Evidenced Based Practice; Systematic Reviews; Critiquing Research

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Evidenced Based Practice Systematic Reviews
Critiquing Research

• CNL Exam Review

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Evidence-Based Practice

• Conscientious integration of best research
  evidence with clinical expertise and patient
  values and needs in the delivery of high-quality,
  cost-effective health care
• Synthesis of knowledge for development of
  guidelines, standards, protocols, or policies to
  direct nursing interventions and practice

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Evidence-Based Practice

• Hospital Priorities
• Pressure Ulcers
• Falls
• Hospital Acquired Infections
• Reducing costs
• Improving patient and staff satisfaction
• Reducing errors
• communication

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Evidenced-Based Practice

• Masters prepared
• Innovators
• Early adopters
• Application
• Evaluate Merit
• Clinical Relevance
• Sufficiency of research base
• Pilot change
• Monitor Outcomes

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Creating an EBP Culture

• Value Reflection
• Develop rituals
• Ask why
• Is there evidence to support it?
• Is it best for patients?
• Are there better ways?
• Share concerns-multidisciplinary
• Gather information

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Intellectual Research Critique

• A careful examination of all aspects of a study
  to judge
• Merits
• Limitations
• Meaning
• Significance
• Bias

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Critique Skills

• Critical thinking
• Logical reasoning
• Knowledge of research methodology
• Attention to details
• Recognition of strengths and weaknesses

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Levels of Evidence
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Rigor in Random Control Studies

• P lt .05
• Sample size
• Reliability of measures
• Control confounding variables
• Replication

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Types of Systematic Reviews

• Meta-Analysis-random control trials
• Systematic Review-other quantitative studies
• narrative findings
• Meta-Synthesis
• Pitfalls
• Literature reviews

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Common Threads

• Problem Formation
• Clearly identified problem and variables
• Identified prior to searching the literature
• Inclusion and exclusion criteria
• Comprehensive Search
• Published and unpublished work
• Networking
• Conferences
• Dissertations
• Two independent selectors

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Common Threads (cont)

• Data Evaluation
• Primary studies evaluated for rigor
• Reliability and validity coding
• Two independent evaluators to establish
  inter-rater reliability
• Quality scores
• Data Analysis/Findings
• Thorough interpretation of studies
• Visual aides to describe studies
• Identification of potential threats and bias

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Systematic Review

• Summarize findings regarding a clinical problem
• Studies have related or identical hypotheses
• Quantitative designs
• Narrative findings

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Meta-Analysis

• Randomized control studies
• Testing interventions
• Studies have related or identical hypotheses
• Statistical Findings
• Measure the magnitude of a common effect
• Test for homogeneity
• Explain heterogeneity
• High level of evidence

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Meta-Synthesis

• Qualitative studies
• Related phenomena
• Develop theory
• Rigor
• Participants and/or primary authors agree with
  interpretations
• Used for enhancing the experience
• Moderate level of evidence

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Levels of Evidence