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Chapter 5

Chapter 5. Evidence-Based Practice. Evidence-Based Practice. Evidence originates from research findings Applied to practice Evidence-based practice decisions involve Clinician Convincing body of evidence Patient preferences and values. Key Steps in Implementing Evidence-Based Practice.

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Chapter 5

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  1. Chapter 5 Evidence-Based Practice

  2. Evidence-Based Practice • Evidence originates from research findings • Applied to practice • Evidence-based practice decisions involve • Clinician • Convincing body of evidence • Patient preferences and values

  3. Key Steps in Implementing Evidence-Based Practice Ask the burning clinical questions. Collect the most relevant and best evidence from a review of the literature, including published literature reviews, meta-analyses, and clinical practice guidelines. Critically appraise the evidence. Integrate all evidence with one’s clinical expertise, patient preferences, and values in making a practice decision or change. Evaluate the change in outcomes after implementing into practice. Source: Adapted from Melnyk, BM, and Fineout-Overholt, E: Evidence-based practice in nursing and healthcare: A guide to best practice. Lippincott, Philadelphia, 2005. Box 1.1, p 9.

  4. Strategy for Point-of-Care Evidence-Based Practice • Based on knowledge of research and evaluation • Ask the question • Resources readily available • Search the resources • Examine the results • Apply findings to the individual patient • “Evidence does not make decisions”—Strauss

  5. Aims of Nursing Research for Clinical Practice • Systematic pursuit of knowledge to answer questions of import • Develop scientific basis of nursing • Develop understanding and utilization of research by nurses at all levels of practice • Ask and answer the question based on how the findings will be used • Studies of the understanding of the human experience of health

  6. Applying Research-Based Evidence to Clinical Practice Informed Practice • Clinical practice guidelines • Practice policies • Recommendations for diagnosis and treatment at national and local levels • Intent to improve decision making for more reliable outcomes

  7. Applying Research-Based Evidence to Clinical Practice (cont’d) Practice standards and guidelines • Standards relate to a framework for practice • Inflexible • Intended for use in all circumstances • Guidelines focus on individual patient care decisions • Provide a reference point and general direction for decision making • Deviation only with a clear rationale for an individual

  8. Applying Research-Based Evidence to Clinical Practice (cont’d) Process to design guidelines • Traditional approach • Common practice is correct practice • Appropriate in the past—fewer diagnostic tests or interventions • Today’s approach • Developed from scientific evidence • Framework for creation of guidelines

  9. Applying Research-Based Evidenceto Clinical Practice (cont’d) Agency for Healthcare Research and Quality • Lead the way for EBP • Mission of AHRQ • Improve quality, safety, efficiency, and effectiveness of health care for all Americans • Guideline use • Reference for health-care providers • Framework for insurance utilization review • Quality assurance and reimbursement • Influencing malpractice litigation outcomes

  10. Applying Research-Based Evidenceto Clinical Practice (cont’d) Implementing AHRQ Guidelines • Overcoming barriers • Evidence based practice centers—private-public partnership • Produce evidence on topics from providers • Provide evidence for use in guidelines • National Guideline Clearinghouse • Electronic repository for guidelines • Research and evaluation activities to develop guidelines, implementation strategies, and outcome-based research

  11. Development of Evidence-Based Practice Guidelines Essential elements • Identification of the topic • Expert panel • Systematic review of the literature—with rating of literature • Development of evidence-based tables • Draft of recommendations based on the evidence • External review of recommendations • Final acceptance of the revised recommendation

  12. Utilization of Guidelines A provider should ask: • Who created the guideline? • What date is the revision? • Is the guideline clinically important? • How strong are the recommendations? • How strong is the available evidence? • Is the guideline applicable to my patient?

  13. Using a Framework to Evaluate Health Science Literature Evaluating the evidence to change practice • Look at the title—does it reflect your interest? • Read the abstract to validate the article is relevant • Evaluate and determine • What is being studied • Who is being studied • Type of study design • How data were analyzed • Evaluate what you have determined at this point • Discuss your evaluation with colleagues and seek other opinions

  14. Building the Evidence for Practice • National Institute for Nursing Research • Aligned nursing science with other institutes in NIH • Increased federal funding for nursing research • Many methods of knowing • Combination of methods

  15. Clinical Decision Making and the Patient’s Health-Care Decisions • First, determine the outcome the patient is desiring • Collect and analyze evidence • Make a judgment on intervention ability for health outcome desired by the patient

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