Chapter 2 MedSurge

Define evidence-based practice and evidence-informed practice.

  • Evidence-Based Practice (EBP):

    • Integration of:

    • Clinical expertise

    • Patient values

    • Best research evidence

    • Focuses on a thorough understanding of scientific evidence leading to improved patient outcomes.

  • Evidence-Informed Practice:

    • Similar to EBP but with a stronger reliance on existing practices or traditions in healthcare.

    • Still incorporates evidence to some extent, recognizing the role of established practices when evidence is scarce.

Discuss why evidence-based practice should be used.

  • Ensures optimal patient outcomes using:

    • Current and rigorous research evidence

  • Reduces variations in care:

    • Standardizing approaches

    • Enhancing effectiveness and efficiency

  • Promotes a higher standard of healthcare:

    • Improves patient safety through research-based strategies that minimize risks and enhance clinical performance.

Explain how to identify nursing evidence that should be put into practice.

  • Evaluate relevance and quality of evidence:

    • Research studies (e.g., randomized controlled trials, observational studies, meta-analyses)

  • Integrate the evidence into clinical practice:

    • Critical appraisal of literature is essential for applying evidence to specific patient scenarios.

Describe the evidence-based practice process.

  • A systematic approach including:

    • Identifying relevant clinical questions

    • Searching for the best evidence

    • Appraising the evidence for validity and applicability

    • Integrating findings into practice.

List the six steps of evidence-based practice.

  1. Ask the burning question:

    • Frame relevant questions using PICOT:

      • Population/Patient Problem

      • Intervention

      • Comparison

      • Outcome

      • Time

  2. Search and collect evidence:

    • Utilize electronic databases, academic journals, and other resources.

  3. Critically appraise the evidence:

    • Assess validity, relevance, and applicability.

  4. Implement practice change:

    • Use evidence to inform changes in practice.

  5. Measure outcomes:

    • Review outcomes and quality of patient care before and after changes.

  6. Assess overall effectiveness:

    • Analyze results and adjust practices as needed.

Identify who should give evidence-based nursing care, including when and where care should be given.

  • All nurses should apply EBP, regardless of the practice environment:

    • hospitals

    • clinics

    • community health organizations.

Describe how the Quality and Safety Education for Nurses (QSEN) project can promote safe patient care.

  • QSEN focuses on:

    • Preparing nurses with necessary knowledge, skills, and attitudes for quality and safety improvement.

    • Integrating principles of quality improvement ensuring the delivery of safe patient care.

Key Concepts

  1. Caring:

    • Core to nursing, emphasizing compassionate patient care and building trust in nurse-patient relationships.

  2. Evidence-Based Practice:

    • A structured approach that standardizes care and optimizes treatment outcomes.

  3. Health-Care Technology:

    • Enhances communication, improves care delivery accuracy, and encourages patient engagement.

  4. Quality Improvement:

    • Continuous efforts focused on enhancing care quality and healthcare delivery processes.

  5. Safety:

    • Essential in healthcare to minimize risks and harm to patients through effective protocols.

Evidence-Based Practice (EBP)
ab parts of clinical decision-making, considering:

  • Evaluation of evidence quality

  • Applicability of existing research

  • Patient preferences and values

  • Costs associated with interventions

  • Availability of clinical expertise

  • Clinical setting context.

Why Use Evidence-Based Practice?

  • EBP is the gold standard in healthcare:

    • Maximizes care efficacy

    • Improves patient safety

    • Addresses healthcare disparities.

Levels of Evidence Quality

  • Level I: Strongest evidence (systematic reviews of trials).

  • Level II: At least one well-designed randomized controlled trial.

  • Level III: Quasi-experimental research evidence.

  • Level IV: Well-designed case-control or cohort studies.

  • Level V: Systematic review of qualitative/descriptive studies.

  • Level VI: Qualitative studies/single descriptive studies.

  • Level VII: Expert opinion, lowest level.

Process for Evidence-Based Practice

  • Distinction between nursing interventions:

    • Dependent Interventions:

    • Require provider’s order and supervision (e.g., medication administration).

    • Independent Interventions:

    • Do not require orders; performed autonomously (e.g., patient education).

Six Steps of EBP: "ASKMME!"

  1. Ask the burning question:

    • Define patient or at-risk group, intervention, comparison, desired outcome, and timeframe.

  2. Search for evidence:

    • Systematically explore databases for relevant studies.

  3. Think critically:

    • Appraise evidence for validity and relevance.

  4. Measure outcomes:

    • Evaluate changes in patient outcomes pre and post-implementation.

  5. Make it happen:

    • Implement changes based on evidence.

  6. Evaluate practice change:

    • Analyze results to assess impact on patient care.

EBP, Quality, and Safety

  • QSEN Project:

    • Bridges nursing education and practice concerning quality and safety.

    • Focuses on areas such as evidence-based practice, safety, teamwork, patient-centered care, quality improvement, informatics.

Practice Analysis Tip:

  • LPN/LVN should use EBP and engage in quality improvement activities, including data collection and committee participation for enhanced care quality.