Chapter 5: Evidence-Based Practice

Question 1

Evidenced Based Practice

Answer 1

a systematic, problem solving approach that:

• integrates best evidence
• uses clinical expertise & experience
• includes patient preferences and values

Question 2

What are the steps of Evidenced-Based Practice (EBP)

Answer 2

1. ask a clinical question in PICOT format
2. collect the most relevant & best evidence
3. critically appraise the evidence you gather
4. integrate all evidence utilizing clinical expertise, patient preferences and values in making a decision of change.
5. evaluate the outcomes of the practice decision or change
6. share the outcomes of EBP changes with others

Question 3

Step 1: Ask a Clinical Question

Answer 3

P: What is the patient population are you interested in?
I: What is the intervention of interest?
C: What are you trying to compare
O: What outcome are you trying to measure?
T: What is the time frame?

Question 4

Step 2: Collect the most relevant and best evidence

Answer 4

• use your PICOT question to expeditiously access info/peer reviewed articles.
• search data base

Question 5

Hierarchy of Evidence

Answer 5

….

Question 6

Step 3: Critically appraise the evidence you gather

Answer 6

Evaluate: scientific merit, clinical applicability, and study limitations.

Question 7

What are the elements of EBP articles?

Answer 7

1. abstract
2. introduction
3. literature review
4. manuscript narrative
5. methods or designs
6. results and conclusions
7. clinical implications

Question 8

manuscript narrative

Answer 8

the body of the article.

a. purpose statement
b. hypotheses
c. variables

Question 9

Step 4: Integrate all evidence utilizing clinical expertise, patient preferences and values

Answer 9

• apply the research to your plan of care

- integrate evidence

Question 10

Apply the research to your plan of care by asking yourself

Answer 10

• Does the practice change fit with scope of practice?
• Are the necessary resources available?
• Is a pilot study necessary?
• Who are the major stakeholders?

Question 11

Integrate evidence through:

Answer 11

• teaching tools
• clinical practice guidelines
• policies and procedures
• assessment or documentation of tools

Question 12

Step 5: Evaluate the practice decision or change

Answer 12

• How is the clinical practice change working?
• How effective was the change?
• Do modifications need to be made?
• Will this change be sustainable?

Question 13

Step 6: Share the outcomes of EBP changes with others

Answer 13

• communicate the results
• sustainability more likely when: value is seen by the change, clinical staff “buys in” to the change, and clinical staff is allowed input in the process.

Question 14

Outcomes Research

Answer 14

• focuses on benefits, risks, costs and holistic effects of a treatment on patients.
• helps make informed decisions on the basis of current evidence: justifies care practices and systems in terms of improved patient outcomes and costs.

Question 15

Outcomes:

Answer 15

observable or measurable effects of an intervention or action

Question 16

Focus of outcomes is

Answer 16

recipient of care

Question 17

Scientific Method

Answer 17

• foundation of research; most reliable/objective
• systematic, step-by-step process
• minimizes bias or opinion by the researcher
• verifies findings from a study are: valid, reliable, generalizable to similar subjects researched.

Question 18

Characteristics of scientific research

Answer 18

• Identifies the problem area of interest.
• Research is conducted in a systematic and orderly way.
• Researchers try to control external factors.
• Researchers gather empirical data through observations and assessments.
• Ultimate goal is to understand phenomena and applicability to a broad group of patients.

Question 19

Quantitative Research

Answer 19

Precise measurement and quantification

Question 20

Quantitative Research focus on

Answer 20

• Numerical data
• Statistical analysis
• Controls to eliminate bias in findings.
• Precise
• Systematic
• Objective

Question 21

Experimental Research

Answer 21

tightly controls conditions to eliminate bias

Question 22

Nonexperimental Research

Answer 22

describe, explain, or predict phenomena

Question 23

Surveys

Answer 23

measure practices, perceptions, education, experience, opinions, and other characteristics of people

Question 24

Evaluation research

Answer 24

determines how well a program, practice, procedure, or policy is working

Question 25

Qualitative Research

Answer 25

- study of phenomena that are difficulty to quantify or categorize such as patient perception of illness - requires inductive reasoning

Question 26

Qualitative Research is obtained in

Answer 26

non-numerical form. ex) written transcripts, interviews and story telling

Question 27

Qualitative Research Methods include:

Answer 27

ethnography, phenomenology, grounded theory

Question 28

ethnography

Answer 28

explores cultural phenomena

Question 29

phenomenology

Answer 29

explores structures of subjective experiences and consciousness

Question 30

grounded theory

Answer 30

discovery of theory through analysis data

Question 31

Nursing Process Compare to Research Process

Answer 31

1. Assess vs Identify an area of interest 2. Diagnose vs Develop research questions 3. Plan vs Determine how the study will be conducted 4. Implement vs Conduce the study 5. Evaluate vs Analyze the results

Question 32

Testing on Human Subjects: The Right of Informed Consent

Answer 32

1. subjects are given full and complete information including potential harm, benefits and alternative methods of treatments. 2. subjects must be fully capable of understanding the research and its implications. 3. subjects have the power of free choice to voluntarily consent or decline participation. 4. subjects must understand how the researcher maintains confidentiality or anonymity.

Question 33

The Belmont Report of 1979: Outline fundamental ethical principles for using any human subject for research including:

Answer 33

1. respect for persons: protecting autonomy 2. beneficence: benefit 3. non maleficence 4. justice: non-exploitive, well-considered procedures

Question 34

Focus of outcomes management to

Answer 34

increase patient safety and decrease medical errors. includes: - fall rates - number of medication errors - incidence of pressure ulcers - infection rates

Question 35

Quality improvement

Answer 35

improvement of health care related processes such as fall prevention

Question 36

Performance improvement

Answer 36

Focused improvement actions, clinical projects in response to problems such as identifying patients at risk for falls and implementing a fall prevention protocol (yellow gown, signage etc...)

Question 37

all members of the health care team collaborate in QI activities for

Answer 37

recognizing trends, identifying recurrent problems and initiating opportunities to improve

Question 38

QI issues to consider:

Answer 38

- high-risk/high volume - high-risk/low volume - potential problems (for patients, staff and institution)

Question 39

High risk/high volume

Answer 39

- potential for injury or death | - may be initiated secondary to a sentinel event.

Question 40

sentinel event

Answer 40

involving death, serious physical or psychological injury

Question 41

national patient safety goals purpose

Answer 41

is to improve patient safety. | Goals focus on problems in health care safety and how to solve them.

Question 42

benefits of joint commision

Answer 42

....

Question 43

Quality Improvement Models

Answer 43

- Six Sigma or Lean | - Rapid Cycle Improvement

Question 44

Six Sigma or Lean

Answer 44

"bottom up approach" All members of the health care team are responsible for developing and integrating changes utilizing the fewest resources to reduce costs, enhance quality and improve teamwork.

Question 45

Rapid Cycle Improvement

Answer 45

A response to a serious problem. Radical changes made in a short period of time.

Question 46

QI Sustainability: Communication

Answer 46

ultimately sustainability will not take place without by-in from the end user

Question 47

QI Sustainability: Communication

Answer 47

Must establish value in the change Must utilize stake-holders input and suggestions/ideas Must communicate results and report findings of of interventions Must revisit interventions and analyze successes/potentials for improvement Must utilize statistical data and sound evidence to measure the need for change and the resulting improvements