Beruflich Dokumente
Kultur Dokumente
PRACTICE
SHARON A. DENHAM, PHD, RN, CNE
TWU, INTERIM ASSOCIATE DEAN
SDENHAM@TWU.EDU
OBJECTIVES
AT THE END OF THE SESSION, PARTICIPANTS WILL BE ABLE TO:
• DEFINE EVIDENCE-BASED NURSING PRACTICE AND ITS PURPOSES.
• IDENTIFY WHY EVIDENCE BASED PRACTICE IS CRITICAL TO CLINICAL PRACTICE.
• DESCRIBE SOME BARRIERS TO EVIDENCE-BASED PRACTICE.
• IDENTIFY WAYS TO SEARCH FOR THE BEST EVIDENCE.
• ASKING SEARCHABLE QUESTIONS AND KNOW THE TYPES OF EVIDENCE TO FIND.
• DISSEMINATE FINDINGS FROM SYSTEMATIC EVIDENCE-BASED REVIEWS
EVIDENCE-BASED PRACTICE IS NOT
• RESEARCH UTILIZATION
• QUALITY IMPROVEMENT
• PERFORMANCE IMPROVEMENT
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NURSING RESEARCH
• QUANTITATIVE STUDIES
• QUALITATIVE STUDIES
• TRIANGULATED APPROACHES/MIXED METHODS
QUANTITATIVE STUDIES
(HARD SCIENCE – NARROW FOCUS)
• USE OBJECTIVE QUANTIFIABLE DATA
• RANDOM CONTROL TRIALS, EXPERIMENTAL DESIGNS, QUASI-
EXPERIMENTAL DESIGNS, DESCRIPTIVE, CORRELATIONAL
• USE SURVEY INSTRUMENTS (MEASURE: KNOWLEDGE, BELIEFS,
ATTITUDES, EXPERIENCES)
Test Relationships
QUALITATIVE STUDIES
(SOFT SCIENCE – BROAD FOCUS)
Gain Insights
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EVIDENCE-BASED NURSING PRACTICE
• ABILITY TO ACCESS, SUMMARIZE, AND APPLY INFORMATION FROM TO
ADDRESS EVERY-DAY CLINICAL PROBLEMS
• EVIDENCE-BASED PRACTICE REQUIRES EMPHASIS ON SYSTEMATIC
OBSERVATION AND EXPERIENCE AND KNOWLEDGE OF THE RESEARCH
LITERATURE TO SUBSTANTIATE CLINICAL DECISIONS
EVIDENCE-BASED PRACTICE
• CONSCIENTIOUS PROBLEM-SOLVING APPROACH TO CAREGIVING
• INCORPORATES: (A) BEST RESEARCH EVIDENCE; (B) INDIVIDUAL’S
VALUES AND PREFERENCES; (C) CLINICIANS’ EXPERTISE
• NOT “THIS IS THE WAY WE HAVE ALWAYS DONE IT” --- INSTEAD,
PROVIDE HIGH QUALITY CARE BASED ON RESEARCH AND KNOWLEDGE
EVIDENCE-BASED PRACTICE
• RESULTS: BETTER CARE DELIVERY & DECISIONS
• CONTRIBUTES TO SCIENCE OF NURSING
• CURRENT AND RELEVANT PRACTICE
BARRIERS TO
EVIDENCE-BASED PRACTICE
• DO NOT VALUE RESEARCH IN PRACTICE
• LACK TIME TO READ RESEARCH
• RESEARCH REPORTS TOO COMPLEX
• DIFFICULT TO CHANGE PRACTICE
• LACK OF ADMINISTRATIVE SUPPORT OR KNOWLEDGEABLE MENTORS
• PROCESS SEEMS OVERWHELMING - LACK EDUCATION/UNDERSTANDING
ABOUT THE RESEARCH PROCESS & EVIDENCE-BASED PRACTICE
EVIDENCE BASED PRACTICE AND
CLINICAL NURSING PRACTICE
• MANAGE THE EXPLOSION OF RESEARCH FINDINGS THAT MAY
IMPROVE CLINICAL OUTCOMES
• RELIANCE ON TEXTBOOKS DOES NOT PROMOTE THE NEEDED
CRITICAL THINKING
• ENHANCE ABILITY TO MAKE QUALITY DECISIONS USING THE MOST
CURRENT & RELEVANT EXPERTISE/KNOWLEDGE
HIERARCHY OF EVIDENCE
LEVEL A:
• GOLD STANDARD: RANDOMIZED CONTROLLED TRIALS (RCT)
• SYSTEMATIC REVIEW OR META-ANALYSIS OF RELEVANT RCT
• CLINICAL PRACTICE GUIDELINES
LEVEL B:
• WELL-DESIGNED STUDIES (NOT RCT)
• CASE-CONTROLLED STUDIES
• UNCONTROLLED STUDIES (CONVENIENCE SAMPLES)
• EPIDEMIOLOGICAL STUDIES
• QUALITATIVE/QUANTITATIVE STUDIES (DESCRIPTIVE, CORRELATIONAL)
HIERARCHY OF EVIDENCE
LEVEL C:
• CONSENSUS VIEWPOINT AND EXPERT OPINION (USE WHEN NO QUANTITATIVE
OR QUALITATIVE STUDIES IN THE AREA OF INTEREST)
• META-SYNTHESIS (SYSTEMATIC REVIEW THAT SYNTHESIZES FINDINGS FROM
QUALITATIVE STUDIES)
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ASKING YOUR QUESTION
PICO IS A MNEMONIC - DESCRIBES 4 ELEMENTS OF CLINICAL QUESTIONS:
• P = POPULATION/PROBLEM - HOW DO YOU DESCRIBE THE PROBLEM OR
A GROUP OF SIMILAR PATIENTS?
• I = INTERVENTION - WHAT MAIN INTERVENTION, PROGNOSTIC FACTOR
OR EXPOSURE IS TO BE CONSIDERED?
• C = COMPARISON - IS THERE AN ALTERNATIVE TO COMPARE WITH THE
INTERVENTION?
• O = OUTCOME - WHAT DO YOU HOPE TO ACCOMPLISH, MEASURE,
IMPROVE OR AFFECT?
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Question Type Problem Intervention Comparison Outcome
Therapy Disease or Therapeutic Type of care, new Mortality rates,
Condition measure (e.g., intervention, work days lost,
medication, placebo pain, level of
surgery, life style) disability
Diagnosis Disease or Test or procedure Gold standard for Test utility, trends,
condition the problem diminished
complications, LOS