What is EBP?
What is it combine with to solve clinical problems?
- EBP : uses research to augment nursing practice
- combine with clinical expertise, pt preferences, and local circumstance –> req lots of imputes from lots of ppl
What is research utilization?
- simpler than EBP –> using research in a practical application
- how research knowledge can be put to use in a clinical setting
Looking for evidence that suggest the best approach from solving a clinical problem –> EBP or utilization research?
- EBP
What is cochrane collaborations?
the idea that research summaries should be available for quick access –> systematic reviews
What are some barriers to implementing EBP?
- intervention needs to be tested on a small scale in a specific env first –> then needs to be repeated in different envs with a larger sample size –> difficult to study in enough different env to provide sufficient evidence
- need to communicate findings –> getting published in a journal is helpful but how many people read them?
- some nurses do not want to change their practice, or have access to new research
- organizations barriers : unit culture, inadequate leadership, financial and staff limitations
- new interventions may require time, training or new equipment that may not be allocated
When looking at the pyramid of evidence hierarchy ( intervention bases research) what is considered the highest level of evidence and why?
- systematic reviews : it combines the results from lower levels of research in the pyramid
What is a meta-analysis?
- statistically integrate quantitative research findings –> data from multiple studies are analyzed
- unit of analysis = individual studies
What is a meta-synthesis?
- integrates and interprets findings from multiple qualitative studies
What are clinical practice guidelines?
How are they generated?
Are these guidelines considered research? why?
- a set of recommendations developed by a panel of experts
- use systematic reviews to generate recommendations
- considered non-research based evidence –> not preforming a study or generating evidence
What are care bundles?
multiple interventions geared towards preventing a problem
How are clinical practice guideline appraised?
AGREE and AGREE II instruments
What is PICO?
What dies it stand for?
What is the format for a PICO question?
- a format for organizing an EBP project
- P : population or pts
- I : intervention, influence, or exposure
- C : comparison or current practice
- O : outcome
- In ___ (Population), what is the effect of ___ (intervention), in comparison to __ (comparison), on ___ (outcome)?
New grad nurses report feeling uncomfortable and unprepared in spacing with pts about end of life care. Currently nursing programs discuss end of life care, and hospital orientation includes a small discussion of the topic.
- how would this situation be evaluated using PICO?
In new grad nurses (P), what is the effect of simulation (I), in comparison to educational models (C), no the knowledge and comfort with discussing end of life care with patients
What 6 facts are considered in evidence appraisal?
- evidence quality
- magnitude of effects
- precision of estimates : how precise are the results
- peripheral effects : other SE or benefits
- financial costs
- clinical relevance
How does a nurse influence EBP in their hospital? (5 steps)
- nurse presents a problem and evidence to a council or team
- the team will “buy-in” to the idea and find research to eval themselves
- the team take the problem and evidence to administration
- small pilot test in the hospital
- if everything goes well it can be adopted (can take months)
When considering the implementation potential what things should you consider?
- is the intervention appropriate to the practice setting
- is it feasible to implement the intervention
- what is the cost benefit ratio
How is quality improvement different from a formal research study?
- improve a healthcare problem internally with generating knowledge that can be applied outside the specific situation = non research based studies
What are the 6 factors in quality improvement?
- intervention changes or modifies as needed : until the problem is considered addressed
- goal is to effect immediate improvement
- necessary activity of a healthcare institution
- dose not require a lit review
- internally funded
QI is an assessment of a pt care problem for the purpose of improving pt care through these 4 steps
- peer analysis
- intervention
- resolution of the problem
- follow up
