Evidence-Based Practice in Nursing

Week: 14
Instructors: Stacey Hurrell DNP, RN, LSN, CNE and Emily James DNP, APRN, PMHNP-BC

Explain the concept of Evidence-Based Practice (EBP) and describe its essential elements.
Define nursing research and differentiate between its two main categories: qualitative and quantitative.
Identify at least three reliable sources to obtain evidence-based information.
Discuss the use of evidence-based practice to guide the delivery of nursing care.

Definition: A problem-solving approach to client care incorporating:
  - The most accurate scientific evidence.
  - Clinical expertise.
  - Client values.
Process:
- Evidence is utilized as the foundation for practice recommendations.
- Implementations occur followed by evaluations.
Inspiration:
- Aimed at providing optimal care for patients and families.
- Often necessitated by the need for system-wide changes.

Definition:
- A desire to acquire knowledge and skills to deliver the best care.
Characteristics:
- Curiosity and awareness of healthcare practices.
- Ability to entertain change, rather than rely solely on tradition or past experiences.

Identify a Problem:
- Formulate a question based on observed practice issues.
Search for Credible Sources:
- Seek factual and reliable information.
Evaluate Findings:
- Critically review the information obtained.
Implement Recommendations:
- Change interventions based on findings.
Review Effectiveness:
- Assess whether the new interventions yield improved results.
Disseminate Results:
- Share findings with peers to inform broader practices.
Goal:
- Use this process to address patient care or workplace issues.

Activity:
- Collaborate with a classmate to discuss a workplace issue that may be systemic in nature.

Definition: A structured way to formulate research questions.
Components:
  - Population: The focus group for the investigation.
  - Intervention: The specific treatment or action performed by the nurse.
  - Comparison: Current intervention or an alternative.
  - Outcome: The anticipated results of the intervention.
  - Time: Duration of the study (if relevant).
Example PICOT Question:
- In sophomore nursing students, does participation in pre-exam meditation, compared to no meditation, improve test anxiety over a semester?

Sources to Consider:
  - Textbooks.
  - Research findings from articles.
  - Articles with practice recommendations.
  - Credible websites.
  - Reports from governmental agencies and non-profit organizations.
  - Conducting a literature search using library databases like CINAHL, PubMed, Ovid Medline, etc.
  - Pay attention to the search words based on PICOT components.
  - Evaluate that information is current (generally within the last 5 years).
  - Prefer articles that are ‘scholarly’ and ‘peer-reviewed’.
  - Consider using a literature matrix to assess findings.

Key Considerations:
  - Involve stakeholders in the process.
  - Determine if a theoretical framework guides the process.
  - Assess feasibility in terms of time, cost, effort, and staffing.
Example Intervention:
- Adding meditation sessions 30 minutes before examinations to reduce anxiety.

Evaluation Questions:
  - Did your intervention lead to significant differences in outcomes?
  - How will you measure these outcomes?
  - Possible methods include pre- and post-intervention surveys or data collection instruments.
  - Were there any limitations or concerns noted during the evaluation?
  - Would you make modifications to the intervention based on your findings?
  - Would you conduct the intervention again?

Final Step in EBP Process:
- Share findings and insights with relevant stakeholders.
Communication Methods:
  - Presentations.
  - Posters.
  - Publications in journals.
  - Conferences.

Purpose:
- To generate new knowledge aimed at advancing solutions for healthcare problems.
- Enhances practice and may prompt further research questions.
Development of Evidence:
- Nursing research is focused on creating new knowledge, while quality improvement focuses on analyzing existing evidence for application.
Guiding the Research Process Using the Nursing Process:
  1. Assessment: Identify the problem.
  2. Analysis: Formulate the research question.
  3. Planning: Design the research methodology.
  4. Implementation: Recruit participants and gather data.
  5. Evaluation: Analyze and disseminate results.

Quantitative Research:
  - Utilizes numerical data for outcome evaluation.
  - Involves counts or measures analyzed using statistical methods.
  - Data is collected through observations or surveys.
  - Involves a controlled experiment where one group receives an intervention, and another does not, allowing comparison of outcomes.
  - Often tests a specific hypothesis.
Qualitative Research:
  - Aims to enhance understanding, describing, and exploring subjective issues in healthcare.
  - Data tend to be narrative; exploring reasons, attitudes, and motivations.
  - Researchers focus on understanding experiences from the participant's perspective.
  - Typically uses smaller sample sizes and data is collected through interviews and dialogues.

Examples: CINAHL or PubMed
Functions:
- Provide access to a diverse range of research articles and academic resources.
- Published in peer-reviewed, professional journals promoting rigorous academic standards.
Research Tips:
- Use relevant keywords and search terms to optimize results.
- Read abstracts to determine the relevance of articles.
Abstract Definition:
- A brief summary of a study detailing its purpose, design, findings, and researcher.

Activity Instructions:
  - Access the St. Kate’s site and select “Library.”
  - Navigate to ‘Databases’ and locate CINAHL Ultimate.
  - Search for a topic of interest or a previously discussed problem by entering search terms.
  - Assess the found sources for currency and authorship credentials.

Check Domain:
  - Favor sites with “edu” or “gov” as they tend to provide credible information.
  - “Org” domains typically offer factual data.
  - Avoid “com” domains unless you confirm credibility since they suggest commercial interests.
Author Credibility:
  - Examine authors' qualifications and affiliations.
  - Assess if the authors have expertise in the article's subject area.
  - Determine the intended purpose of the website.
  - Verify if the information is current and accurate.

Characteristics:
  - Contain articles subjected to review by professionals in similar fields to ensure scholarly quality.
  - Undergo rigorous review processes, with authors making edits based on peer feedback before publication.
  - Considered a reliable source of scholarly evidence.
  - Access to many nursing journals available through library and database resources.

Clinical Practice Guidelines:
- Evidence-based recommendations for managing diseases and preventive care.
Critical Pathways:
- Clinical tools that apply evidence-based guidelines to organize care delivery for treatment.
- Aim to standardize care, enhance client outcomes, and allow for individualization per client needs.
Standards of Care:
- Represent typical interventions entered in care for specific conditions affecting clients.