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Introduction to Evidence-Based (Informed) Practice (EBP). Ms. Laura Banfield, Health Sciences Library Dr. Michelle Butt, School of Nursing. Fall 2009. Learning Objectives. Define evidence-based (informed) practice and the steps in the process

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introduction to evidence based informed practice ebp

Introduction to Evidence-Based (Informed) Practice (EBP)

Ms. Laura Banfield, Health Sciences Library

Dr. Michelle Butt, School of Nursing

Fall 2009

learning objectives
Learning Objectives
  • Define evidence-based (informed) practice and the steps in the process
  • Distinguish background and foreground questions and identify resources to answer them
  • Differentiate among different research approaches and designs
  • Use PICO to formulate a clinical question
  • Understand the steps needed to plan and carry out a search of the literature for the best external evidence
evidence based practice ebp
“The integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making”

(Sackett et al., 2000)

Evidence-Based Practice (EBP)
slide4

Clinical Decisions

Patient preferences

and actions

Clinical state, setting, and circumstances

Clinical Expertise

Clinical Expertise

Health care resources 

Research evidence

DiCenso, Cullum & Ciliska [as adapted from Haynes, Devereaux & Guyatt (2002)]

Introduction to EBP

slide5

Evidence-Based Practice (EBP)

  • “The best available evidence is used

alongside clinical expertise and the

patient’s perspective to plan care”

(Flemming, 1998, p.36)

  • Evaluation of performance (or outcome)

occurs via peer assessment, an audit, or

through a process of self-reflection

(Flemming, 1998)

Flemming, K. (1998). Asking answerable questions. Evidence-Based Nursing, 1(2), 36-7.

slide6

Steps of EBP*

  • Construct a relevant, answerable question from a clinical case.
  • Search the literature to retrieve the best evidence.
  • 3. Critically appraise the literature (evidence) for validity and applicability.
  • 4. Apply the evidence to your clinical practice.
  • 5. Evaluate the outcome or performance.

*From:Flemming, K. (1998). Asking answerable questions. Evidence-Based Nursing, 1(2),

36-7.

slide7

Asking Clinical Questions

Two Types of Clinical Questions:

1. Background

2. Foreground

slide8

Background & Foreground Questions

  • Background questions are:
    • general in nature
    • address gaps in background knowledge
    • examples include: pathophysiology, or risk
    • factors of a disease; an overview of a nursing
    • theory
  • Foregroundquestions are:
    • focused on the particular patient scenario, and
    • ask for specific knowledge to manage the patient
slide9

Background & Foreground Questions

  • Background questions
  • Need to be answered first
  • Can be answered by books or general Websites
  • Foreground questions
  • Need to be very focused
  • Can be answered by searching journal

databases

slide10

Background & Foreground Questions

  • Examples of Background questions:
  • What is the mechanism of action of insulin?
  • How do you conduct a neurological assessment?
  • Examples of Foreground questions:
  • Is exercise more effective than a low-fat diet in reducing

blood pressure in hypertensive patients?

  • Is there a relationship between cell phone use in adults

and the incidence of brain tumors?

slide12

Two Major Research ‘Categories’

Quantitative Researchis an “objective, systematic process to describe and test relationships and, examine cause and effect interactions among variables” (Burns & Grove, 1993, p. 777)

Qualitative Researchis a systematic, subjective approach used to describe life experiences and give them meaning” (Burns & Grove, 1993, p. 777)

quantitative research
Quantitative Research**
  • Goal is the discovery of relationships, or causation (cause & effect).
  • Based on scientific method (hypothesis formation and testing)
  • Many quantitative designs compare two or more groups
  • Often involves an element of control
  • Objectivity (related to measurement)
  • Collection of data (numerical) and analysis via statistics

**Burns & Groove, 1993; Roberts & Burke, 1989

slide14
Studies focus primarily on one of the following:

Therapy/Treatment/Intervention; Prevention and Control – Effectiveness

Etiology/Causation/Harm

Prognosis – Outcome

Diagnosis and Screening/Assessment

Economics

Quantitative Research Studies

quantitative research designs
Quantitative Research Designs***

Quantitative research designs (studies)

include:

  • Randomized Controlled Trials (RCTs)
  • Cohort Study (Cohort Analytic)
  • Case-Control Study
  • Cross-Sectional Study (survey)
  • Case Report or Study

***Greenhalgh, 1997

slide16

Steps in Searching for Research Literature – Quantitative Research

  • What aspect of care are you interested in?
      • Etiology/causation?
      • Therapy/treatment/prevention?
      • Diagnosis?
      • Prognosis?
      • Quality of care?
  • What are you doing? (Intervention)
  • Who are you doing it to? (Patient population)
  • What do you want/not want to happen? (Outcome)
steps in searching for research literature quantitative research
Steps in Searching for Research Literature – Quantitative Research
  • Ask a focused question using PICO*

* This is what you will do for your evidence-based resources report (assignment)

framing the question
Framing the Question
  • P opulation / Situation
  • I ntervention / Exposure
  • C ounter intervention
  • O utcome
question therapy
Question - Therapy

Is water as effective as alcohol in preventing umbilical cord infections in newborn infants?

slide20
P opulation:

I ntervention:

Counter intervention:

O utcome:

newborn infants

water

alcohol

umbilical infections

Question - Therapy

question causation etiology or harm
Question – Causation (Etiology) or Harm

Do vending machines in high schools increase the risk of

obesity?

question causation or harm
P opulation:

E xposure:

Counter exposure:

O utcome:

High school students

Soft drinks in vending machines

No soft drinks

Obesity

Question – Causation or Harm
qualitative research
Qualitative Research
  • Aim is to discover meaningor gain understanding of a phenomena
  • Investigates a phenomena in-depth

Roberts & Burke (1989)

slide24
How people feel or experience a certain situation or circumstance

Sampling of a small group of people

Data collected via in-depth unstructured interviews, observation, focus groups, diaries

Analysis of findings in narrative format

Qualitative Research

qualitative research25
Qualitative Research

Examples of qualitative research designs include:

  • Phenomenology
    • Examine the ‘lived experience” of individuals experiencing a phenomena
  • Grounded Theory
    • Goal is to understand a social-psychological process and develop a theory
  • Ethnography
    • Study of a group or culture within their own setting
framing the qualitative question
Framing the QUALITATIVE Question
  • P opulation
  • S ituation
question
Question

How do caregivers feel about placing a spouse with Alzheimer’s Disease in a nursing home?

question28
P opulation:

S ituation:

caregivers

placing a spouse with Alzheimer’s Disease in a nursing home

Question
steps in searching for research literature
Steps in Searching for Research Literature
  • Ask a focused question using PICO (for

quantitative studies)

  • Determine what are the best sources for this question, e.g. which journal database – CINAHL, Medline
slide30
Identify the terminology used in the chosen resource (thesaurus):

Nursing & Allied Health (CINAHL) subject headings

MeSH (Medical Subject Headings)

Map your question to the thesaurus

Steps in Searching for

Research Literature

hands on workshops for searching will be offered
Hands-on Workshops for Searching Will be Offered

When?

  • one hour during tutorial on:
    • Thursday, October 1st OR
    • Friday, October 2nd

Where?

  • eClassroom – upper level, Health Sciences Library