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

Triggers: Problem-based and Knowledge-based

Organizational Priorities Sufficiency of the Research Base Appropriateness of change for the patient

population/organization Continuous feedback loops

Triggers

Triggers

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)

Priorities of the Institution

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

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

Measuring and comparing

Take action to improve

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

Change: the final step

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

Good Luck!