Getting ready, Getting Started

1. Getting ready, Getting Started Stepping up to Evidence Based Practice - Ideas into Action 2 Debra Ugboma January 2010

2. Objectives • Consider personal, team and environmental issues influencing EBP • Undertake a SWOT analysis of your clinical area (in relation to EBP) • Identify strategies to address weaknesses or threats • Discuss how opportunities and strengths can be maximised • Begin thinking about ideas for action.. • What do I need for this session: • Paper/pen for SWOT • Worksheet 2

3. What is Evidence Based Practice (EBP) “Doing right things right” (Muir Gray, 2009 p41) “.. the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patient/clients (Sackett et al 1996 p 71-72) “Practice supported by a clear, up-to-date rationale, taking into account the patient/clients preferences and using your own judgement. If we practice EBP then we are set to give the best possible care” (Aveyard and Sharp, 2009 p4) Page 3

4. Stepping up to EBP.. Active involvement in research Projects into publication! Structured EBP projects Implementing EBP dissertations Evidence from others/policy etc. Getting involved in audit Ideas into action Questioning care, responding to feedback

5. A PHT Model?

6. Identify some of the things you think you need to integrate EBP into everyday working life?

7. Now undertake a SWOT analysis of your clinical area in relation to EBP?

8. Weaknesses and Threats… What gets in the way of EBP? • Competing/higher priorities for time • work and home • Skill • finding and appraising literature • research too complex • Access • too much information • poor quality information • Library/IT/Computer resources Aveyard and Sharp, 2009

9. Weaknesses and Threats.. What gets in the way of EBP? • Leadership/organisational culture/implementing change • managers have other priorities • no clear/strategic direction • knowledge of EBP doesn’t result in changed behaviour • Role modelling • role models out of date/poor practice – students influenced more by practice educators than evidence • challenging practice of others is difficult • ritualistic practice is alive and well • Relevance • some problems too complex to be answered by research • research doesn’t always take into account holistic/individualised care • “cook book” approach doesn’t always work Aveyard and Sharp, 2009

10. Did you identify “lack of time” on your SWOT analysis? • To get you started, identify at least 6 “sessions of time” over the next 6 months for EBP activities and your own development • Protect this time! • Complete question 1 of worksheet 2 and consider different ways to incorporate EBP into your (or your teams) role/daily work rather than as an add-on e.g. weekly at the end of hand- over, discuss a care issue and continue to use time to drive it forward. • Try further activities: http://www.rcn.org.uk/development/learning/learningzone/personal_skills/time_management

11. Tackling weaknesses and threats… • What preparation do YOU need before getting started? • Do you have a current Athens password – if not, re-set via the library website: http://www.porthosp.nhs.uk/library-services.html • What can you read (see resources)? • Can you identify a potential supporter/facilitator? This will likely be clearer once you have identified a project/topic, but have some ideas. • Do you need to hone/learn any skills? If these are library focussed, suggest doing this linked to a specific search.

12. Opportunities… • Keep articles/guidelines/evidence available to read when you have time • Agree with each other that you will ask each other why you approach a task in a particular way • Ask students to talk about what they are learning – maybe bringing in lecture notes/references • Consider attending a clinical conference – these are often great places to get ideas and “jump start” you into action • Get staff talking about what is important to them – what are their “bug bears” • Start to identity your potential “implementers” or lead for projects

13. What can you do to embrace them and let them surface? Who else can you involve? What can you do to maximise their impact? Complete questions 2 and 3 of worksheet 2 Take a look at your opportunities and strengths…

14. Audit can be a great starting point for EBP It can help generate questions It may help identify care issues that “matter” or that staff feel strongly about You might get involved in auditing national guidelines (tools often available) Think about the audit cycle… Getting involved in clinical audit

15. Getting involved in clinical audit… • What audits are undertaken in your clinical area? • Which audits have a nursing or midwifery focus? • How is the audit cycle organised in your area? • What is your role in audit? • How can you increase your involvement in audit, or lead a particular audit cycle? • Can you identify one aspect of care that is not currently audited, that you think could benefit from audit? • For more information about audit, contact your local lead or within PHT: http://pht/Departments/ClinicalAudit/default.aspx

16. Generating your care/EBP question… Ideas into Action • Preparing the environment and staff… • Getting involved in audit… • Getting ready for EBP… • Helps generate ideas and questions. • Do you have a question or idea? • Whose idea was it? • How did it come about?

17. Help is out there… • PHT Learning and Development Team: http://www.phtlearningzone.org.uk/ • PHT Clinical Audit: http://pht/Departments/ClinicalAudit/default.aspx • PHT Library Clinical Outreach: fran.lamusse@porthosp.nhs.uk and darrel.mason@porthops.nhs.uk • RD Learning - Putting evidence into practice (free 5 day course) http://www.rdlearning.org.uk/coursedetails.asp?ID=39473 • Foundation of Nursing Studies – great for ideas about projects, sharing information etc. http://www.fons.org/default.ASP

18. Making a start… • Complete the sections on the “do one thing” page on • worksheet 2 • Try them out before the next session. How did it go? • Begin talking with your team about your/some “ideas for action” • What is important to them, what care issue would they like to review or address Identify at least one “idea for action” before you attend/undertake the next session (3)

19. Resources • Aveyard H and Sharp P. 2009. A beginners guide to evidence based practice in health and social care. Maidenhead: Open University Press • Craig JV and Pearson M 2007 Evidence-based practice in nursing In: Craig JV, Smyth RL (Eds) 2007 The Evidence-Based Practice Manual for Nurses, Edinburgh: Churchill Livingston Elsevier • Department of Health – Governance and National Clinical Audit: http://www.dh.gov.uk/en/Publichealth/Patientsafety/Clinicalgovernance/index.htm • Foundation of Nursing Studies (useful for project ideas and guidance for developing practice): http://www.fons.org/default.ASP • Guidance with SWOT - http://www.teachernet.gov.uk/professionaldevelopment/tipd/guidance/swot/ • Library http://www.porthosp.nhs.uk/library-services.html • Tagney J, Haines C 2009 Using evidence-based practice to address gaps in nursing knowledge. British Journal of Nursing Vol 18 (8): 484-489