Ebn application
Sponsored Links
This presentation is the property of its rightful owner.
1 / 68

EBN Application PowerPoint PPT Presentation


  • 99 Views
  • Uploaded on
  • Presentation posted in: General

EBN Application. 莊情惠 , MSN, RN Head Nurse, Chang Gung. Quality of Care. Broad topic Critically important Implementation key concern Many component parts. Component Parts. Patient, clinicians, systems Problem identification and refinement Use of evidence Interventions

Download Presentation

EBN Application

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


EBN Application

莊情惠, MSN, RN

Head Nurse, Chang Gung


QualityofCare

  • Broad topic

  • Critically important

  • Implementation key concern

  • Many component parts


Component Parts

  • Patient, clinicians, systems

  • Problem identification and refinement

  • Use of evidence

  • Interventions

  • Implementation

  • Adoption into practice


Quality of Care

  • Similar to:

    • Evidence based nursing (EBN)

    • Quality improvement

  • Uses evidence & clinical expertise

  • Patient outcomes and preferences

  • Within systems of care


Why is EBN important?

  • Manage explosion

    • Literature

    • Technology

  • New way to think

    • Practice

    • Research

    • Knowledge development


EBN Promotes Translation

Research Literature

into

Individualized care


What Nurses Do with EBN

Obtain valid information

Search for, assess & use literature

Use information (evidence)

Develop interventions

and

Apply to clinical situations


EBN Promotes:

Systematic observation plus

Experience and

Research literature

to support

Nursing decisions


Origins of EBM in 1970s

  • Started in Medicine

  • Synthesis of research literature

  • Guidance for practice


EBP History in Nursing

  • First (1970’s) called

    • Research utilization

    • Translation into practice

  • Now called

    • EBN

    • Evidence based nursing


Our Outline

  • What is evidence based nursing (EBN)

  • Goals of EBN

  • Products

  • Procedures for EBN reviews

  • Strengths and Weaknesses


EBN Goals

  • Improve patient outcome

  • Reduce healthcare costs


EBN Growing Rapidly

  • Nursing - 2,500 citation

  • Medicine - 21,000 citations


Types of EBN Reports

  • EBN to guide clinical decisions

  • How to do EBN

    Can be confusing to newcomer


Where Are EBN Reports ?

  • Professional journals

  • World Wide Web (WWW)

  • Books


How Do I Get EBN Reports?

  • Your library

  • Web

    Many are free


Professional Journals

  • Evidence Based Nursing

  • World Views on EBN- Sigma Theta Tau product

  • Your professional journal?


Book Most Cited

DiCenso, Ciliska & Guyatt(2005). Evidence-based nursing; A guide to clinical practice. St. Louis, Elsevier Mosby.


Other Sources on Web

  • Practice guidelines

  • Governmental sources

  • Cochrane Database


Our Outline

  • What is evidence based nursing (EBN)

  • Goals of EBN

  • Products – A model and an example

  • Procedures for EBN reviews

  • Strengths and Weaknesses


EBN – Example

  • Problem

    • Type II Diabetes Mellitus

    • Clinic management

  • Goal - Process improvement


Assess Support

  • Nursing management

  • Other departmental leaders

  • Nursing team


Problem or Question

  • Current guidelines not followed

  • Lacked measures

    • Glycosylated hemoglobin (HbA1c)

    • Lipids (LDL)

  • Lacked performance

    • Blood pressure checks

    • Annual foot exams

    • Monofilament testing


Establish Desired Patient Outcomes

  • Control of HbA1c and LDL

  • Improve performance to >80%

    • Foot exams

    • Filament testing

  • Improve patient involvement


Challenges Encountered

Data base accuracy

Staff turnover

Computer software upgrades

Sustainability


Our Outline

  • What is evidence based practice (EBN)

  • Goals of EBN

  • Products

  • Procedures for EBN reviews

  • Strengths and Weaknesses


How Do I Get Started?

