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Evidence-Based Nursing Part Two . Integrating EBP Knowledge into Clinical Practice. Four Tools for Integration . Iowa Model for Evidence-Based Practice Journal clubs Critical Appraisal of Topics Clinical Audit. Iowa Model for EBP. Highlights of the Model .
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Evidence-Based Nursing Part Two Integrating EBP Knowledge into Clinical Practice
Four Tools for Integration • Iowa Model for Evidence-Based Practice • Journal clubs • Critical Appraisal of Topics • Clinical Audit
Highlights of the Model • Triggers: Problem-based and Knowledge-based • Organizational Priorities • Sufficiency of the Research Base • Appropriateness of change for the patient population/organization • Continuous feedback loops
Problem focused Risk management data Process improvement data Internal / external benchmarking data Financial data Identification of clinical problem (first and last are original) Knowledge focused New research or other literature Nat’l Agencies or Organizational standards Philosophies of care Questions from Institutional Standards Committee (first is new) Triggers
If Yes then…. • Form a team • Assemble relevant research & related literature • Critique and synthesize research for use in practice • Sufficient research to guide practice? (“no” is not a stopping point) • Develop a guideline or standard of practice • Pilot change in practice / is change appropriate? • Monitor process and outcome data / share results
Journal clubs • Teaching-based: emphasis on skill building, such as honing searching skills • Topic-based: often focused on critical appraisal • EBP skills-based: participants go through each step of EBP process • Can be nursing staff only or multidisciplinary • All clubs need a clinically meaningful context for their topics!
Critical Appraisal of Topics (CATS) • Assess the quality of a single study • Can results be applied to your patients?
Critical Appraisal of Topics • National Guideline Clearinghouse http://www.guideline.gov • Journals such as Evidence Based Nursing • EBM Tools at Centre for Evidence-based Medicine site http://www.cebm.net
Clinical Audit Examine your care practices and compare your results with clinical guidelines or best practice statements • Define best practice • Measure and compare • Act to achieve change
Audit Cycle (simplified) Defining quality Take action to improve Measuring and comparing
Reilly, L et al. “Reducing Foley Catheter Device Days in an Intensive Care Unit: Using the Evidence to Change Practice.” AACN Advanced Critical Care 17(3):272-83
Method Smackdown • Discuss strengths and weaknesses of each method/approach to integrating EBP • Best area(s) for application of a method? Image courtesy WWE
Method Review • Iowa Model for Evidence-Based Practice • Journal clubs • Critical Appraisal of Topics • Clinical Audit • Strengths and weaknesses • Best time/place for application