What is Nursing Practice

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What is Nursing Practice??

• Critical thinking
• Evidence Based Practice (EBP)

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EVIDENCE-BASED NURSING PRACTICE

• AcknowledgmentDonna Ciliska, RN, PHD
• February 6, 2002
• Linda Patrick

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Objectives of Presentation

• To define evidence-based practice
• To define use of evidence in nursing and health
  care
• Application

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Evidence-Based Practice

• the explicit, judicious and conscientious use
  of current best evidence from health care
  research in making decisions about the health
  care of individuals and populations
• Sackett

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New York Times

• The Year in Ideas 2001
• the process of examining beliefs that have been
  based primarily on teaching and experience,
  rather than evidence has been compared to
  stripping the curtain away from the Wizard of Oz
  to reveal an ordinary man.

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What EBP is

• Evidence-based practice is an approach to health
  care wherein health professionals use the best
  evidence possible, i.e. the most appropriate
  information available, to make clinical decisions
  for individual patients, EBP values, enhances and
  builds on clinical expertise, knowledge of
  disease mechanisms, and pathophysiology.

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What EBP is continued

• It involves complex and conscientious decision
  making based not only on the available evidence
  but also on patient characteristics, situations,
  and preferences.
• It recognizes that health care is individualized
  and ever changing and involves uncertainties and
  probabilities.
• Ultimately EBP is the formalization of the care
  process that the best clinicians have practices
  for generations. (McKibbon, 1998)

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National Health Forum (1997)

• a key objective for the health sector should be
  to move rapidly toward the development of an
  evidence-based health system, in which decisions
  are made by health care providers,
  administrators, policy makers, patients and the
  public on the basis of appropriate, balanced and
  high quality evidence

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Netherlands 2002

• Health care practitioners must show how their
  practice is evidence-based to maintain their
  right to practice
• Health professional school curricula have to be
  evidence-based and teach EBP in order to achieve
  accreditation.

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Remember Evidence-Based Decisions
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Why Bother with Evidence- Based Practice?

• Improve patient behaviours
• Improve patient knowledge
• Improve physiologic parameters
• Improve psychosocial parameters
• Reduced costs
• (Heater et al, 1988)

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Research Evidence

• Formulate an answerable question
• Conduct an efficient literature search
• Critically appraise the evidence
• Apply the results in health care decisions
• Evaluate the outcome

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1. FORMULATE AN ANSWERABLE QUESTION

• P
• I
• C
• O

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2. CONDUCT AN EFFICIENT LITERATURE SEARCH

• identify search terms
• identify appropriate data bases
• start broad or narrow?

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What is Literature

• Systematic Reviews
• Qualitative Studies
• Quantitative Studies
• Opinion Pieces and others

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Systematic Reviews

• Systematic consolidation of the literature on
• a specific topic
• Comprehensive identification of studies
• Review of study relevance
• Evaluation of methodological quality
• Extraction of data
• Analysis of data
• Drawing of conclusions

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Quantitative Studies

• Investigation of a research question that seeks
  to measure/quantify
• Attempt to control environment(variables)
• objective /concrete
• Use of statistical analysis
• Types
• Experimental/quasi experimental
• Descriptive
• Examplesgtgtgtgtgtgt

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Qualitative Studies

• Qualitative research focuses on experiences
• The goal is not to measure/ quantify/control
• Types
• Ethnography
• Phenomenology
• Grounded Theory
• Examplesgtgtgtgtgtgtgtgtgtgtgt

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Comments

• The research question determines the method
• No research is completely objective
• The importance of working with decision makers
• Not all research is good research

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3. CRITICAL APPRAISAL

• Are the results of the study valid?
• What were the results?
• Will the results help me?

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Validity Criteria

• Study Design
• Selection Bias
• Participation rate was 80 or greater of eligible
  participants.
• Confounders.
• Blinding

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4. APPLY THE RESULTS IN HEALTH CARE DECISIONS

• Applicability (what were the results can they
  help me????)
• Can I apply the findings of research done in
  other settings/ countries?
• Is the context similar to the area where I
  practice?
• Are the patients similar to my patient(s)

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Remember Evidence-Based Decisions
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Remember

• It is the clinical practitioner who establishes
  the relevance of the research evidence to a given
  context and validates the outcome of its
  application on a case-by-case basis (DeBourgh,
  2001).

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EVALUATE THE OUTCOME

• How does the RN evaluate outcomes???

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Recent Evidence-based Findings

• Compression treatment improved healing of venous
  leg ulcers
• Structured and individualized safety program
  reduced falls in nursing homes
• Nurse home visits reduced child abuse
• Nursing interventions increased smoking cessation
  rates in adults.

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Recent Evidence-Based Findings

• Support group reduced grief and distress in
  bereaved, homosexual men
• Education improved quality of life and lung
  function in patients with asthma
• Patient distress after radiotherapy to the head
  and neck was often hidden
• Long term dietary folate decreased risk of colon
  cancer in women

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Recent Evidence-Based Findings

• Early mobilization is better than bed rest for
  medical procedures and after health care
  procedures
• Adolescents identified many barriers to Pap
  screen
• Perceived breast milk inadequacy was related to
  sociocultural influences

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What are the Challenges for Clinicians?

• TIME
• ACCESS
• SKILL IN CRITICAL APPRAISAL
• LANGUAGE OF RESEARCH
• SENSE OF CONTROL OVER PRACTICE
• ENVIRONMENT/CULTURE

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OPPORTUNITIES

• Overcoming Challenges

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Bridging the Gap

• Practice guidelines
• Evidence based practice journals
• Systematic reviews (Cochrane)
• EBN-specific centres
• Other dissemination strategies
• information access- electronic journals

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NURSES OF 2010

• Work comfortably and competently with a variety
  of communication technologies telehealth,
  videohealth, email health
• Manage to keep CARING as part of their role
• Have kept consumer confidence and trust

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NURSES OF 2010

• Inquiring minds ask clinical questions
• Have easy access to information
• Evidence based resources at fingertips, wireless
  link to libraries, on-line resources in your
  field, ability to find the best information in 30
  seconds.
• Have critical appraisal skills, or use
  pre-appraised literature.

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NURSES OF 2010 (cont)

• Consider how the best research evidence fit with
  patient preference, own skills and resources
  available
• Apply evidence-based decision to practice
• Evaluate decision
• Tell others about what they did and how it
  worked!

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2010 Summary

• We use research evidence (quantitative and
  qualitative) in making decisions with patients
  about their care
• We are beyond the argument of doing EBP for
  saving money and do it because it involves the
  best care (within the resource context) for
  patients