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Evidence-based Practice What Does it Mean for Nursing?

Evidence-based Practice What Does it Mean for Nursing?. Nancy Wells Vanderbilt Medical Center October, 2007. What is evidence-based practice?. Evidence-based Practice. Process by which clinical decisions are made using: Best available research evidence Clinical expertise

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Evidence-based Practice What Does it Mean for Nursing?

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  1. Evidence-based PracticeWhat Does it Mean for Nursing? Nancy Wells Vanderbilt Medical Center October, 2007

  2. What is evidence-based practice?

  3. Evidence-based Practice Process by which clinical decisions are made using: • Best available research evidence • Clinical expertise • Patient preference

  4. Historical Perspective Variation in practice leads to: • Variable quality of care • Higher cost of care • Potential for errors that may cause harm

  5. Translating research into practice

  6. Skills Required for EBP • Clearly identify practice problem or new knowledge ( innovation) • Find research literature • Critically evaluate research findings • Apply to practice through change process

  7. Identifying Practice Problem • Why are we doing this? • Why are we doing it this way? • Can we produce better outcomes with greater consistency?

  8. Clinical practice problems in your setting?

  9. Critically Evaluating Research • Literature review • Integrative literature review • Systematic literature review • Meta-analysis

  10. Strength of the Evidence Level I – systematic review, met-analysis, well-designed RCTs Level VII - opinion

  11. Resources for Reviews • Nursing journals • Clinical work station sites • Up-to-date • Zynx • Eskind Digital Library • Cochrane Reviews

  12. Clinical Practice Guidelines • Agency for Healthcare Research & Quality (AHRQ) • Early examples • Skin integrity • Acute pain guideline • Urinary incontinence

  13. AHRQ Evidence-based Reports Examples of reports available • Cancer symptom management (2002) • Coronary heart disease in women, systematic review (2003) • Mechanical ventilator criteria for weaning (2000) • Wound healing, laser treatment and vitamin-assisted closure (2004)

  14. Evidence-based Nursing Practice • AHRQ clinical nursing practice guidelines • To be released in December • Joanna Briggs Institute (JBI) • JBI Connect • National Guideline Clearinghouse • Guidelines.gov

  15. Application to Practice • Does the research apply to my patient population? • Would this practice change improve process of care? Patient outcomes? • Is there support for this practice change?

  16. EBP Models • CURN project  Research utilization • Review, synthesis, application, evaluation • Stettler Model of Research Utilization • Critical thinking & decision making • Iowa Model of Research in Practice • Quality assurance meets research utilization

  17. Planned Change • Assess current practice (processes and outcomes) • Identify and implement changes to modify processes • Evaluate effects on processes and/or outcomes

  18. Evaluation • Processes of care • Outcomes of care

  19. Documentation of Groin Sites • Investigators: Stacy Sherrard, Grace Vincente & Felicia Lowe • 1 month trial of education and coaching to improve documentation of groin sites post-catheterization

  20. Groin Site Documentation

  21. Summary • Reduce variations in practice • Improve the quality of care provided • Maintain or improve patient outcomes

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