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Understanding and Articulating the Differences Between QI, Research or Evidence Based Practice. Regina Taylor, MN, RN, ACNS-BC. Objectives. Differentiate between quality improvement, research and evidence based practice in nursing

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Understanding and articulating the differences between qi research or evidence based practice l.jpg

Understanding and Articulating the Differences Between QI, Research or Evidence Based Practice

Regina Taylor, MN, RN, ACNS-BC


Objectives l.jpg
Objectives Research or Evidence Based Practice

  • Differentiate between quality improvement, research and evidence based practice in nursing

  • Discuss strategies to ensure nurses at all levels in all areas of practice understand and can describe the differences


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“A precursor to leading is understanding the distinct differences, yet overlapping associations between those 3 important activities.”(Newhouse, p.435)


Quality improvement l.jpg
Quality Improvement differences, yet overlapping associations between those 3 important activities.”

  • “Systematic, data-guided activities designed to bring about immediate improvement in healthcare delivery in particular settings.”

    (Lynn, et al, 2007, p. 667*)

    *= From ANCC Magnet Application Manual, 2008


Examples of qi l.jpg
Examples of QI differences, yet overlapping associations between those 3 important activities.”

  • Nursing Sensitive indicators

  • Performance Measures

  • Compliance checks

  • Example: Examination of use of intervention at unit/facility level to attempt to decrease patient falls


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Nursing Research differences, yet overlapping associations between those 3 important activities.”

  • “A systematic search for knowledge about issues of importance to the nursing profession.” (Polit and Hungler, 1995*)


Example of nursing research l.jpg
Example of Nursing Research differences, yet overlapping associations between those 3 important activities.”

  • Testing of an innovation that may impact nursing practice in general (i.e. including outside of the facility), such as to prevent falls or injury from falls or pressure ulcers


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QI or Research differences, yet overlapping associations between those 3 important activities.”

QI Rapid Cycle Process

Research Process

Form hypothesis

Study protocol/Data collection

Analysis and interpretation of data

Implementation into practice

(Kring, p. 163)

  • Plan

  • Do

  • Study

  • Act


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QI or Research? differences, yet overlapping associations between those 3 important activities.”

  • Intervention

  • Risk

  • Audience

  • Data source

    (Reinhardt and Ray, p.5)


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Differences differences, yet overlapping associations between those 3 important activities.”

  • Philosophical underpinning

  • Purposes

  • EBP value

  • Generalizability

  • Beneficiaries

  • Risks and Burdens

  • Sample Size

  • Instruments

  • Design and methods

  • Implementation of findings

  • Social acceptance

(Kring, 2008)


Evidence based practice l.jpg
Evidence-Based Practice differences, yet overlapping associations between those 3 important activities.”

  • “Conscious use/integration of the best research evidence with clinical expertise and patient preferences in nursing practice (adapted from Sackett, et al, 2000*)

  • EBP is a science-to-service model of engagement of critical thinking to apply research-based evidence (scientific knowledge) and practice-based evidence (art of nursing) within the context of patient values to deliver quality, cost-sensitive care.


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Examples of EBP differences, yet overlapping associations between those 3 important activities.”

  • Use of evidence-based standards from professional organization

  • Use of research to guide protocols

  • Institute for Healthcare Improvement (IHI) bundles

  • Specifics:

    • Safe patient handling

    • Falls prevention

    • Pressure ulcer prevention

    • Restraint free environments


Integration of qi ebp and nr l.jpg
Integration of QI, EBP, and NR differences, yet overlapping associations between those 3 important activities.”

QI

Met

Not Met

EBP

Evidence

No Evidence

NURSING RESEARCH


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If in doubt…. differences, yet overlapping associations between those 3 important activities.”

  • Ask the experts

    • Nurse researchers/scientists

    • Quality Management

    • Institutional Review Board

    • Advance Practice Nurses

    • Affiliated faculty


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Strategies to ensure differentiation differences, yet overlapping associations between those 3 important activities.”

  • Educational seminars, including

    • Grand Rounds (evidence based case study analyses)

    • Webinars

  • Reinforcement/Education at the bedside

  • Documentation:

    • EBP Fact Sheets

    • Website

  • Use of tools (Rating, differentiation, such as Kring, p. 167)

  • Journal Clubs (in person, on line)


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Additional Strategies differences, yet overlapping associations between those 3 important activities.”

