GNUR 360: Chap. 13: Building an Evidence-Based Nursing Practice – Flashcards
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Evidence based practice
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conscientious integration of best research evidence with clinical expertise and patient values and needs in the delivery of quality, safe, cost-effective health care
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Best research evidence
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Produced by the conduct and synthesis of numerous, high-quality studies in a health related area * Generated in terms of health promotion, illness prevention, and the assessment, diagnosis, and management of acute and chronic illnesses
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Sources of evidence based practice
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1. Systematic review 2. Meta-analysis 3. Integrative reviews 4. Meta-summaries 5. Meta-synthesis
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Benefits of evidence based practice
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1. Improved outcomes for patients, providers, and agencies 2. Leads to best treatment (National guidelines [Gold Standard]) plan 3. Integral part of the Magnet Status process
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Integrative review
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Rigorous analysis and synthesis of results from independent qualitative and quantitative studies and theoretical and methodological literature to determine the current knowledge for a particular concept, measurement methods, or practice topics
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How do qualitative integrative reviews contribute to EBP?
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1. ID and refine questions and outcomes 2. ID types of participants and interventions 3. Augment and provide data for research synthesis 4. Highlight inadequacies in methods 5. Explain findings and interpretation of findings 6. Help make recommendations
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Systematic review
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Structured, comprehensive synthesis of quantitative and outcomes studies in a particular healthcare area to determine the best research evidence available for expert clinicians to use to promote EBP
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Steps involved in systematic reviews?
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1. Formulate purpose and ID scope 2. Develop specific questions or hypothesis 3. Establish criteria of inclusion/exclusion of studies 4. Conduct extensive literature search of all sources 5. Develop questionnaire and contact authors to gather data 6. Critique studies for scientific merit and data analysis 7. Analyze and interpret data 8. Report the review
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Meta-analysis
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Statistical analysis carried out to integrate and synthesize findings from completed studies to determine what is known and not known about a particular research area *Pools results into a single qualitative analysis
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Results reported in a meta-analysis
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1. Large, diverse sample that is more representative of the target population 2. Determination of overall significance of probability of pooled data 3. Indication of the efficiency of the intervention from the average effect size determined from several quality studies 4. Strength of relationship between variables
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Meta-summaries
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Synthesis of multiple primary qualitative studies to develop a description of current knowledge in an area *Expands our knowledge base
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How do we determine the best evidence for use of practice?
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1. The strength of the evidence is on a continuum from high-quality results to lower quality results 2. Evidence-based guidelines are essential in developing evidence-based practice fro nursing
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Strongest type of evidence
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1. Meta-analysis 2. Integrative reviews 3. Experimental studies
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Weakest types of evidence
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1. Descriptive surveys 2. Qualitative studies 3. Correlational studies 4. Quasi-experimental studies
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Iowa Model of Evidence-Based practice
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Provides direction for the development of EBP in a clinical agency *Triggers that initiate the need for change, such as risk management data, financial data, organizational standards/policies, nad philosophy of care
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What questions would apply to the Iowa model?
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1. What are effective strategies for implementation? 2. What are outcomes from using the research findings? 3. Do the data support the change? 4. Is the proposed change an agency priority? 5. Was the cost of the study worth the outcome?
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Grove model of implementing EBP
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In this model, NURSES ID a practice problem, search for the best research evidence to manage the problem in their practice, and use an evidence-based guideline to manage their problems * Compare agency cite protocols against evidence-based guidelines
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How is the grove model used for EBP?
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Nurses critically appraise... 1. Significance of the health care problem 2. Strength of the research evidence 3. Link to national standards 4. Cost-effectiveness of using the guideline in practice
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What factors whould you consider in instituting a practice change?
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1. Will the implementation take a long time? 2. What support is needed to make the change? 3. Are nursing staff members facilitators or barriers to the effect the study? 4. Magnet status hospitals expect nurses to be positive about practicing EBP
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What barriers may exist to prevent utilization?
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Administration barriers... 1. research not valued 2. Limited change in agency or change not based on research 3. Limited resources to make research-based change Clinician barriers... 1. Nursing staff members dont know how to do a search on a topic of interest 2. lack of education about research process to read studies 3. Do not believe research findings 4. Do not know how to implement findings
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What factors should you consider when monitoring outcomes?
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1. After the change is effected, the outcomes must be monitored for effectiveness 2. Change should be documented regarding improved quality of care, decreased costs, saved nursing time, and improved access to care 3. Revise policies 4. Revise standing protocols 5. Provide feedback
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PICOT
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Method to formulate questions in EBP P: population or participants of interest in your clinical setting I: intervention needed for practice C: comparisons of interventions to determine the best intervention for your practice O: outcomes needed for practice and ways to measure the outcomes in your practice T: What is the time frame?
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Elements that ensure successful collaboration in EBP
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1. clarity 2. Decision-making 3. Contingency planning 4. Regular meetings
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Access to evidence-based guidelines
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1. Agency for Healthcare Research and Quality (AHRQ) 2. National Guideline Clearinghouse (NGC) 3. Academic Center for Evidence-Based Nursing 4. American College of Physicians 5. American Academy of Pediatrics
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How does the nurse implement EBP models?
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1. ID the practice problem 2. Search the best research evidence 3. Determine quality guideline by assessing (authors, significance of the problem, strength of evidence, link to national standards, cost-effectiveness of guideline)
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Translational research
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Evolving concept defined by the NIH as the translation of basis scientific discoveries into practical applications
