

Two or more individuals who depend on one another for emotional, physical, and or financial support

How do you define a community

People and the relationships that emerge among them, agencies, institutions, and shared physical enviroment

Social determinants of health

Social determinants of health (SDOH) have a major impact on peoples health, well being, and quality of life. Examples are:

• Safe housing, transportation and neighborhoods

• Racism, discrimination, and violence

• Education, job opportunities, and income

• Access to nutrients foods and physical activity opportunities and income

• Polluted air and water 

• Language and literacy skills 

Access and quality of health services can

Impact health

Those without health insurance are less likely to

Participate in preventive care and most likely to delay medical treatment

Individual Behaviors

• The majority of public health and healthcare interventions focus on changing individual behaviors such as substance abuse, diet, and physical activtity

• Positive changes in individual behavior can reduce the rates of chronic disease in this country. This includes diet, activity, alcohol, cigarette and other drug use.

• Hand washing

• Smoking is leading cause of preventable death in US

• Marijuana smoke contains many of same toxins, irritants, and carcinogens as tobacco smoke

• Secondhand smoke causes 41,000 deaths each year

Disease Prevention

Primary prevention= interventions to maintain health

Secondary prevention= intervention/prevention to prevent disease progression. Patient is asymptomatic.

Tertiary prevention= Interventions to improve functioning when disability is present

Primary Prevention

• Includes interventions to stop the development of disease.

• health promotion is critical component such as diets, activity, and healthy lifestyles.

• the program should address one modifiable risk factor and a way to modify it. Reducing exposure

Examples of Primary Prevention

• Use of safety belts

• Immunization

• Avoid smoking

• Improving roads

• Fluoridation

Primary Prevention: Community Approach

• Mass media

• advertising

• increasing tax

• banning smoking in public places

Secondary Prevention

• Occurs when person is asymptomatic after disease has begun

• Focus is to detect the disease in it’s earliest stages

• Intervention is to slow the progression or reverse

Examples of Secondary Prevention

• Screening is the key, disease must have a long latent period in which disease can be identified.

• Pap test for cervix cancer

• PSA blood test for prostate cancer

Tertiary Prevention

• Disability is present and the need to maintain or improve functioning.

• Interventions are directed to recovery, disability, or death stage

• Purpose to reduce long term impairments, extend the quality of life, and increase survival

Examples of Tertiary Prevention

• Stroke rehabilitation

• SCI Rehabilitation

• Cardiac Rehabilitation

• Diabetes/Insulin Therapy

Chronic Disease

he total number of people with chronic disease is increasing and the number of individuals having two or more.
In 2020, it is projected that 157 million people will have chronic disease and 81 million will have multiple conditions.

Chronic diseases are

The leading cause of death worldwide

Focus on Care Coordination

• Self management

• Transitional Care

• Health Literacy

• Disease management

Barriers to success

• Lack of access

• Inadequate consumer education

• Failure to ensure empowerment, leading to self management

Vulnerable Populations

• People who are at risk for developing health problems and issues to accessing health. 

• Factors include physiological, psychological, economic, ethnic, religious, social, cultural and communication factors.

• Issues related to diet, housing, safety, education and transportation

Who is the librarian

Brooke gross

Things to remember

1. 1am not here to judge you

2. There is no stupid or excessive questions

3. My hours and location are flexible

Research consultations

• Email

• Zoom

• In person

• Through Appointment page

Common consult topics

• Journal / database tutorials

• Annotated Bibliography

• Keyword search suggestions

• Citation styles

• Peer review sources

Reference questions

24 hour online chat and FAQ page

Research guides

• CHHS guides - full list

• Nursing and allied health guide

Getting started with research

• One search

• Tutorials and how to guides

Reference questions

Reference desk - cravens 4th floor

Circulation services

• Library hours

• Physical books

• Textbooks on reserve

Other sources

Library events and workshops along with computers and printing

6 rights of medication administration

• Right Medication

• Right Dose

• Right Patient

• Right Route

• Right Time

• Right Documentation

What is informatics

• Science of collecting, managing, and retrieving information

• Streamline processes and improve overall patient outcomes technology and data to create change that may lead to more efficient delivery of care, better patient care, improved health outcomes and lower costs

Harriet Werley

• First nurse researcher n 1950s

• Data processing, ongoing research

• Increased nursing participation

All aspects of care delivery are based on

• Evidence

• Patient Safety

• Quality improvement initiatives 

• Research compliance

• Policy development

Capability links in healthcare

• Support video or picture graphics

• Communication and email

• Patient confidentiality

Electronic Databases

• CINAHL

• Cochrane Library

• Pubmed

• Health Source

• Google Scholar

• MEDLINE

• PyschINFO

Accuracy

• Is information accurate and reliable? NO WIKIPEDIA

• .gov, .edu, .org

Authority or Source

• What are the credentials of author or organization?

• Was there a peer review?

What is APA

American Psychological Association

APA regulates the following

• Stylistics - consistency among the sciences

• In text citations

• References

• Computer friendly

Title Page Contains 5 elements in Student APA

1. Page Number

2. Title of Manuscript

3. Authors name

4. Institutional affiliation

5. Course name and number

6. Instructors name

7. Assignment due date

Abstract

Separate page, 150-350 words, Summation of article and include methodology, Major results, Discovery within study

Intro

Research topic, Research question, Historical value to study, Narrowing of topic, and How author wants to address the study

Method

Participants, Design, Materials, and Procedure used within the study

Results

Summary of the data collected

Discussion

Did the data support findings?

Summary of gained knowledge

Limitations