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Supporting a Culture for Evidence Based Nursing Practice. Adele Mattinat Spegman, PhD, RN Director, Institute on Nursing Excellence. HEAL. TEACH. DISCOVER. SERVE.

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supporting a culture for evidence based nursing practice

Supporting a Culture for Evidence Based Nursing Practice

Adele Mattinat Spegman, PhD, RN

Director, Institute on Nursing Excellence

HEAL. TEACH. DISCOVER. SERVE.

slide2

Pravikoff DS, Tanner AB, Pierce ST. (2005). Readiness of U.S. Nurses for Evidence-Based Practice. American Journal of Nursing, 105 (9), 40-51.

  • 70% nurses in practice graduated prior to 1990
  • RNs report lack of skills or resources to conduct searches
  • 76% respondents never searched CINAL; 58% never searched MEDLINE
  • 82% hadn’t used hospital library
  • 46% reported familiarity with term “EBP”

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

why does ebnp seem so hard to implement
Misconceptions: Cookbook approach

Limited ‘know how’ regarding EBP strategies

Issues of time, access, workload

Attitudes

Skepticism & lack of self-efficacy

Limited motivation

Trust in traditional practices

Lack of perceived reward

Why does EBNP seem so hard to implement?

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

gmc s approach to an ebnp educational program
GMC’s approach to an EBNP educational program
  • The learning needs of GMC nurses reflect diversity of US nurse workforcePravikoff, Tanner, Pierce, (2005)
  • Encouraged, not mandatory
  • Accessible – on-line program
  • CEUs
  • Novice-to-expert approach
  • Modules transferred into resource: ppt → pdf
    • links to eJournals, eBooks

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

3 part series
3-Part Series
  • Introduction to EBNP
    • Definition & relevance
  • Using EBNP
    • Focus on 5 steps (identify, search, judge, implement, evaluate)
    • Detailed descriptions, examples, strategies
  • EBNP as template for research activities
    • Focus on research methods: designs, variables, data collection, analysis

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

what is ebnp
What is EBNP?
  • EBP is the conscientious use of current best evidence in making decisions about patient care. (Sackett, Straus, Rickardson, Rosenberg & Haynes, 2000)
  • A 3-component approach to solving problems, all with equal importance:
    • Systematic search for and critical appraisal of most relevant evidence to answer a specific clinical question.
    • Clinical expertise (skills, experience, insight, experience, etc)
    • Patient/family preferences and values

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

why is ebnp a priority
Knowledge explosion

Need for time-effective process to critique

Focus on outcomes

Consumer awareness

Professional, federal, & regulatory pressures

Professional responsibility

Keeping pace with other professions

Why is EBNP a priority?

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

how does ebnp differ from traditional practices
How does EBNP differ from ‘traditional’ practices?
  • Evolution of ‘research utilization’
    • RU: utilization focuses on a single study without inclusion of clinician expertise or pt/family value
    • By definition, EBP is broader in scope (multiple sources of evidence, clinical expertise, pt/family).
  • Extends the nursing process into the 21st century: critical thinking caring synthesis systematic evaluation clinical decision-making autonomous practice responsive to pt/family values & needs

(Mallock & Porter-O’Grady, 2006)

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

using ebnp
Using EBNP
  • Asking answerable questions
    • Foreground, background, PICO format
  • Searching for the best available evidence
    • Mosby Nurse Consult, Ovid, PubMed, Internet
    • Primary/secondary sources, systematic reviews, review processes
  • Judging the evidence
    • Hierarchy of evidence!
    • Participants, sample size, inclusion/exclusion
    • Local applicability
  • Implementation and evaluation

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

using ebnp1
Using EBNP
  • Asking answerable questions
    • Foreground, background, PICO format

Question templates:

Etiology: Are __ who have __ at __ risk for __ compared with ___?

Prevention: For __ , does the use of __ reduce the future risk of __ compared with __?

Meaning: How do __ diagnosed with __ perceive __?

(Melnek & Fineout-Overholt, 2005, p. 31)

http://www.uicomp.uic.edu/IntMedRes/teach/question.htm

http://www.uicomp.uic.edu/IntMedRes/teach/question.htm

http://www.nursingconsult.com/das/book/82671869-2/view/1323

http://www.nursingconsult.com/das/book/82671869-2/view/1323

http://http://www.nursingconsult.com/das/book/82946866-4/view/1323chapter 2, ‘background & foreground Qs’

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

using ebnp2
Using EBNP
  • Searching for the best available evidence
    • Mosby Nurse Consult, Ovid, PubMed, Internet
    • Primary/secondary sources, systematic reviews, review processes
    • Search strategies for OVID

http://www.nursingconsult.com/das/book/82671869-2/view/1323

http://www.uicomp.uic.edu/IntMedRes/teach/srchovid.htm

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

slide12

EBNP resources on the Internet

Academic Center for Evidence-Based PracticeThe University of Texas Health Science Center at San Antonio School of Nursing

Evidence Based Public Health Nursing, UI at Chicago

AHRQ: Agency for Healthcare Research and Quality

Joanna Briggs Institute, Royal Adelaide Hospital, Australia

Registered Nurses’ Association of OntarioNursing Best Practice Guidelines

Western Australia Centre for EBN and Midwifery (systematic reviews & best practices)

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

slide13

Evidence-Based Nursing Journals

CJNR - Canadian J of Nursing Research

http://www.biomedcentral.com/bmcnurs/

Evidence-based Child Health: A Cochran Review Journal (GMC-HSL) 03/01/06 to present

Evidence-based nursing

Evidence-based healthcare

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

using ebnp3
Using EBNP

http://www.nlm.nih.gov/nichsr/ihcm/hsrceval.html

Judging the evidence

    • Hierarchy of evidence!
    • Participants, sample size, inclusion/exclusion
    • Local applicability
      • How is evidence rated?
      • What factors increase the strength – value – of researched evidence?
      • How strong are best practice guidelines? Aren’t best practices based on clinical evidence?
  • Implementation and evaluation

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

ebnp as template for research activities
EBNP as template for research activities
  • Are the results valid?
    • Bias, confounding variables
    • How does the study design impact the value of the evidence?
  • What are the results?
    • Reliability issues: sample size, attrition
    • Inclusion, exclusion criteria
    • Statistical significance
    • Clinical significance
  • Will the results help locally?
    • Similarities of participants with pt/families
    • Research ‘control’ issues

O’Rourke & Booth, 2000

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

slide16

Thank you.

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.

slide17
Assess = describe/formulate problem

Performance improvement audits = data collection

Revising protocols, standards = intervention

Evaluation of care = analysis

Nursing scholarship = examinations of actual practice and current literature to support new understandings about nursing care.

GEISINGER

HEAL. TEACH. DISCOVER. SERVE.