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What is Evidence-Based Practice?. Evidence-Based Practice from a Nursing Perspective Cynthia Padula, PhD, RN Nurse Researcher, The Miriam Hospital Master’s Program Director, Rhode Island College. Objectives. Describe evidence based practice from a nursing perspective

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what is evidence based practice

What is Evidence-Based Practice?

Evidence-Based Practice from a Nursing Perspective

Cynthia Padula, PhD, RN

Nurse Researcher, The Miriam Hospital

Master’s Program Director, Rhode Island College

objectives
Objectives
  • Describe evidence based practice from a nursing perspective
  • Identify challenges to using evidence based practice in nursing
  • Compare and contrast evidence based nursing and medicine
  • Recognize the impact of the Magnet movement on evidence based nursing practice
  • Identify resources relevant to nursing
definition
Definition

“Process by which nurses make clinical decisions using best available evidence, clinical expertise, & patient preferences in the context of available resources” (DiCenso, 1998)

what is evidence based nursing practice
What is Evidence-Based Nursing Practice
  • Builds on process of research use, but more encompassing
  • More specific than term ‘best practices’
  • Does not foster rigid adherence to standardized guidelines
  • Recognizes the role of clinical expertise
  • EB nursing practice is a state of mind!
why evidence based practice in nursing
Why Evidence-Based Practice in Nursing
  • Fueled by accrediting bodies, professional organizations, third party payers
  • Potential to improve quality, reduce variations in care
  • Focus on practices that result in best possible outcomes at possibly lower cost
  • Provides a way to keep pace with advances
why evidence based practice in nursing1
Why Evidence-Based Practice in Nursing
  • Potential to narrow the ‘research-practice gap’:

adoption of research findings into practice can

take as long as 17 years (Balas & Boren)

  • Impacted by perception that published research is not
  • relevant to practice
  • Provides a means to answer problematic clinical
  • practice issues
  • Potential to improve individual bedside practice;
  • supports/improves clinical decision-making skills
  • Bedside nurse as conduit!!
traditional basis for nursing practice stetler
Traditional Basis for Nursing Practice (Stetler)
  • Rituals, unverified rules
  • Anecdotes, isolated experiences
  • Customs, opinions, unit cultures
  • Physicians’ authority
bases for practice in nursing stetler 1998
Bases for Practice in Nursing (Stetler, 1998)
  • Philosophical/conceptual basis: mission; values; professional practice models; conceptual frameworks; professional codes
  • Regulatory basis: state practice act; JCAHO; regulatory agencies
  • Traditional basis
  • *Evidence-based practice
alternative approach
Alternative Approach
  • Clinical expertise as necessary but not sufficient to provide best possible care
  • Emphasis is on systematic, reproducible, unbiased evidence
  • Focus on evidence authority *in combinationwith clinical expertise
core competencies
Core Competencies
  • Ask: why are we doing this..

what is the evidence?

  • Think critically!
  • Think out of the box!
core competencies cont
Core Competencies (cont.)
  • Prioritize and clearly articulate answerable

clinical questions with a focus on outcomes

  • Appreciate role of quality improvement activities
  • Evaluate practice outcomes
  • *Work effectively with others
core competencies cont1
Core Competencies (cont.)
  • Search for evidence
  • Evaluate the evidence
core competencies cont2
Core Competencies (cont.)
  • Read and understand research
levels of evidence hierarchy stetler et al
Levels of Evidence Hierarchy(Stetler et al.)*
  • Level I: Meta-analysis of multiple RCTs
  • (‘gold standard’)
  • Level II: Individual RCTs
  • Level III: Quasi-experimental
  • Level IV: Non-experimental; qualitative
  • Level V: Program evaluation; QI; RU; case reports
  • Level VI: Opinion of respected authorities

*modified slightly by Padula

evidence based practice process
Evidence Based Practice Process
  • Identify a practice issue
  • Formulate an answerable question
  • Search for best evidence
  • Critically evaluate the evidence and clinical relevance
  • Make recommendations
  • Apply to clinical practice
  • Evaluate impact/effectiveness/ outcomes
readiness of us nurses for ebp pravikoff et al 2005
Readiness of US Nurses for EBP (Pravikoff et al., 2005)
  • Purpose: to examine nurses’ perceptions of their skills in obtaining evidence and their access to tools with which to do so.
  • Sample: stratified random sample of 3,000 RNs across the US; 1,097 responded
  • Measurement: 93 item measure; content validity established; varying response format
sample characteristics pravikoff et al
Sample Characteristics (Pravikoff et al.)
  • 91% female
  • 79% between >40 years of age
  • Educational preparation:

Diploma 17%

AD 34%

BSN 39%

MS 9%

  • Employment: 60% in hospitals
subscale information need seeking
Subscale: Information Need/Seeking
  • How often do you need
  • information to support nursing role?

