NURS 6010 Research for Evidence-Based Practice
Evidence-Based Practice (EBP) is a thoughtful integration of the best available evidence, coupled with clinical expertise. As such it enables health practitioners of all varieties to address healthcare questions with an evaluative and qualitative approach. EBP allows the practitioner to assess current and past research, clinical guidelines, and other information resources in order to identify relevant literature while differentiating between high-quality and low-quality findings.NURS 6010 Research for Evidence-Based Practice
UNIT BACKGROUND:
Evidence based practices was founded by Dr.Ardice Cochrane , a British epidemiologist.Cochrane was a strong proponent using evidence from randomized clinical trials because he believed that this was the strongest evidence on which clinical practice division is to be based.NURS 6010 Research for Evidence-Based Practice
Evidence based health care practices are available for a number of conditions such as asthma,smoking cessation,heart failure and others.However these practices are not be implemented in care delivery and variation of practices[CMS,2008;Institute of medicine ,2001].Recent findings in the united states and Netherlands suggest that 30% to 40 % of patients are not receiving evidence based care,and 20% to30% of patients are receiving unneeded or potentially harmful care.
DEFINITION:
The most common definition of Evidence-Based Practice (EBP) is from Dr. David Sackett. EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett D, 1996) Muir Gray suggests that evidence based health care is:
“an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits the patient best”(Muir Gray, 1997)
PURPOSES
1. Evidence based practice is an approach which tries to specify the way in which professionals or other decision mkers should make decisions by identifying such evidence that there may be for a practice and rating it according to how scientifically sound it may be. 2. Its goal is to eliminate unsound or excessively risky practices in favour of those that have better outcomes. 3. Evidence based practices has contributed a lot towards better patient outcomes. 4. The ultimate goal of evidenced based nursing is to provide the highest quality and most cost-efficient nursing care possible. 5. The purpose of evidence based practice in nursing is mainly to improve the quality of nursing care.
For example: If you are caring for a child who was in a motor vehicle accident and sustained a severe head injury, would you want to know and use the effective ,empirically supported treatment established from randomized controlled trials to decrease his or her intracranial pressure?
If the answer is “yes“,the empirical evidences are essentially very important in most of the clinical decision-making situations. The goal of EBP is the integration of: (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver values to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve. Conceptually, the trilateral principles forming the bases for EBP can be represented through a simple figure:
STEPS OF EVIDENCED BASED PRACTICE :
Evidence based practice process involves 5 steps as:
1. Formulating a clear question based on a clinical problem 2. Literture review to search for the best available evidences 3. Evaluating and analyzing the strengths and weaknessof that evidence in terms of validity and genelisability 4. Implementing useful findings in clinical practice based lon valid evidence 5. Evaluating efficacy and performance of evidences through a process of self reflection , audit, or peer aseessment 1.Formulating a clear question based on a clinical problem:[ ASK the question ] The first step is to formulate a clear question based on clinical problems.Ideas come from different sources but are categorized in two areas: Problem focused triggers and Knowledgee focused triggers. Problem focused triggers are identified by healthcare staff through quality improvement,risk surveillance,benchmarking data,financial data, or recurrent clinical problems.Problem focused triggers could be clinical problems,or risk management issues.NURS 6010 Research for Evidence-Based Practice
Example:Increased incidence of deep vein thrombosis and pulmonary emboli in trauma and neurosurgical patients.Diagnosis and proper treatment of a DVT is a very important task for health care professionals and is meant to prevent pulmonary embolism.This is an example of an important re tht more research can be conducted to add into evidence –based practice. Knowledge focused triggers are created when health care staff read research, listen to scientific papers at research conferences.Knowledge based triggers could be new research findings that further enhance nursing ,or new practice guidelines. Example: Pain management .,prevention of skin breakdown , assessing placement of nasogastric tubes, and use of saline to maintain patency of arterial lines.
When selecting a question ,nurses should formulate questions that are likely to gain support from people within the organization.The priority of the question should be considered as well as the sevearity of the problem.Nurses should consider whether the topic would apply to many or few clinical areas.Also,the availability of the solid evidence should be considered.This will increase the staff willingness to implement into nursing practice.
When forming a clinical question the following should be considered:the disorder or disease of the patient, the intervention or finding being reviewed, possibly a comparison intervention and the outcome.An acronym used to remember this is called the PICO model.:
P-Who is the patient population?
I-What is the potential intervention or area of interest?
C-Is there a a comparison intervention or control group?
O-What is the desired outcome?
2.Literature review to search for the best available evidence :[ ACQUIRE the evidence ]NURS 6010 Research for Evidence-Based Practice
Once the topic is selected ,the research relevant to the topic must be reviewed . It is important that clinical studies , integrative literature reviewes , meta analysis, and well known and reliable existing evidence based practices guidelines are accessed in the literature retrieval process .The article can be loaded with optionated nd or biased statements that would clearly taint the findings, thus lowering the credibility and quality of article.Time management is crucial to information retrieval.To maintain high standards for evidence based practice implementation, education in research review is necessary to distinguish good research from poorly conducted research.it is important to review the current materials.Once the literature is located, it is helpful to classify the articles either conceptual or data-based.Before reading and critiquing the research ,it is useful to read theoretical and clinical articles to have a broad view of the nature of the topic and related concepts , and to then review existing evidence based practice guidelines. 3. Evaluating and analyzing the strengths and weakness of that evidence in terms of validity and generalisability: [APPRAISE the evidence]
Use of rating systems to determine the quality of the research is crucial to the development of evidence based practice. Once you have found some potentially useful evidence it must be critically appraised to determine its validity and find out whether it will indeed answer your question. When appraising the evidence the main questions to ask, therefore, are: Can the evidence (e.g. the results of the research study) be trusted? What does the evidence mean?
Does this answer my question?
Is it relevant to my practice?
Different appraisal and interpreting skills must be used depending on the kind of evidence being considered. Additionally, guidance and training on appraising different types of evidence are available from some of the websites listed on the Useful Internet Resources. 4.Implimenting useful findings in clinical practice based on valid evidence :Evidence is used alongside clinical expertise and the patient’s perspectives to plan care:[ APPLY:talk with the patient ]
After determining the internal and external validity of the study ,a decisions is arrived at whether the information gathered does apply to your initial question.It is important to address questions related to diagnosis ,therpy ,harm, and prognosis. Once you have concluded that the evidence is of sound quality, you will need to draw on your own expertise, experience and knowledge of your unique patient and clinical setting. This will help you to decide whether the evidence should be incorporated into your clinical practice.NURS 6010 Research for Evidence-Based Practice
You must consider both the benefits and risks of implementing the change, as well as the benefits and risks of excluding any alternatives. This decision should be made in collaboration with your patient, and in consultation with your manager or multidisciplinary team where appropriate.The information gathered should be interpreted according to many criteria and should always be shared with other nurses . 5.Evaluating efficacy and performance of evidences through a process of self reflection ,audit , or peer assessment: [self-evaluation ]
Finally after implementation of the useful findings for the clinical practices;efficacy and performance is evaluated through process of self reflection ,internal or external audit or peer assessment.Part of the evaluation process involves following upto determine if your actions or decisions achieved the desired outcome.NURS 6010 Research for Evidence-Based Practice