  • Establish reasonable budget (as separate FCP or line items) for research

  • Start with basic education for staff: Research process, protection of human subjects, sharing your findings; enhance all staff nurses ability to evaluate research using their selected tool

  • Assist staff with verbalizing how research is systematically reviewed and used for evidence based practice; focus on enculturation of research and EBP

  • Articulate, and develop further, relationship with academic affiliates and own research staff, including MDs, regarding staff developing research skills/mentoring

  • Facilitate attendance at research and EBP conferences.

  • Assist with local research and EBP conferences


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“Preparing the workforce involves developing competencies in QI, EBP, informatics, patient-centered care, and interdisciplinary collaboration.”(Newhouse, p. 435)


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Magnet Requirements: Educational in QI, EBP, informatics, patient-centered care, and interdisciplinary collaboration.”

  • List continuing education programs (classroom or electronic) and the number of nurses completing each during the past 24 months. Do not include orientation or inservice education. Include programs covering…

    • Research, including protection of human subjects

    • Evidence-based practice

    • Application of ethical principles

    • Quality improvement

    • Data and information analysis competencies


Evidence based practice soe l.jpg
Evidence Based Practice SOE in QI, EBP, informatics, patient-centered care, and interdisciplinary collaboration.”

  • Describe and demonstrate

    • The structure(s) and process(es) used to evaluate existing nursing practice, based on evidence

    • The structure(s) and process(es) used to translate new knowledge into nursing practice.

    • How translation of new knowledge into nursing practice has affected patient outcomes.


Research soe l.jpg
Research SOE in QI, EBP, informatics, patient-centered care, and interdisciplinary collaboration.”

  • Provide annual report (research efforts and presentations could be included here)

  • Provide a budget summary for most recent fiscal year, actual to budget, for nursing education, conference attendance, and research


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Research SOE (cont.) in QI, EBP, informatics, patient-centered care, and interdisciplinary collaboration.”

  • The institution’s policies, procedures (including IRB) and processes that protect the rights of participants in research (NK 2)

  • The credentials or related experience of all external experts and other resources used to develop and/or improve the infrastructures, capacities, and processes for evidence-based practice and research (NK4 and NK 4EO)


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Research SOE (Cont.) in QI, EBP, informatics, patient-centered care, and interdisciplinary collaboration.”

  • Describe and demonstrate

    • Consistent membership and involvement by at least one (1) nurse in the governing body responsible for the protection of human subjects in research, and that a nurse votes on nursing-related protocols.

    • The structure(s) and process(es) used by the organization to develop, expand, and/or advance nursing research.

    • Nursing research studies from the past 2 years, ongoing or completed, generated from the structure(s) and process(es) above. Provide a table including:

      • Study title

      • Study status

      • Principal investigator name(s)

      • Principal investigator credential(s)

      • Role(s) of nurses in the study

      • Study scope (internal to a single organization, multiple organizations within a system independent organizations collaboratively)

      • Study type (replication-yes or no; qualitative, quantitative, or both). Select one (1) completed research study and respond to the four (4) criteria listed in the guidelines provided.


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References in QI, EBP, informatics, patient-centered care, and interdisciplinary collaboration.”

  • ANCC Manual, 2008

  • Newhouse, R. (October, 2007). “Diffusing Confusion between Evidence Based Practice, Quality Improvement and Research.” Journal of Nursing Administration. Vol 37. No. 10, 432-435.

  • Kring, D. (June, 2008). “Research and Quality Improvement: Different Processes, Different Evidence.” MED/SURG Nursing. Vol. 17, No. 3, 162-169.

  • Reinhardt, A, and Ray, L. (February, 2003). “Differentiating Quality Improvement from Research.” Applied Nursing Research. Vol 16, No. 1, 2-8.


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Questions? in QI, EBP, informatics, patient-centered care, and interdisciplinary collaboration.”

Contact:

Regina Taylor, MN, RN, ACNS-BC

[email protected]

404-321-6111. ext. 6487


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