Evidence Based PracticeStephanie Ros, Suhailah Al-Houmaidy, Kaitlyn Hawkins, Brittany Huff, Hanna Mercer

What is Nursing Research?

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Nursing research……

1. Expands a practical knowledge for a discipline or occupation.

2. Provides a basis on which practice decisions and behaviors are set.

3. Generate a secure scientific base for nursing practice.

4. Used to study facts essential to nursing.

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Nursing research provides:

Evidence created by nursing research delivers quality and cost-effectiveness for nursing interventions.

Health care recipients receive benefits.

Needed in regions that indirectly affect nursing care processes. by nursing research delivers quality and cost-effectiveness for nursing interventions.

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The evolution of nursing research…

• Early 1800’s : Nurses were often uneducated members of lower social classes.

• 1853-1856: Florence Nightingale during the Crimean War.

• 1970’s: Shift to improvement of patient care.

• 1980’s: Naturalistic paradigm.

• 2015: health care delivery issues internationally.

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Components of research process….

• The research process entails forming a research study concept, planning and implementing that study, and reporting findings.

• The process entails a rational course as each course of action builds on the previous acts.

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STUDY DES IGNS

• Blueprint for researcher.

Two primary methods:

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1. Qualitative research.

2. Quantitative research.

Quantitative design:

Statistical analysis of numerical data collected.

• Purpose: apply or hypothesize knowledge from a smaller sample of individuals to a larger population.

• Indication: needs assessment, survey, quasi-experimental, experimental, meta-analysis, methodological, and secondary analysis.

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Qualitative design:

Describes the observable occurrence rather than verify

cause and effect.• Purpose: Exploring the little known or double

observable occurrence.

• Indications: ethnography, grounded theory, and

phenomenology.

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TRIANGULATION:

1. Implements multiple research methods in the same study.

2. Most commonly incorporates qualitative and quantitative design in combination.

3. Convenient when research is collecting data from multiple sources and methods.

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Pilot Studies:

• Small scale (trial study).• Easily attainable.

• Recognizes strengths and limitations for bigger

planned studies.

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QUIZ TIME!!

TRUE OR FALSE1. Nursing practice based on tradition is historically how nurses have practiced.

2. Evidence-based nursing practice may include practice based on expert opinion.

Evidence Based Practice

• Evidence is defined as, “something which shows that something else exists or is true”(Webster, 1947).

Two types of evidence

1. External evidence: is looking at scientific aspects

2. Internal evidence: is using clinical experience to look at client and family preferences and needs

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What is Evidence Based Practice?

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Goals of Evidence Based Practice

Provide practicing nurses with the best evidence-based data

Resolve problems in the clinical setting

Attain quality in care delivery

Reduce variations in nursing care

Promote effective nursing interventions

ANA Standards of Practice 

The registered nurse integrates evidence and research findings into practice.

The registered nurse:

1. Utilizes current evidence-based nursing knowledge, including research findings, to guide practice.

2. Incorporates evidence when initiating changes in nursing practice.

3. Participates, as appropriate to education level and position, in the formulation of evidence-based practice through research.

4. Shares personal or third-party research findings with colleagues and peers.

5. Utilizes evidence-based interventions and treatments specific to the diagnosis or problem

Nurses Role in Evidence Based Practice

• 1) to evaluate and promote EBP• 2) collect data• 3) utilize research findings• 4) identity problems in the clinical setting• 5) help develop research questions

Nurses Role in Evidence Based Practice

Higher level nurses should:• Be an active members of research teams• Establish an environment which supports

nursing research • Integrate findings into practice• Design studies independently

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TRUE OR FALSE 3. The "gold standard" of evidence-based practice is the use of multiple study research

findings.

4. We need to base our nursing practice on evidence because of ethical considerations

Evidence Based Practice

SHOW ME THE EVIDENCE!

THErEDpILL. (2014, October 13).

Locating Published Research and Evidence Summaries

• Integration of Evidence + Research Findings = Effective Clinical Decision-making.