  • Read research reports

  • Develop skills for research critique

  • Understand research reports

    • Concepts

    • Terminology


Develop Internet Skills

  • Use data bases

  • Use major EBN sources

    • PubMed

    • CIHAHL

    • Google Scholar


Ask for Helpand Help Yourself

  • Librarian

  • WWW

  • Lectures

  • Conferences


Work with Others

  • Sharing helps refine process

  • Improves reliability

  • Increase commitment


Steps in a EBN review

  • Ask

  • Access

  • Appraise

  • Implement

  • Evaluate


Ask the question

  • Identify a question

  • Define and refine the question


Sources of Questions

  • Practice question, problem or practice

  • Basis for question

    • Concern about adverse outcomes

    • Cost

    • Time use

    • Patient complaint


Components of Question - PICOT

  • Patients

  • Intervention

  • Comparison (current practice)

  • Outcome

  • Time frame


Access the Literature

  • Search literature – Reports are sample

  • Develop sample criteria

    • Inclusion

    • Exclusion

  • Obtain reports


PICOT Advantages

  • Pushes clear definitions

    • Population

    • Comparison

    • Outcome

  • Focuses search

    • Too narrow – miss important ones

    • Too broad – not apply to context


Appraise literatureAnswer 3 Questions

  • Quality high enough to use (valid)?

  • Findings fit my setting?

  • What impact would EBN have on my patients?


Is Report Quality Good Enough (Valid)?

  • Use research critique skills

  • Consider statistical significance


Does Report Fit My Setting?

  • Comparison = Current practice

  • Consider

    • Patients

    • Colleagues

    • Setting

    • Resources


Extract Data from Each Report

  • Write a summary

  • Include specific information

  • Develop data collection forms

  • Establish a code book


Code Book Includes

  • Methodological features

  • Quality assessment


Code Methods

  • Study source

  • Publication year

  • Research design

  • Authors/investigators characteristics


Quality Assessment

  • Scientific merit

  • Intervention description

  • Study outcomes


Steps in a EBN review

  • Ask

  • Access

  • Appraise

  • Implement

  • Evaluate


Critical Appraisal

  • Uses individual report/articles

  • Assembles body of evidence

  • Focuses on a single practice issue


Critical Appraisal Two Goals

  • Internal consistency

  • Clinical significance


Internal Consistency Questions

  • Did authors

    • Answer the question?

    • Measure variables as planned?

  • Were measurements

    • Reliable?

    • Valid?


Internal Consistency(continued)

  • Were analyses appropriate?

  • Were conclusions

    • Reasonable?

    • Supported by results?

    • Matched to initial question/aim?


Hierarchy of Evidence

  • Single-case report

  • Case series report

  • Case-control studies

  • Cohort studies

  • Nonrandom trials

  • Randomized controlled trials (RCT)

  • Meta-analysis and evidence reviews


Hierarchy

  • From single-case report to RCT

  • Internal validity increased

  • Bias in studies reduced


Rating the Evidence

  • Several approaches

    • Endorsed by professional bodies

    • Consensus reached when RCTs numerous

  • Quality of evidence rated

    • High

    • Moderate

    • Low or very low


Rating the Evidence

  • Study limitations

  • Inconsistency of results

  • Indirectness of evidence

  • Imprecision

  • Publication bias


Clinical Significance

  • Will it make a difference in clinical my setting?

  • How important is the study?

  • Clinical expertise valuable here at this point.


Steps in a EBN review

  • Ask

  • Access

  • Appraise

  • Implement

  • Evaluate


Implement

  • Identify stakeholders

  • Seek support of stakeholders

    • Nursing managers

    • Hospital administration

    • Other departments


Consider Effect of EBN

  • Others EBN would affect

  • Processes that would be affected

  • Educate nurses

    • Who make change

    • Who are affected by change


Evaluate

  • Assess cost effectiveness

  • Patient

    • Acceptance

    • Satisfaction

    • Complaints


Measure Relevant Information

  • Wait times

  • Patient census

  • Staff turnover

  • Medication errors


Evaluate Patient Outcomes

  • Diabetes clinic care

    • HbA1c

    • Filament testing

  • Intensive care

    • Pneumonia in intubated patients

    • EBN

      • head elevation

      • hand washing


Use Information Already Collected

  • Incident Reports

  • Satisfaction surveys


Evidence Based Nursing Overview

  • What is evidence based nursing (EBN)

  • Goals of EBN

  • Products

  • Procedures for EBN reviews

  • Strengths and Weaknesses


Strengths

  • Reduces variations in practice

  • Gives consistent results

  • Reduces knowledge/practice gap


EBN Success Requires

  • System wide support

  • Support of leaders

  • Evaluation

  • Monitoring adherence


Nursing Interventions

  • Behavioral Change Interventions

    • Patients

    • Nurses

    • Others in system

  • Few RCT trials

  • Fewer systematic reviews


Forces Pushing EBN Today

  • Cost

  • Safety

    Allows nurses to do more with less


Summary

  • EBN – What it is

  • Goals of EBN

  • Products

  • Procedures for EBN reviews

  • Strengths and Weaknesses


Thank You


  • Login