Falls- Evidence-based Practice
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Transcript of Falls- Evidence-based Practice
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Process to PracticeRoxanne L. Ebo
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An approach to clinical practice
A way to keep current with new developments
An integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served.
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… a methodological approach to clinical practice where evidence is used to inform decision-making about making a diagnosis (or interpreting a diagnostic test), selecting an intervention, or evaluating prognostic indicators
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… an approach to health care practice in which the clinician is aware of the evidence that bears on her clinical practice, and the strength of that evidence
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… an approach to decision making in which the clinician uses the best evidence available, in consultation with patient, to decide upon the option which suits that patient best
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Evidence based health care is
the integration of individual clinical expertise
with the best available external
clinical evidence and the values and
expectations of the patient
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Involves life-long, self-directed, problem-based learning
Involves exploring the relationship between clinical reasoning and research evidence
Involves practice
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Do nothing … and get out of date Depend solely on courses/conferences Choose the main professional journal(s)
and read them cover to cover every month
Learn how to find and appraise the evidence to answer questions that come from clinical practice
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Knowledge Standard
Each nurse possesses, through basic education and continuing learning, knowledge relevant to her/his professional practice
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Knowledge Standard Indicators
Providing a theoretical and/or evidence-based rationale for all decisions
Understanding the knowledge required to meet the needs of complex clients
Knowing where/how to access learning resources when necessary
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Knowledge Standard Indicators Seeking and reviewing research in nursing,
health sciences and related disciplines Using research to inform practice/professional
service
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Knowledge Application Standard
Each nurse continually improves the application of professional knowledge
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Knowledge Application Standard Indicators
Ensuring practice is based in theory and evidence and meets all relevant standards/guidelines
Assessing/describing the client situation using a theory, framework or evidence-based tool
Managing multiple nursing interventions simultaneously
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Knowledge Application Standard Indicators
Evaluating/describing the outcome of specific interventions and modifying the plan/approach
Integrating research findings into professional service and practice
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Thompson, C. et al. Evid Based Nurs 2004;7:68-72
The cognitive continuum.
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Define the Question Identify Question ~ Search and Screen
Literature ~ Refine Question Collect the Evidence Critically Appraise the Evidence for
Validity and Relevance
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Integrate the Evidence and Patient Factors Make & Carry Out the Decision
Evaluate the Process Results ~ Self-reflection
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A clinical question should incorporate at least three elements
Patient Age, sex, ethnicity, etc. Condition, diseases, general health status
Intervention Education, diagnostics, treatment plan, self-
care, etc.
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Comparison Intervention Placebo, etc.
Outcome Expected and actual effects on patient
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Do nurse led tobacco cessation interventions result in decreased smoking rates after hospital admission for coronary heart disease?
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PATIENT (Adult) coronary heart patients Smokers Discharged from hospital
INTERVENTION Nurse led tobacco cessation programmes
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COMPARISON (Non-nurse led tobacco cessation programmes
Self-administered, non-nurse administered, etc.) No comparison
OUTCOME Lower rates of tobacco use among Patient
group
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Not all questions are of a clinical nature
Intervention can be interpreted very broadly
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“Important medical questions are typically studied more than once, often by different research teams in different locations. A meta-analysis combines results from different studies, hopefully averaging out any differences caused by random change or local variation and getting at something close to the real truth. In general a meta-analysis, if you can find one, will be a better guide to practice than an individual article.”
SUNY Downstate Medical Center, 2003
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Usefulness = Relevance x Validity Work
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