•  New research and technologies emerge - old ideas and opinions are subject to scrutiny. Nurses MUST keep up with new perspectives on care!

• Health Care Providers = No time to research. DATABASES TO THE RESCUE!

• The number, scope and ownership of the databases changes over time, making them a vital part of academic libraries.

Evidence in Evidence Based Practice

What and Where is the Best Evidence?

Research Reports

Clinical Practice Journals

Evidence Base Journals

Computerized Databases

Computerized Information Systems

1. CINAHL Information Systems ( The Cumulative Index to Nursing and Allied Health Literature). Has undergone significant enhancements during last years.

2. MEDLINE (Medical Literature Analysis and Retrieval System). Most comprehensive online resource for medical literature. Includes medicine, nursing, pharmacy, dentistry & veterinary medicine.

3. OVID SP (Or OVID for short) provides access to online databases, academic journals, & other products in the area of health science.

Management Information Systems (2012, January 15).

Evidence Based Practice

Locating Electronic Sources• Internet - Google, Yahoo, Ask, MSN (Considered a great

starting point)Librarians• Department of Health, Nursing Associations,

Professional OrganizationsSpecialist

Nurses• Computerized Databases (OVID, CINAHL, MEDLINE)Surgeons• Universities, Hospital computerized databases Researchers• National Institute of Health, Mayo Clinic, The Johns

Hopkins UniversityEducationalists

Evidence in Evidence Based Practice

Past – Paper journals in the library

• If not available – library orders them online from another library.

Present – Electronic databases

• Universities and Libraries build their databases by purchasing electronic databases of full-text online articles.

Future –subscription to computerized

databases

• Journals are available online through subscription and users can purchase directly from publishers.

Levels of Evidence

From Weakest to Strongest:

1. Basic Research and Animal Research

2. Case Series and Case Reports3. Case Control Studies4. Cohort Studies5. Randomized Controlled Trials6. Systemic Review7. Meta Analysis

Evidence Based Medicine Guide (2014, October 30).

Types and Levels of Evidence

• In the Past: Journal article with single study. Reader is the critic.

• Nowadays: Systematic approach. Synthesis of multiple researches on a single topic.

• Meta- Analysis• Meta-Synthesis

Types of Evidence

1. Meta-analysis - the findings of multiple studies on a single topic that are statistically analyzed to produce a summary statistic.

2. Meta-synthesis - findings of multiple studies on a single topic that amplifies the narrative information contained in the reports.

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TRUE OR FALSE5. We can always use vendor research to support

our decision to use the product.

6. Individual research studies published in the journal literature are reliable EBNP sources because

they all meet the highest standards of quality.

How Do Nurses Keep Up To Date With Evidence Based Practice?

Nurses should critically read journal articles based on research pertaining to their specialty of practice.

This includes:

• Peer Reviewed Articles

How can nurses be sure that what they are reading is authentic?

1. Blind Review

2. Critical Appraisal

What Is Critical Appraisal?

Critical Appraisal is the methodical process of using specific strategies of evaluation to analyze and establish validity of research evidence that has the potential to be

used in practice.

How does this relate to ethics?

• Healthcare professionals have an ethical duty to evaluate the effect that implemented changes have on specific patient outcomes.

• What if a particular change in practice turns out to do more harm than good?

Research Requires:

Careful and complex analysis

Wise implementation

Patient Outcome Assessment

(Webb & McLaughlin, 2014, p. 100)

Advice For New Nurses

• Seek expert guidance from Clinical Nurse Researchers (CNRs), Clinical Nurse Specialists (CNSs), and experienced health care professionals.

• Develop skills by consistently reviewing developed models based on Evidence Based Practice.

Evidence Based Practice is ALWAYS EVOLVING!!

Evidence Based

Practice

PATIENT OUTCOMES

RESEARCH EVIDENCE

TIME ACCESSEXPERT

DISAGREEMENTS

Evolution Of Evidence Based Practice Examples

Pressure Ulcers

Catheter Associated Urinary Tract Infections

Spreading the Evidence

• Research evidence plays a very significant role in health care practice.

