EBP and Research council June 1, 2011

1. EBP and Research councilJune 1, 2011 Getting ready for Magnet

2. What’s New with EBNP and Research UAB Research Day abstracts dueJune 8

3. What’s New with EBNP and Research Kristy Benefield and Marcia Lowe presented at NANN ConferenceMany UAB folks presented at FACES Any others?

4. Educational offerings

5. Evidence Based Practice WorkshopWPCC Room E • Sept 12, 8:00 am to 12:00 noon

6. How to do an Oral or Poster Presentation • Place: WPCC Room E • August 22, 9:00 am to 12:00 noon

7. Express Learning • Every 1st and 3rd Wednesday from 12 to 1pm

8. How to Publish • Place: WPCC Room B • June 6, 9:00 am to 12:00 noon

9. Nursing research Workshop • Total number of participants per workshop: 60 • Place: WPCC Room E • Date: October 17, 9:00 am to 12:00 noon

10. EBP and Research Day • September 9, 2011 • MCSA

11. IRB Training Let’s take the Training Challenge! You can do at work or at home. Go to UAB Homepage (One) Click on Directories and resources Click on UAB Research Click on Institutional Review Board for Human Subjects (bottom) Click on Forms Choose CITI, (if this is first time) Choose Renewal (if need to update)

12. Council Member Highlight Kristy Benefield Kristy has been working at UAB for 19 years. She is an associate degree nurse and certified neonatal ICU nurse. She serves as the Women's services bereavement coordinator. Research interest's are perinatal bereavement and psycho social issues that effect nurses and lead to compassion fatigue. My poster is titled Regional Newborn Intensive Care: Coping Strategies of Nurses. This is a qualitative study that examines coping strategies that are utilized by RNICU nurses when a patient dies and the adequacy of available institutional support. One thing she can’t do without is her family including my four greyhounds!!!

13. CAP Presentations Marie Toffel Lauran Riker

14. Getting Ready for Magnet

15. What We Learned from…Magnet CarnivalMagnet Mock Visit

16. EBP and Research Booth • Booth during Magnet Carnival on May 4 • Most nurses visiting the booth could not state the definition of EBP and the EBP Process • Most did not know we have an EBP and Research Council

17. Let’s Intervene • Give this one page to one nurse one your unit

18. Magnet Mock Visit:What we Learned • Need examples of EBP • Don’t mix up EBP and Research • Examples of how EBP and Research are translated into practice • What are the outcomes • What resources do we have for staff • Each unit needs a EBP bulletin board

19. What are the Purposes of the Council • To Serve as a Resource for nurses interested in evidence based practice and research • To be a direct link to the Center for Nursing Excellence • To provide opportunities that promote Evidence Based Nursing Practice and Research at University Hospital

20. Goals of the Council • To provide opportunities that promote Evidence Based Nursing Practice and Research at University Hospital • To help to meet our state and national presence goal • Publications • Presentations • Projects

21. What Education or Training is available for EBP or Nursing Research? • Workshops • Online Website • Research Day • Online IRB training • Council Meetings • Grand Rounds • Mentorship Program

22. How do you share Information about this council with others? • Website • Email • Verbal • Brochure • Research Day

23. What made you be part of this council?

24. What We Need to Know • All nurses understand the distinctions between quality improvement, evidence based practice, and nursing research. • Nursing practice reflects the outcomes of quality improvement, evidence based practice, and nursing research. • Staff nurses on all shifts can articulate their own understanding of the sources of evidence (Provide Examples) across the organization as they relate to their practice and/or patient care.

25. Evidence-based nursing practice The process by which nurses make clinical decisions using: • the best available research evidence, • their clinical expertise, and • patient preferences.

26. 5 Steps of Evidence Based Practice • Ask the “burning” question • Collect the most relevant and best evidence. • Critically appraise the evidence • Integratethe information to make a practice decision or change • Best evidence, clinical experience, patient preferences, values • Evaluatethe practice decision or change.

