Evidence-Based Practice and Nursing Databases Willa Fields, RN, DNSc, FHIMSS
Outline • Introduction to Evidence-Based Practice • Steps of EBP • Nursing Terminologies
Clinical Expertise Research Evidence Patient Preferences What is Evidence-Based Practice? “the conscious and judicious integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making” (Sackett et al., 2000)
Clinical Expertise Research Evidence Patient Preferences EBP Process Environmental & Organizational Context Decision Making Adapted from: www.ebbp.org
Problem • It takes up to two decades to translate research findings into practice (AHRQ) • Practice needs to incorporate research findings sooner!
Evidence-based Practice • “Gold standard” of practice in 21st century. • EBP is public mandate! • Federal agencies and policy making bodies have placed a major emphasis on accelerating EBP (The Joint Commission, Magnet status designation) • It leads to improved safety and quality of care.
Outcomes of EBP • Bridges the gap between research and practice • Encourages the use of empirically-supported interventions • Elevates patient preferences in the decision making process • Increases case study research
To practice EBP, you need both information and health literacy • Information literacy • Awareness of need to know, ability to find, analyze and interpret the information. • Health literacy • Capacity to obtain, process, and understand health information and services to make appropriate health decisions. • EBP process requires information and health literacy.
The Steps of Evidenced-Based Practice • Asking • Acquiring • Appraising • Applying • Assessing • Disseminating Ask the burning clinical question in “PICO” format Search for the best evidence Critically appraise the evidence for validity, reliability & applicability Integrate the evidence with one’s clinical expertise and pt’s preference Evaluate the change resulting from implementing the evidence in practice Share results through conferences and publications
Step 1: Asking the Question • Most important step and most challenging. • If question is not searchable, EBP is off to a faulty start. • Motivation for the question is what a clinician is to do or how to conduct patient care. • PICO question drives the entire EBP process
PICO – It’s not a Salsa! • P = patient population • I = intervention of interest • C = comparison intervention/status • O = Outcome
Example What is the best form of birth control to use? In teenagers how effective is Depo-Provera versus oral contraception in the prevention of pregnancy? P: teenagers I: Depo-Provera C: oral contraception O: prevention of pregnancy? Initial search terms
Step 2: Searching for Best Evidence • Question informs clinician on the keywords to search, which database to use, etc. • Levels of evidence need to be considered and are different with type of question. • Cause and effect question needs Meta-Analyses or Systematic Reviews. • If question relates to meaning of a construct or phenomenon, then qualitative evidence is important.
Break into groups of 4-5 students and formulate a PICO question and search terms Volunteers to share results? • PICO Question • Search Terms
Searching for the Best Evidence • First, look for Systematic Reviews (Cochrane collaboration) or meta-analyses and Clinical Practice Guidelines (CPGs): • These are regarded as the strongest level of evidence on which to base practice decisions. • Then, primary single studies
Finding Sources of Evidence • SDSU Library Online Resources (http://infodome.sdsu.edu/research/databases/nursing.shtml) • Data Bases • PubMed (http://www.ncbi.nlm.nih.gov/PubMed/) • MedlinePlus (http://www.nlm.nih.gov/medlineplus/) • CINAHL (http://www.ebscohost.com/thisTopic.php?topicID=172&marketID=1) • Psycinfo (http://www.apa.org/psycinfo/) • National Guidelines Clearinghouse (NGC) (www.guideline.gov) • Agency for Healthcare Research and Quality (AHRQ) (http://www.ahrq.gov/clinic/epcix.htm) • Journals • EBP sites • Cochrane Collaborative (www.cochrane.org) • Joanna Briggs Institute (www.joannabriggs.edu.au) • Professional Groups • Patient groups
Step 3: What is Critical Appraisal? • Assessment of the evidence by systematically reviewing its validity & reliability to see how useful it can be in decision-makings • Make sense of the evidence • “Is evidence good enough to help making decisions?”
Step 3: Critically Appraising Evidence • Focus on three questions: • Validity: • Are the results of the study or systematic review valid? • Reliability: • What are the results? Are they reliable? • Applicability: • Are the findings clinically relevant to my patients? • Purpose is to determine value of research to practice. • Will be covered in Research Course
Why should we critically appraise? • Published research is not always reliable! • Published research is not always relevant! • Need a systematic framework to interpret research. • To assess clinical meaningfulness
Critical Appraisal • What is the paper about? • Do I trust it? • What did they find? • Is it relevant to my setting? • Many critical appraisal tools are available • Streamlined, rapid approach • Require understanding of basic statistics
Step 4: Integrating the Evidence • Dependent on the availability of valid, reliable evidence. • If evidence exists, it will be integrated with clinical expertise and patient preference to make decision. • Clinical judgment influences how patient preferences and values are assessed, integrated into decision making.
Step 5: Evaluating the Outcome • Evaluating outcome in health care providers’ own setting. • Important to consider bias introduction and confounding influences. • Patient evaluations of experiences as well as nurses’ evaluation must be considered. • Interdisciplinary collaboration is essential.
Step 6: Disseminating the Results • Poster • Staff meeting • Professional conference • Publication • Journal • Newsletter
Summary • EBP process is about making clinical decisions considering patient values, available evidences & clinician expertise. • EBP process promotes critical thinking skills. • EBP process requires computer literacy skills and critical appraisal skills.