61%: once or twice a week

  • How do you find the information
  • needed?

67% always or freq sought a colleague

58% didn’t use research reports at all

82% had never used a hospital library

subscale resource availability and use
Subscale: Resource Availability and Use
  • 83%: at least somewhat successful when searching the Internet
  • 19% somewhat confident in ability to search CINAHL; 76% never search CINAHL
  • 36% somewhat confident in ability to search MEDLINE
  • 83% rarely or never sought librarian assistance; 82% didn’t use hospital library
resource use availability cont
Resource Use/Availability (cont.)
  • 77% had never received instruction re: electronic resources
  • 36% reported had access to electronic databases; 29% did not know if access was available
  • 26% had access to electronic databases on nursing units
  • 49% had access to the Internet on units
subscale individual barriers other than time
Subscale: Individual Barriers (other than time)
  • Lack of value for research in practice
  • Lack of understanding of electronic databases
  • Difficulty accessing materials
  • Lack of computer skills
  • Difficulty understanding articles
  • Lack of: access to computer; library access; search skills; research knowledge; critiquing skills
differing challenges nursing medicine
Varying entry levels

Rapid indoctrination

Off unit access difficult

Clinical reality more ‘subjective’/’human response’

Most quasi or below; qualitative

MD degree

Internship/residency

Easier access off unit

Focus on ‘objective’ reality/ treatment effectiveness research

More RCTs

Differing Challenges:Nursing Medicine
using the magnet influence
Using the Magnet Influence
  • Administered by the American
  • Nurses Credentialing Center

http://nursingworld.org.ancc

  • Magnet designation recognized
  • and rewards nursing excellence
  • Forces of Magnetism (14) identified via a landmark study (McClure & Hindshaw)
selected forces
Selected Forces
  • Professional models of care

-must designate a nursing theory

  • Quality of care

-support of research/evidence based practice

  • Quality improvement

-nurse driven, evidence based quality initiatives

selected forces cont
Selected Forces (cont.)
  • Professional development

-training, mentoring

  • Interdisciplinary relationships

-opportunities for collaboration; consultation

collaboration is key
Collaboration is Key
  • Library can serve as archive for nursing publications/Magnet applications (Rourke)
  • Committee participation
  • Heightened visibility
  • Facilitation is key
  • Write library services and
  • librarians into grants
resources
Resources
  • Evidence Based Nursing Journal
  • Online Journal of Knowledge Synthesis for Nursing, Sigma Theta Tau

http://www.nursingsociety.org

  • US Preventive Services Task Force

http://www.ahrq.gov/clinic/uspsfact.htm

selected lifespan resources
Selected Lifespan Resources
  • Direct links to PubMed and Ovid
  • Micromedex
  • > 3000 journals
  • DXplain
  • MD consult
references
References
  • Baras, E., & Boren, S. (2000). Managing clinical knowledge for
  • healthcare improvement (pp. 65-70). Germany: Schattauer
  • Publishing.
  • Dee, C., & Stanley, e. (2005). Nurses’ information needs: nurses’ and
  • hospital librarians’ perspective. J Hosp Librar, 5(2), 1-13.
  • Hallyburton, A., & St. John, B. (2009). Partnering with your library to
  • strengthen nursing research. J Nsg Educ, 49(3), 164-167.
  • McClure, M., & Hinshaw, A. (2002). Magnet hospital revisited.
  • Washington DC: ANA.
  • Pravikoff, D., Tanner, A., & Pierce, S. (2005). Readiness of US nurses
  • for evidence-based practice. AJN, 105(9), 40-51.
references cont
References (cont.)
  • Rourke, D. (2007). The hospital library as a “Magnet Force”…Med Ref
  • Svcs Quar, 26(3), 47-54.

Sherwill-Navarro, P., & Roth, K. (2007). Magnet hospital/magnetic

  • libraries. J Hosp Librar, 7(3), 21-31
  • Stetler C. et al. (1998). Evidence-based practice and the role of nursing
  • leadership. JONA, 28(7/8), 45-53.
  • Stetler, C. et al. (1998). Utilization-focused integrative reviews. Appl
  • Nurs Res, 11(4).