EVIDENCE BASED PRACTICE

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EVIDENCE BASED PRACTICE: 

EVIDENCE BASED PRACTICE KIRAN RANDHAWA

OBJECTIVES: 

OBJECTIVES Define EVIDENCE BASED PRACTICE Enumerate sources of EBP Identify barriers & overcome them Explain model of EBP levels of collaboration Adopt EBP in clinical field.

OVERVIEW OF EVIDENCE BASED PRACTICE : 

OVERVIEW OF EVIDENCE BASED PRACTICE Most definitions include three components- research – based information, clinical expertise & patient preferences. Ingersoll’s [2ooo] definition succinctly captures the essence of EBP as, “the conscientious, explicit & judicious use of theory derived, research based information in making decisions about care delivery to individuals or groups of patients & in consideration of individual needs & preferences.”

OVERVIEW OF EVIDENCE BASED PRACTICE : 

OVERVIEW OF EVIDENCE BASED PRACTICE Most definitions include three components- research – based information, clinical expertise & patient preferences. Ingersoll’s [2ooo] definition succinctly captures the essence of EBP as, “the conscientious, explicit & judicious use of theory derived, research based information in making decisions about care delivery to individuals or groups of patients & in consideration of individual needs & preferences.”

SOURCES OF EVIDENCE : 

SOURCES OF EVIDENCE Tradition Authority Trial & error Personal experience Intuition Borrowed evidence Scientific research

WHO ARE THE USERS OF EVIDENCE-BASED PRACTICE : 

WHO ARE THE USERS OF EVIDENCE-BASED PRACTICE Nurses (RN, NP) Nursing assistants Physicians Respiratory Therapists Physical Therapists Pharmacists Others

WHY USE EBP? : 

WHY USE EBP? Advances quality of care provided by nurses. Increases satisfaction of patients Refocuses nursing practice away from habits and tradition to evidence and research

ADOPTING AN EVIDENCE BASED PRACTICE : 

ADOPTING AN EVIDENCE BASED PRACTICE Asking a clinical question. Searching the literature for relevant research. Critically appraising what has been found. If change is warranted, following steps occur. Implementing a practice change. Evaluating the change in practice.

BARRIERS : 

BARRIERS Studies demonstrate that the reason nurses do not draw on research are related to individual & organizational factors. Individual factors are those characteristics that are inherent to nurse. Organizational factors are related to administration, resources, facilities & culture of the system. Barriers such as nurses not valuing research, being resistant to change, lack of time & resources obtain evidence are major reasons nurses don’t use research findings at point of care. In addition , the communication gap between researcher & clinician, organizational culture, as well as inability to evaluate nursing research have been identified.

STRATEGIES FOR OVERCOMING BARRIERS TO ADOPTING AN EBP : 

STRATEGIES FOR OVERCOMING BARRIERS TO ADOPTING AN EBP To overcome barriers to using research findings in practice, the MODEL OF DIFFUSION OF INNOVATIONS (Rogers, 2003) has been used in nursing literature. Diffusion involves the movement of molecules from areas of higher concentration to lower concentration. In the same way, innovative nursing practices frequently begin in a small number of institutions & eventually spread or diffuse, becoming standard practice everywhere. The model includes four major concepts: innovation, communication, time & social system.

Slide 12: 

Rogers defines diffusion as “the process as 1. An innovation 2. Is communicated through certain channels 3. Overtime 4. Among members of a social system.” Initially only a minimum number of individuals known as early adopters embrace the innovation. The individuals who are slow or fail to adopt the innovation are laggards.

Time: 

Time Devote 15 minutes a day to reading evidence related to clinical problem Sign up for emails that offer summaries of research studies in your area of interest. Use a team approach when considering policy changes to distribute workload among members. Bookmark websites having clinical guidelines to promote faster retrieval of information. Evaluate available technologies to create time saving systems that allow quick & convenient retrieval of data . Negotiate release time from patient care duties to collect , read & share data related to relevant nursing problems. Search for already established clinical guidelines because they provide synthesis of existing research.

Research in practice not valued: 

Research in practice not valued Make a list of reasons why health care providers should value research & use this for discussion with colleagues. Invite nurse researchers to share why they are passionate about their work When disagreements arise about a policy or protocol, find an article supports your position & share it with others. When selecting a work environment, ask about the organizational commitment to EBP. Link measurement of quality indicators to EBP. Participate in EBP activities to demonstrate professionalism that can be rewarded through promotion. Provide recognition during National Nurses Week for individuals involved in EBP projects.

Lack of knowledge about research & EBP: 

Lack of knowledge about research & EBP Take a course or attend a continuing education offering on EBP. Invite a faculty member to unit meeting to discuss EBP. Consult with advance practice nurses. Attend conferences where clinical research is presented & talk with presenters about their studies. Volunteer to serve on committees that policies & protocols. Create a mentoring program to bring novice & experienced nurses together.