27. What is Best Practice for___________________________? EBP Question in PICO (T) Format___________________ ______________________________________________ What does the Literature Say? Critically Appraise the Literature. Implement Practice Change: Evaluate Practice Change:

28. Know your Evidence

29. Types of Studies • Evidence Pyramid • The base: idea or laboratory research • The top: thorough examination of valid studies on a topic • As you move up the pyramid, the amount of available literature decreases, but increase in relevance to clinical setting

30. A Way to Look at this Data • Look at the Study

31. Testable Hypotheses? • Lung cancer is associated with cigarette smoking • Smokers have more lung cancer than non-smokers • Smoking causes lung cancer

32. Statistical Hypotheses • H0: There is no association between number of years of smoking and presence of lung cancer vs • HA: There is association between the number of years of smoking and presence of lung cancer

33. Strength of Evidence: A key issue • In considering different designs for a study to be undertaken • In interpreting the outcome of studies already done.

34. β-Carotene and Lung Cancer in Smokers • Several observational studies have shown a strong relationship between higher blood levels of β-carotene and lower lung cancer risk among smokers. • Is this sufficient reason to encourage smokers to take vitamins to enhance their blood levels of β-carotene?

35. Observational Studies • An observational study is a study in which a researcher simply observes behavior in a systematic manner without influencing or interfering with the behavior.

36. Cohort Studies • Several cohort studies have shown a strong relationship between between higher blood levels of β-carotene and lower lung cancer risk among smokers. • Is this additional information sufficient reason to encourage smokers to take vitamins to enhance their blood levels of β-carotene?

37. Cohort Study • A longitudinal study of the same group of people (the cohort) over time. Usually the members of a cohort are of approximately the same age — for example, all those with 21st birthdays during the year 2000.

38. Clinical Trial • A large long-term clinical trial compared 30 mg/day of β-carotene + 25,000 IU/day retinylpalmitate to placebo for lung cancer incidence among smokers [NEJM (334:1150-1155 May 2, 1996)].

39. β-carotene/retinylpalmitate Arm • Participants in the β-carotene/retinyl palmitate arm with higher blood levels of β-carotene had lower lung cancer incidence. • Is this additional information sufficient reason to encourage smokers to take vitamins to enhance their blood levels of β-carotene ?

40. Placebo Arm • Participants in the placebo arm with higher blood levels of β-carotene had lower lung cancer incidence. • Is this sufficient reason to encourage smokers to take vitamins to enhance their blood levels of β-carotene?

41. What is Critical Question? What else do we need to Know? • How did the β-carotene/retinyl palmitate arm compare to the Placebo arm?

42. CARET Results • Participants in the β-carotene/retinyl palmitate arm, after five to eight years, had: • 28% higher lung cancer incidence, • 17% higher total mortality, • 26% higher cardiovascular mortality.

43. Essence of a Clinical Trial • The Essence of a Clinical Trial is that it be a Fair Test

44. Level of Evidence Rating Scale

45. Examples of EBP in our Practice • Use of bundles help decrease line infections • Journal clubs help increase nurse knowledge • Best practice in measuring central venous pressures • What is best practice for…… • Tracheostomy care • Changing an IV dressing • Preventing central venous catheter infections • Preventing pressure ulcers • Listening to bowel sounds • Changing a LVAD dressing • Discharging a patient

46. What We Need to Know • The organization contributes to one or more nationally benchmarked (at the unit level) databases. • There are action plans for nurse sensitive clinical indicators that are below the benchmarked midpoint. • There are action plans for patient and nurse satisfaction scores that are below the benchmarked midpoint.

47. Nursing Research • Nursing research involves the systematic inquiry specifically designed to develop, refine, and extend nursing knowledge • The intent of nursing research is to answer questions and develop knowledge using a scientific method such as quantitative, qualitative, or mixed methods.

48. The Research Process • Identify and Develop a Researchable Problem • Significance of the Problem • Problem statement • Specific Aims • Research Question (s) or Hypotheses • Definitions • Literature Review (Search for Information) • Conceptual Framework • What is known and not known about the problem

49. The Research Process • Develop a Plan (Methods) • Design • Sample • Setting • Data collection (Procedure, Protocol) • Instruments • Analysis

50. The Research Process • Results • Discussion • Limitations • Implications