Evidence-based neonatal nursing care

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Evidence-based neonatal nursing care

• Trish McInerney, PhD
• University of the Witwatersrand
• Straight From The Heart Bettering Our Best and
  Beating the Odds
• October 2008
• Durban

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This presentation will attempt to answer the
following questions

• What is evidence based practice?
• Joanna Briggs Institute
• JBI model of EBP and the neonatal node
• Some evidence relating to neonatal care

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What does evidence-based practice mean to you?
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Perhaps I could ask this question another way
Why do you do things the way you do?
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In asking you why you do things the way you do
I could guess at a few of your responses!
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Because

• That was how I was taught how long ago was
  that?
• Because that is the policy in this hospital /
  clinic who made that policy decision? And on
  what information was it based?
• That is the way Ive always done it! have you
  thought about what youre doing? Could it be done
  better?

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Evidence based practice and evidence based health
care, have their origins in evidence based
medicine
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Evidence-based medicine is the conscientious,
explicit and judicious use of current best
evidence in making decisions about the care of
individual patients. David Sackett et
al (1996)
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The randomised controlled trial approach to EBP
has severe limitations when we try to apply it to
nursing and midwifery.
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Today, there is a much broader perspective taken
of evidence. Evidence does not only come from
RCTs!It is more than effectiveness that
drives our clinical decision making!
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Need for evidence

• Health professionals seek evidence to
  substantiate the worth of a wide range of
  activities and interventions
• This means that the type of evidence we need
  depends on the activity and its purpose

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• Five types of evidence
• Evidence of feasibility
• Evidence of appropriateness
• Evidence of meaningfulness
• Evidence of effectiveness
• Economic evidence

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Example of feasibility

• By feasibility we mean the extent to which an
  activity is practical.
• What factors impact on the success or failure of
  introducing evidence-based practice in a neonatal
  care unit?

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Example of appropriateness

• This is the extent to which an activity is
  ethical or apt for that culture.
• Is it appropriate to expect fathers to take an
  active role in caregiving in neonatal units in
  Africa?

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Example of meaningfulness

• Refers to the personal experiences, opinions,
  values, thoughts, beliefs and interpretations of
  clients.
• What are parents experiences of being told that
  their preterm baby has severe abnormalities?

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Example of effectiveness

• This refers to cause and effect
• What effect does prone positioning of the neonate
  have on sudden infant death syndrome?

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Example of economic evidence

• There are a number of different study types
  relating to economics. These are
• Cost description evaluations
• Cost minimisation evaluations
• Cost effectiveness evaluations
• Cost utility evaluations
• Cost-benefit evaluations

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Implementing EBP

• Implementation may be in the form of clinical
  practice guidelines practical procedures
• Policies
• JBI CONnect Neonatal Node

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Some current evidence in infant care - from
systematic reviews

• The effectiveness of interventions for infant
  colic
• Possibly useful
• Dietary interventions, eg low allergen diet for
  B/F mother, low allergen formula milk
  behavioural interventions, eg reduced stimulation
  (Grade B)
• No effect
• Pharmaceutical interventions, dietary
  interventions soy substitute formula milk
  behavioural interventions increased carrying
  (Grade B)
• Possibly harmful (Grade A)
• Dietary intervention herbal tea

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Current evidence (cont)

• Management of asymptomatic hypoglycaemia in
  healthy term neonates
• Early and exclusive B/F is safe to meet the
  nutritional needs of healthy term newborns
  worldwide (Grade A)
• Healthy term newborns that are B/F on demand need
  not have their blood glucose routinely checked
  and need no supplementary foods or fluids (Grade
  A)
• Maintenance of normal body temperature in
  addition to B/F is necessary to prevent
  hypoglycaemia (Grade A)

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Current evidence (cont)

• Early childhood pacifier use in relation to B/F,
  SIDS, infection and dental malocclusion
• As B/F confers an important advantage on all
  children and the incidence of SIDS is very low,
  it is recommended that health professionals
  generally advise parents against pacifier use,
  while taking into account individual
  circumstances (Grade B)

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Grades of evidence

• Grade A effectiveness established to a degree
  that merits application
• Grade B effectiveness established to a degree
  that suggests application
• Grade C effectiveness established to a degree
  that warrants consideration of applying the
  findings
• Grade D effectiveness established to a limited
  degree
• Grade E effectiveness not established

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Systematic reviews currently being undertaken

• Suctioning children with an artificial airway in
  a healthcare setting a systematic review
• A systematic review of positioning of preterm
  infants for optimal physiological development

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Current SRs (cont)

• Neonatal hypoglycaemia - the diagnostic accuracy
  of point-of-care testing methods

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Evidence sources

• Cochrane Library www.cochranelibrary.com
• Joanna Briggs Institute www.joannabriggs.edu.au
• DARE (Database of Abstracts of Reviews of
  Effectiveness) - www.york.ac.uk/inst/crd/
• NHS Centre for reviews and dissemination
  (University of York)
• Agency for Healthcare Research and Quality (AHRQ)