Lack of technological skills to find evidence : 

Lack of technological skills to find evidence Consult with a librarian about how to access databases & retrieve articles. Learn to bookmark important websites Commit to acquire computer skills.

Lack of resources to access evidence : 

Lack of resources to access evidence Write a proposal for funds to support access to online databases & journals. Collaborate with nursing program for access to resources Investigate funding possibilities from others

Lack of ability to read research: 

Lack of ability to read research Organize a journal club where nurses meet regularly to discuss the evidence about a specific problem. Write down questions about an article & assist in answering questions. Clarify unfamiliar terms by looking them up in a dictionary or research textbook. Use one familiar critique format when reading research.

Communication gap between researcher & nursing staff: 

Communication gap between researcher & nursing staff Identify clinical problems & share them with nurse researchers Participate in ongoing unit-based studies. Subscribe to journals that provide uncomplicated explanations of research studies.

Resistance to change : 

Resistance to change Listen to people’s concern about change. When considering a EBP project, select one that interests the staff, has a high priority, is likely to be successful, having a baseline data. Mobilize talented individuals to act as change agents. Create a means to reward individuals who provide leadership during change.

Organization does not embrace EBP: 

Organization does not embrace EBP Link organizational priorities with EBP to reduce cost & increase efficiency. Recruit administrators who value EBP. Form coalitions with other healthcare providers to increase the base of support for EBP. Use EBP to meet accreditation standards or gain recognition.

HOW HAS NURSING EVOLVED AS A SCIENCE?: 

HOW HAS NURSING EVOLVED AS A SCIENCE ?

Cycle of scientific development : 

Cycle of scientific development

USING EVIDENCE THROUGH COLLABORATION TO PROMOTE EXCELLENCE IN NURSING PRACTICE: 

USING EVIDENCE THROUGH COLLABORATION TO PROMOTE EXCELLENCE IN NURSING PRACTICE . In late 1800s , Florence Nightingale followed many principles of EBP. A culture of EBP is emerging within nursing through collaborative efforts by nurses & health care organizations

MODEL OF EBP LEVELS OF COLLABORATION : 

MODEL OF EBP LEVELS OF COLLABORATION

Slide 27: 

Nurses, in a variety of roles, contribute to EBP. They can identify clinical problems, participate in EBP changes, serve as change agents or opinion leaders , or establish a vision for the organization. Organizational factors that build a culture for EBP include setting performance expectations for individual nurses, integrating EBP into governance structures & providing recognition & rewards for involvement in EBP.

Slide 28: 

Regional interventions include using skills of a local librarian, collaborating with local librarian, collaborating with a local program of nursing & using resources from regional centers. Many national & international entities have made considerable contributions to nursing research & EBP.

FORMULATING EBP QUESTIONS : 

FORMULATING EBP QUESTIONS The primary purpose of EBP questions is to make decisions about patient care based on best current evidence gathered from systematic problem solving approach. EBP incorporates a systematic search for evidence & critical appraisal of findings with clinical expertise & the patient’s & family’s values & preferences to provide best patient care.

Slide 30: 

One widely used model in EBP is PICO model . P- Patient population or patient condition of interest I- Intervention of interest C- Comparison of interest O- Outcome of interest

Keeping it ethical: 

Keeping it ethical Nurses must be certain that research questions, posed can be answered while respecting the rights of human subjects. Eg:- bedsores. Regardless of answers that are found to questions, nurses must consider patient preferences when making practice decisions.

Slide 32: 

Nurses are expected to act as patient advocates by assuring that their rights are upheld. Three major principles are identified:- respect for persons, beneficience & justice. (Belmount report) Nurses are also expected to facilitate the development of scientific knowledge in nursing

EVIDENCE BASED PRACTICE MODELS TO OVERCOME BARRIERS : 

EVIDENCE BASED PRACTICE MODELS TO OVERCOME BARRIERS Several models have emerged & serve as the foundation for evidence based practice. Some are conduct & utilization of research in nursing (CURN) project, the settler model, & the lowa model for EBP to promote quality care.

Wheel of professionalism in nursing: 

Wheel of professionalism in nursing

BIBLIOGRAPHY: 

BIBLIOGRAPHY Ciliska , D. (2005). Educating for evidence-based practice. Journal of Professional Nursing. Dec.,21(6), 345. Nola A. Schmidt, Janet M. Brown, Evidence based Practice for Nurses, Jones & Barlett Publishers, 1 st edition, New Delhi, 2010 Profetto -McGrath, J. Critical thinking and evidence-based practice. Journal of Professional Nursing. Dec., 21(6), 365. Titler , M.G., Kleiber , C. Steelma , V. Rakel , B., Bufreau G., Everett, L.Q., Buckwalter , K.C., Tripp-Reimer, T. & Goode, C. (2001). The Iowas Model of Evidence -Based Practice to Promotoe Quality Care. Critical Care Nursing Clinics of north america , 13(4), 497-509.

Slide 37: 

Thank you