Nursing Chapter 10 – Flashcards
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"the conscientious, explicit and judicious use of current best evidence in ,making decisions about the care of the individual patient. it means integrating individual clinical expertise with the best available external clinical evidence from systematic research
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Dr. Sackett's defintion of EBP
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EBP stands for
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evidence- based practice
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leads to best treatment (Gold Standard) plan
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evidence- based practice
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evidence- based practice goal is implementation of ____ ____ ____- ____ ____ to promote positive outcomes
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high- quality cost- effective care
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evidence- based practice goal is implementation of high- quality cost- effective care to promote positive outcomes
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evidence- based practice
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Research vs evidence- based practice : develops new knowledge
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Research
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Research vs evidence- based practice : validates existing knowledge
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Research
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Research vs evidence- based practice : translating the evidence and applying it to clinical decision making
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evidence- based practice (EBP)
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Research vs evidence- based practice : goes beyond research as includes clinical expertise and patient values
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evidence- based practice (EBP)
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Research vs evidence- based practice : opinion leaders and expert opinion valued
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evidence- based practice (EBP)
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Research vs evidence- based practice : about investigation, exploration, and discovery
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Research
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too much information to sift through
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clinical reality
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too little time to access literature
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clinical reality
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what works for one patient may not work for another
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clinical reality
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how do u provide the best up to date care possible
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right information at right time
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1. cultivate a spirt of inquiry 2.ask a burning clinical question 3. collect the most relevant and best evidence 4. critically appraise the evidence 5. integrate evidence with clinical expertise, patient preferences, and values in making a practice decision or change 6. evaluate the practice decision or change 7. disseminate evidence based practice results
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steps in evidence based process
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type of clinical questions (5)
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- intervention - prognosis/ prediction - diagnosis - etiology - meaning
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what intervention most effectively leads to an outcome
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intervention
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what indicators are most predictive of an outcome
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prognosis/ prediction
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what test most accurately diagnoses an outcome
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diagnosis
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to what extent is factor associate with an outcome
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etiology
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how does an experience influence an outcome
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meaning
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asking clinical questions using ______ format
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PICOT
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P in PICOT stands for
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population of interest
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I in PICOT stands for
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intervention or issue of interest
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C in PICOT stands for
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comparison of interest
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O in PICOT stands for
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outcome expected
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T in PICOT stands for
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time needed for the intervention to achieve the outcome or the time in the course of the disease/ symptom that the intervention is applied
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True or False: a well- formulated PICOT question should specify the measurable patient outcomes that need to be addressed
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true
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which of the following components of a PICOT question is absent from the following clinical question: "among patients with dementia, how does the use of reorientation therapy compared with regular, surprised mobility affect patient agitation?" a. P (population) b. I (intervention) c. O (outcome) d. T (time)
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d. T (time)
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strong or weak evidence: meta- analysis
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strong evidence
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strong or weak evidence: integrative reviews
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strong evidence
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strong or weak evidence: experimental studies
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strong evidence
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strong or weak evidence: descriptive surveys
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weak evidence
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strong or weak evidence: qualitative studies
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weak evidence
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strong or weak evidence: correlational studies
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weak evidence
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strong or weak evidence: quasi- experimental studies
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weak evidence
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meta- analysis or systematic reviews of multiple well- designed controlled studies
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level of evidence
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well- designed randomized controlled trials
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level of evidence
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well- designed nonrandomized controlled trials
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level of evidence
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observational studies with controls
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level of evidence
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systematic review of descriptive and qualitative studies
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level of evidence
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single descriptive or qualitative study
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level of evidence
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opinions of authorities and/ or reports of expert committees
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level of evidence
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is on a continuum from high- quality results to lower quality results
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the strength of evidence
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are essential in developing evidence- based practice for nursing
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evidence - based guidelines
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a narrowly focused synthesis of research findings from quantitative studies
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systematic review
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looks at studies of similar methodology
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systematic review
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has same standards of clarity, rigor, and replication as primary research studies
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systematic review
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statistically pools results from previous studies into single quantitative analysis
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meta- analysis
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allows for application of scientific criteria; for example, same size, level of significance, variables
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meta- analysis
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which of he following sources of evidence would be the best evidence to use to suggest a clinical practice change? a. well- designed randomized controlled trial (RCT) b. a systematic review that encompasses multiple studies c. expert opinion of experienced and educated nurses d. a case study that addresses a similar clinical situation
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b. a systematic review that encompasses multiple studies
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identifying problem- and knowledge- focused triggers
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The Iowa Model of EBP
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determining whether the issue is an organizational priority
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The Iowa Model of EBP
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forming a team
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The Iowa Model of EBP
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selecting, reviewing, critiquing, and synthesizing available research evidence
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The Iowa Model of EBP
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piloting the practice change
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The Iowa Model of EBP
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evaluating the pilot and dissemination of results
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The Iowa Model of EBP
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depending on pilot and dissemination of results, rollout and integration of the practice are facilitated with periodic evaluation
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The Iowa Model of EBP
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the JHNEBP process for EBP is
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the PET Process
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what does PET stand for in the PET Process
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- practice question - evidence - translation
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identify EBP question and define its scope; leadership responsibility assigned and interdisciplinary stakeholders recruited for team; team meetings scheduled
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practice question
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internal and external evidence search conducted; evidence critiqued, summarized, and rated; recommendations developed depending on the evidence strength and need for change
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evidence
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determine appropriateness of recommendation in specific settings; develop action and evaluation plan; implement plan; evaluate and report outcomes; secure support for widespread change; identify next steps
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translation
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what barriers may exist to prevent utilization (2)
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- administrative barriers - clinician barriers
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research not valued
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administrative barriers
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limited change in agency or change not based on research
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administrative barriers
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limited resources to make research- based change
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administrative barriers
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do not read research reports
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clinician barriers
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lack education about research process
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clinician barriers
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do not believe research findings
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clinician barriers
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do not know how to implement findings
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clinician barriers
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the agency for healthcare research and quality's (AHRQ) helps with guidelines through development of an expert panel
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how guidelines are developed for EBP
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the group designates the scope of the guidelines
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how guidelines are developed for EBP
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they synthesize the findings to develop recommendations for practice
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how guidelines are developed for EBP
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guidelines developed are presented at meetings and published
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how guidelines are developed for EBP
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pain management
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AHRQ practice guideline
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decubiti prediction/ prevention
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AHRQ practice guideline
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cataract treatment in adults
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AHRQ practice guideline
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depression treatment
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AHRQ practice guideline
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screening, diagnosis, management of sickle cell disease in newborns and infants
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AHRQ practice guideline
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otitis media treatment in children
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AHRQ practice guideline
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availability of cardiac rehabilitation services
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AHRQ practice guideline
