Ch. 6 4205 Evidence-Based Practice, Advocacy, & Bill of Rights

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Ch. 6 4205Evidence-Based Practice, Advocacy,
Bill of Rights

• Presented by
• Pamela Roberts, MSN RN

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EBP Defined

• The process of providing clinically competent
  care, supported by the best scientific evidence
  available, such as outcomes research and expert
  advisers.

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EBP Characteristics

• Framework for clinical practice
• Considers internal and external influences on
  practice
• Encourages critical thinking
• Judicious use of evidence for broad-based
  thinking
• Numerous studies cited

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Critical Thinking and EBP

• Translating theory to practice
• Posing answerable questions
• Broad-based critical thinking
• Analysis, synthesis, interpreting, and drawing
  conclusions

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Using Evidence-Based Practice

• Asking the right questions
• Why was the research done, what setting was used?
  
• Applying innovation to practice
• Innovation is originality
• Evaluating the effect of predetermined outcome
• Was success achieved?
• How were the results disseminated?
• Disseminated dispersed, distributed

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Why are we using Evidence-Based Practice?

• Increased rate of information distribution
• You can google anything you want on the internet
• Nontraditional
• EBP moves away from tradition. This is the way
  weve always done it. Well, maybe that way has
  been wrong all these years
• Decision making based on comprehensive body of
  knowledge
• Patient care improvement
• Implementing the Fallen Star program has
  decreased the rate of falls
• Conscientious use of current best evidence in
  making decisions about nursing care
• By educating clients based on whats current

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Why use EBP?

• Efficacy
• The ability to reach the desired result
• Efficiency
• Desired result timely with minimal effort
• Effectiveness
• The ability to produce the desired result

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The Nurses Role in EBP

• Active in the evolution of EBP in the
  organization
• Promote ways to systemize evidence at the bedside
• Remained enlightened about the use of EBP
• We do CEUs, take classes, read articles and what
  not

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How do we use EBP?

• Translating evidence into practice
• PET
• P Practice question
• PICO
• E - Evidence
• T Translation
• Are the changes in practice feasible? If so,
  actions are taken to put the change into
  practice, this is when a plan is developed

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PICO for practice question

• Patient, population, or problem
• Intervention
• Comparison with other treatments
• Outcomes

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Searching for Evidence

• PubMed (MEDLINE)
• CINAHL (The Cumulative Index to Nursing and
  Allied Health Literature)
• The Cochrane Library

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CINAHL

• EBSCO
• 2700 nursing, allied health, biomedical, and
  consumer health journals
• ANA and NLN journals
• Various depths of coverage
• References dissertations, books, standards of
  practice, legal cases, critical pathsetc.

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MEDLINE (PubMed)

• Produced by the National Library of Medicine
• Premier source for biomedical literature
• 5000 journal with 300 nursing specific
• Evidence-based filters in clinical queries

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The Cochrane Library

• A collection of seven databases
• Contains evidence summaries and synthesizes
  reviews
• Reviews are based on the best available
  information in health-care interventions
• Structured to minimize bias
• Good evidence-based source

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Search tips

• Use controlled vocabulary for keywords and
  phrases
• Use AND, OR, and NOT
• Ex Clinical competence AND
• Intravenous therapy

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More search tips

• Think of alternative spellings such as tumour,
  behaviour, gynaecology American vs. British)
• Use limits such as age, date of publication, and
  language

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Reviewing the search

• Has it been reviewed? If so by whom?
• Why was it published?
• Has it been cited?

• Who wrote it?
• Who sponsored the research?
• When was it published?

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Advocacy
Workplace
Patient
Whistle-Blowing
Professional
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Advocacy

• Advocacy is the foundation and essence of nursing
  and nurses have a responsibility to promote human
  advocacy
• Advocacy is helping people grow and self
  actualize
• Nurses must advocate for themselves, clients,
  family members, subordinates, and their
  profession

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Goals of the Advocate

• Inform
• Autonomy (enhance this)
• Respect
• To respect the decisions of others, even if you
  dont agree with it.

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How Nurses Can Act as Advocates

• Helping others make informed decisions
• Cultural and ethnic diversity and sensitivity
• Directly intervening on behalf of others
• Continuing care of DNR client

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Advocating for Clients

• Clients needs and goals are paramount
• Advocate the distribution of resources
• Leadership must be willing to take risks
• Time out procedures (right pt, right site, right
  surgery)
• DNRs
• Ethics Committee for Staff
• Must be willing to accept conflict

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Bills of Rights

• Passed by the National League for Nurses and
  American Hospital Association in the 1960s
• Privacy law primarily protects the rights of the
  patient
• Guide professional practice

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Subordinate Advocacy

• What is it?
• The manager helps subordinates resolve ethical
  problems and live with the solutions at the unit
  level
• Like if you have a problem on E5, you should try
  to solve the problem and live with the
  consequences on E5

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PromotingSubordinate Advocacy

• Staff needs, (listen to)
• Empower staff
• Promote autonomy (for the nurses)
• Face challenges (and solve problems together)
• Go to bat for the staff (when needed)

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Workplace Advocacy

• Manager insures safe, growth oriented environment
• Occupational health and safety must be assured

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Internal vs. External Whistle-Blowing

• Internal whistle-blowing
• Within the organization, reporting up the chain
  of command
• External whistle-blowing
• Reporting outside the organization, such as the
  media or an elected official
• Public awareness has increased
• People are more likely to complain when they feel
  wronged
• Nurses must act individually or collectively

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Professional Advocacy

• Leader-managers also must be advocates for the
  nursing profession
• Professional duty is assumed by entering the
  profession of nursing
• Speak out on consumer issues, continuing and
  expanding attempts to influence legislation, and
  increasing membership on governmental health
  policy-making boards and councils
• Speak out on staffing issues