• The important issue is spreading the evidence. This is not always simple.

• Researchers are responsible for information being readily available and written in a clear and concise format.

• Health care professionals must remember to apply research methods appropriately to specific patient populations.

• Expert disagreements occur.

• Scientific process is lengthy.

• Despite the difficulties, nurses must still provide patients with the best available health care based on evidence of patient outcomes.

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MULTIPLE CHOICE

7. The basis for evidence-based practice is :

A.Clinical research & practice

B.The nursing process

C.Clinical algorithms

D.Critical thinking

Types and Levels of Evidence

MULTIPLE CHOICE8. An outcome of evidence-based practice includes:

A. Practice guidelines

B. Standardized care

C. Reduced workload for nurses

D. Reduced hospital length of stay.

Evidence Based Practice

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Clinical Practice Guidelines (CPG)

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Clinical Practice Guideline (CPG)

What is a CPG???• “A CPG is an evidence-based guide to

clinical practice, developed by experts in a particular field for direct application in clinical environments” (Polit and Beck, 2012).

A Little History

• In 1992- AHRQ/USDHHS

• In 2008- Medicare Improvements for Patients and Providers Act

CPGs Today

• Development/use of CPGs has greatly increased

• CPGs can be found on the Internet, directly from multiple specialty organizations (such as NGC) and library databases.

• Websites to see nursing CPGs:• http://www.guideline.gov

• http://www.aann.org/pubs/content/guidelines.html

• http://www.ena.org/practice-research/research/cpg/Pages/Default.aspx

• http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html

Ethical Issues Related To Research

• Institutional review• Institutional review board (IRB) or human

subjects committee

• Informed Consent• Right to Refusal/Withdrawal

Ethical Issues Related To Research

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Nuremberg Code

The Declaration of Helsinki

Historical Examples of Unethical Research

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www.holocaustresearchproject.org

Historical Examples of Unethical Research

Tuskegee Syphilis Study (1932 - 1972)

The Jewish Chronic Disease Hospital (1960s)

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MULTIPLE CHOICE9. A nurse’s first responsibility in conducting research is to:

A.  Identify what research questions to pursue

B. Select members of the oversight committee

C. Apply to the Institutional Review board for permission to conduct research

D. Identify the participants in the study after the study has been approved.

QUIZ TIME!!

MULTIPLE CHOICE10. The best evidence on which to base your clinical practice is based on:

A. Outcomes of a research project

B. Practice guidelines

C. Standards of nursing care

D. Critical pathways

Works Cited

• Burns, N., & Grove, S. K. (2010). Understanding nursing research: Building an evidence-based practice. St. Louis: Saunders.

• Cooper, K. L. (2013). Evidence-based prevention of pressure ulcers in the intensive care unit. Critical Care Nurse, 33, 57 – 67. doi: 10.4037/ccn2013985

• Greenfield, S., Steinberg, E.P., & Auerbach, A. (2011). Clinical practice guidelines we can trust. Insitute of Medicine of National Acedemics, 11, 1-3. Retrieved from: www.iom.edu/cpgstandards

• Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chang, Y., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: Nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99, 229 – 236. doi: 10.3163/1536-5050.99.3.010

• Melnyk, B.M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

• Munhall, P. L. (2012). Nursing research: A qualitative perspective. Massachusetts: Jones and Bartlett Learning.

• Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

• Webb, J. J., & McLaughlin, R. A. (2014). Nursing research and evidence-based practice. In B. Cherry & S. R. Jacob (Eds.), Contemporary nursing: Issues, trends, & management (6th ed., pp. 87 – 104). St. Louis: Elsevier Mosby.

• Welden, L. M. (2013). Electronic health record: Driving evidence-based catheter-associated urinary tract infections (CAUTI) care practices. OJIN: The Online Journal of Issues in Nursing, 18(3). doi: 10.3912/OJIN.Vol18No03PPT02