1 / 17

Supporting a Culture for Evidence Based Nursing Practice

Supporting a Culture for Evidence Based Nursing Practice. Adele Mattinat Spegman, PhD, RN Director, Institute on Nursing Excellence. HEAL. TEACH. DISCOVER. SERVE.

Ava
Download Presentation

Supporting a Culture for Evidence Based Nursing Practice

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Supporting a Culture for Evidence Based Nursing Practice Adele Mattinat Spegman, PhD, RN Director, Institute on Nursing Excellence HEAL. TEACH. DISCOVER. SERVE.

  2. Pravikoff DS, Tanner AB, Pierce ST. (2005). Readiness of U.S. Nurses for Evidence-Based Practice. American Journal of Nursing, 105 (9), 40-51. • 70% nurses in practice graduated prior to 1990 • RNs report lack of skills or resources to conduct searches • 76% respondents never searched CINAL; 58% never searched MEDLINE • 82% hadn’t used hospital library • 46% reported familiarity with term “EBP” GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  3. Misconceptions: Cookbook approach Limited ‘know how’ regarding EBP strategies Issues of time, access, workload Attitudes Skepticism & lack of self-efficacy Limited motivation Trust in traditional practices Lack of perceived reward Why does EBNP seem so hard to implement? GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  4. GMC’s approach to an EBNP educational program • The learning needs of GMC nurses reflect diversity of US nurse workforcePravikoff, Tanner, Pierce, (2005) • Encouraged, not mandatory • Accessible – on-line program • CEUs • Novice-to-expert approach • Modules transferred into resource: ppt → pdf • links to eJournals, eBooks GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  5. 3-Part Series • Introduction to EBNP • Definition & relevance • Using EBNP • Focus on 5 steps (identify, search, judge, implement, evaluate) • Detailed descriptions, examples, strategies • EBNP as template for research activities • Focus on research methods: designs, variables, data collection, analysis GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  6. What is EBNP? • EBP is the conscientious use of current best evidence in making decisions about patient care. (Sackett, Straus, Rickardson, Rosenberg & Haynes, 2000) • A 3-component approach to solving problems, all with equal importance: • Systematic search for and critical appraisal of most relevant evidence to answer a specific clinical question. • Clinical expertise (skills, experience, insight, experience, etc) • Patient/family preferences and values GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  7. Knowledge explosion Need for time-effective process to critique Focus on outcomes Consumer awareness Professional, federal, & regulatory pressures Professional responsibility Keeping pace with other professions Why is EBNP a priority? GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  8. How does EBNP differ from ‘traditional’ practices? • Evolution of ‘research utilization’ • RU: utilization focuses on a single study without inclusion of clinician expertise or pt/family value • By definition, EBP is broader in scope (multiple sources of evidence, clinical expertise, pt/family). • Extends the nursing process into the 21st century: critical thinking caring synthesis systematic evaluation clinical decision-making autonomous practice responsive to pt/family values & needs (Mallock & Porter-O’Grady, 2006) GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  9. Using EBNP • Asking answerable questions • Foreground, background, PICO format • Searching for the best available evidence • Mosby Nurse Consult, Ovid, PubMed, Internet • Primary/secondary sources, systematic reviews, review processes • Judging the evidence • Hierarchy of evidence! • Participants, sample size, inclusion/exclusion • Local applicability • Implementation and evaluation GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  10. Using EBNP • Asking answerable questions • Foreground, background, PICO format Question templates: Etiology: Are __ who have __ at __ risk for __ compared with ___? Prevention: For __ , does the use of __ reduce the future risk of __ compared with __? Meaning: How do __ diagnosed with __ perceive __? (Melnek & Fineout-Overholt, 2005, p. 31) http://www.uicomp.uic.edu/IntMedRes/teach/question.htm http://www.uicomp.uic.edu/IntMedRes/teach/question.htm http://www.nursingconsult.com/das/book/82671869-2/view/1323 http://www.nursingconsult.com/das/book/82671869-2/view/1323 http://http://www.nursingconsult.com/das/book/82946866-4/view/1323chapter 2, ‘background & foreground Qs’ GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  11. Using EBNP • Searching for the best available evidence • Mosby Nurse Consult, Ovid, PubMed, Internet • Primary/secondary sources, systematic reviews, review processes • Search strategies for OVID http://www.nursingconsult.com/das/book/82671869-2/view/1323 http://www.uicomp.uic.edu/IntMedRes/teach/srchovid.htm GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  12. EBNP resources on the Internet Academic Center for Evidence-Based PracticeThe University of Texas Health Science Center at San Antonio School of Nursing Evidence Based Public Health Nursing, UI at Chicago AHRQ: Agency for Healthcare Research and Quality Joanna Briggs Institute, Royal Adelaide Hospital, Australia Registered Nurses’ Association of OntarioNursing Best Practice Guidelines Western Australia Centre for EBN and Midwifery (systematic reviews & best practices) GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  13. Evidence-Based Nursing Journals CJNR - Canadian J of Nursing Research http://www.biomedcentral.com/bmcnurs/ Evidence-based Child Health: A Cochran Review Journal (GMC-HSL) 03/01/06 to present Evidence-based nursing Evidence-based healthcare GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  14. Using EBNP http://www.nlm.nih.gov/nichsr/ihcm/hsrceval.html Judging the evidence • Hierarchy of evidence! • Participants, sample size, inclusion/exclusion • Local applicability • How is evidence rated? • What factors increase the strength – value – of researched evidence? • How strong are best practice guidelines? Aren’t best practices based on clinical evidence? • Implementation and evaluation GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  15. EBNP as template for research activities • Are the results valid? • Bias, confounding variables • How does the study design impact the value of the evidence? • What are the results? • Reliability issues: sample size, attrition • Inclusion, exclusion criteria • Statistical significance • Clinical significance • Will the results help locally? • Similarities of participants with pt/families • Research ‘control’ issues O’Rourke & Booth, 2000 GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  16. Thank you. GEISINGER HEAL. TEACH. DISCOVER. SERVE.

  17. Assess = describe/formulate problem Performance improvement audits = data collection Revising protocols, standards = intervention Evaluation of care = analysis Nursing scholarship = examinations of actual practice and current literature to support new understandings about nursing care. GEISINGER HEAL. TEACH. DISCOVER. SERVE.

More Related