Application of Research into Practice

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Application of Research into Practice

• Using Evidence-Based
• Practice
• T. Heather Herdman, RN PhD
• Assistant Professor
• Bellin College of Nursing
• Green Bay, WI

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Research in Practice

• Evidence-based practice
• A problem solving approach to practice that
  involves the conscientious use of current best
  evidence in making decisions about patient care

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Problem-Solving Approach

• Incorporates
• Systematic search for and critical appraisal of
  the most relevant evidence to answer a burning
  clinical question
• Ones own clinical expertise
• Patient preferences and values

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Why Evidence-Based Practice?

• If your child was born prematurely, would you
  want her healthcare providers to give you
  information about how other parents have coped
  with parenting a preterm infant, based on
  evidence from well-designed qualitative and/or
  descriptive studies?
• If your mother was diagnosed with breast cancer
  and needed to decide what type of treatment to
  choose, would you want to know the evidence
  regarding the risks and benefits of each
  treatment option as determined from clinical
  trials with other similar cancer patients?
• If you were in a car crash and were paralyzed,
  would you want to know and use the most
  effective, empirically supported treatment
  established through randomized controlled trials
  to increase your chances of regaining mobility
  and sensation?

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Clinical Decision Making

• Health care professionals face complex decisions
  daily regarding patient careand must do so with
  decreased resources (less staffless money for
  equipment and supplies)
• What is an appropriate outcome for this patient?
• What intervention is most effective for getting
  this patient to meet that outcome?
• What is the most efficient method for providing
  appropriate care for this patient?

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Research Practice Gap

• Evidence indicates that patients receiving care
  based on most up-to-date information from
  research studies experience 28 better outcomes
  than those patients receiving non-research based
  care
• Only a small percentage of healthcare providers
  incorporate research findings into patient care
• Melnyk Fineout-Overholt (2005)

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Research Practice Gap

• It can take as long as 17 years to translate
  research findings into practice
• How many lives are lost?
• How many unnecessary hospitalizations?
• How many ineffective treatments?
• How much unnecessary cost?
• How much time wasted out of your work day?

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Patient Satisfaction

• There is some evidence to indicate that
  healthcare providers using evidence-based
  practice receive higher patient satisfaction
  scores that those who do not
• Provides more ability for nurses to control their
  own practice
• Increases nurse morale
• Decreases nurse turnover

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Key Steps of Evidence-Based Practice

• Ask the burning question (PICO format whenever
  possible)
• Patient population of interest
• Intervention of interest/Interest area
• Comparison of interest
• Outcome of interest
• Collect the most relevant and best evidence to
  answer the clinical question

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Key Steps of Evidence-Based Practice

• Critically appraise the evidence for its
  validity, relevance and applicability
• Integrate the evidence with ones own clinical
  expertise, assessment of patient condition
  available healthcare resources, along with
  patient preferences and values to implement a
  clinical decision
• Evaluate the change resulting from implementing
  evidence into practice

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Barriers to Evidence-Based Practice

• Im a practitioner not a researcher!
• Lack of knowledge regarding EBP strategies
• Misperceptions/negative views about research
• Lack of time and resources to look for, read,
  critique and implement research
• Peer pressureweve always done it this way
• Too much information to process
• Lack of belief that EBP can improve outcomes of
  care

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Facilitators of Evidence-Based Practice

• Support/encouragement from administration
• Time to critically appraise studies and implement
  their findings
• Clearly written research reports
• Implementation infrastructure
• Shared vision/mission within the healthcare team
• Credibility of the research/guidelines

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Questioning Clinical Practice

• Ask questions about your clinical practice
• Does sucrose decrease pain in neonates?
• Does nonnutritive sucking decrease pain in
  neonates?
• Does kangaroo care decrease pain in neonates?
• Which of these treatments is most effective?
• Is one more effective than the others?
• What does a cost-benefit analysis show when
  comparing one treatment to the other?
• Can we make a good clinical case for one
  treatment over the other?

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Questioning Clinical Practice

• Adopt a reflective, inquiring approach
• Asking the right questions takes as much skill
  as giving the right answers!
• Robert Half

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Questioning Clinical Practice

• How do your patients respond to interventions
  that you use?
• Are there alternative treatments you can think of
  that might have a better impact?
• Are there things that you find really
  dissatisfying about your practice?
• What things cause patients the most
  dissatisfaction?

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Questioning Clinical Practice

• Consider research taking place in other clinical
  practice settings
• Look to the Centers for Evidence-Based Practice
  that exist around the world
• Germany, New Zealand, Australia, United Kingdom,
  United States, Canada

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Adopting Practice Change

• Critique and synthesize research studies and
  evidence-based clinical practice guidelines
• Decide whether or not findings should be
  implemented into practice in your setting, given
  your organizations resources and patient
  population

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Adopting Practice Change

• Consider
• How relevant is the research to practice?
• Are the findings consistent across studies?
• Are there adequate studies and/or sample sizes to
  make the findings meaningful?
• Is this change practical for your setting?
• What is the risk of harm for the patients and how
  does that compare to the potential benefit for
  them?

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Developing EBP Protocols or Guidelines

• Protocols or Guidelines provide
• Comfort for practitioners that the practice
  changes are based on evidence versus opinion or
  cost factors
• The level of evidence available on the topic
• Guidance on how to implement the practice change,
  and what parts of that change are based on what
  level of evidence

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Implementing Practice Change

• Diffusion of an innovation
• Nature of the innovation
• Manner in which it is communicated to members of
  a social system (healthcare providers)
• Barriers include
• Conflicting research results
• Research reports that are hard to understand
• Lack of compilation of research evidence
• Lack of providers knowledgeable about research

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Changing Clinical Practice

• Results of 44 systematic reviews focused on the
  effectiveness of strategies to change practice of
  healthcare professionals
• Passive dissemination of research is ineffective
• Range of interventions found effective in
  changing behaviors
• Multifaceted interventions more likely to be
  effective than single intervention
• Individual provider beliefs, attitudes
  knowledge impact behaviors but organizational,
  economic and community environments are also
  important
• Diagnostic analysis should be done to identify
  barriers and supportive factors likely to
  influence proposed changes in practice
• Successful strategies to change practice need to
  be adequately resourced and require people with
  appropriate knowledge and skills

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Strategies for Changing Clinical Practice

• One-on-one sessions with health care educators
  and staff to explain desired change
• Manual computerized reminders to prompt
  behavior change
• Educational meetings or inservices requiring
  active participation of learners
• Audits feedback in which clinical performance
  is monitored through electronic database or chart
  review
• Direct observation and feedback

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Conclusions

• EBP is critical if we are to provide the best
  care at the right time and at the lowest cost
• Efficiency
• Effectiveness
• Best outcome