evidence-based practice back to the basics anne burnett, rn-bc, msn, crrn veterans healthcare system...
TRANSCRIPT
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Evidence-Based PracticeBack to the Basics
Anne Burnett, RN-BC, MSN, CRRN
Veterans Healthcare System of the Ozarks
April 4, 2011
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Learning Objectives
• Evidence-Based Practice History
• EBP Process
• An Example of Using EBP
• ABC Mnemonic
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Florence Nightingale
“The most important practical lesson that can be given to nurses is to teach them what to observe – how to observe – what symptoms indicate improvement – what the reverse – which are of importance – which are of none”.
(Nightingale, 1860)
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Translation
• Teach nurses what is important to monitor
• How to monitor it
• What trends show improvement
• What trends show negative change
• Which indications are important
• Which indications don’t matter
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Professional Nursing
• Information– Collecting– Interpreting– Evaluating
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EBP Defined
• Combines– Research – Data Collection– Nurse experience– Patient wishes and needs
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DATA
• Nursing Assessment
• Observations
• Collecting
• Care improvement
• Evaluating
• Sharing
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Academic & Publishing Landmarks
• 1860
• 1873
• 1900
• 1907
• 1912
• 1923
• 1923
• 1929
• 1952
• Nightingale
• Hospital RN Programs in US
• American Journal of Nursing
• Teacher’s college of Columbia
• National League of Nursing Education
• 1st Doctoral Program in Nursing Education
• Goldmark Report
• 1st Master of Nursing
• Nursing Research Journal
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Key Drivers for the 20th Century
• Nursing Research Conferences – 1960’s– American Nurse’s Association
• Building Foundations– Developing Academic Programs
• Frameworks and understanding research– The Practice of Nursing Research– Burns & Grove, 1980’s
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Key Drivers for the 21st Century
• Formalizing five steps of EBP– Melnyk & Fineout-Overholt; Evidence-Based Practice
in Nursing & Healthcare
• Nursing developing a researched body of knowledge– Boswell & Cannon; Introduction to Nursing Research
Incorporating Evidence-Based Practice
• EBP Conferences– Locally, Regionally, Nationally
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Veterans Healthcare System of the Ozarks
• EBP Council
• Made up of nurses from diverse care delivery areas: – Acute care– Surgery– Outpatient areas– Psychiatric care
(Boswell & Cannon, Ch.1; Hockenberry, et al; Mantzoukas; Titler; Turkel, et al)
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Challenges & Solutions
• Challenges– Culture Changes– Introducing EBP– Implementing EBP– Educational Gaps– Prior Experience
• Solutions– Education for staff
& the council– Poster Presentations– Developing
Nursing Projects– Research Critiques
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EBP Council
• Serves as resource– Developing Change Strategies
• Share information– How to access research
• Guiding staff to other change venues– Appropriate change process– Example the Watson Theory Project
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Integrating EBP
• Studies on how to integrate EBP• Culture of change• Recent research developments• Nurse Empowerment
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Skills
• Developing skills• Overcoming resistance to change• Engaging staff
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Mnemonic Development
• Mnemonics have been used by nurses for years
• Tool to integrate multiple step processes
• ADPIE
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Mnemonic
• Reduce volumes of information
• Helps sequence– Complex information
• Building Blocks for EBP
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The ABCs of EBP
= Ask
= Consider
= Facilitate
= Books
= Develop
= Evaluate
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A = Ask the Question
• A is the essence of EBP
• Melnyk & Fineout-Overholt – “BURNING QUESTION”
• Right Question
• Right way
• Key to using EBP
• A has a secondary mnemonic:– PICOT
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PICOT Format
• P = Population.
• I = Intervention.
• C = Comparison.
• O = Outcome.
• T = Time.
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Secondary Mnemonic
• PICOT
• Filtering
• Project Goals
• Focus the research
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Goals for PICOT
• Application of the collected evidence
• Narrow focus
• End product
• Application
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PRACTICE PICOT
• So this sample question reads:
• Does this diabetic teaching tool help my diabetic patients reduce their A1c in six months compared to the current process we use?
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Example of the PICOT
• Population: Diabetic patients
• Intervention: Diabetic teaching tools
• Comparison: A1c prior to the education
• Outcomes: A1c after the education
• Time: 3 months, 6 months, Ongoing
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ABCs of EBP
= Ask
= Books= Consider
= Develop
= Evaluate
= Facilitate
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B = Books
• B stands for books; meaning research• Use the question to narrow the search to
manageable amounts• Internet search engines & research sites• http://www.ahrq.gov • http://www.cdc.gov
(Boswell & Cannon, Ch.7; Burns & Grove, Ch.2; Melnyk & Fineout-Overholt, Ch.3)
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B = Books
• Using Search engines & sites
• Nursing Organizations
• On-line libraries at work or school
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Caution!!!!
• CINAHL Full Search under EBSCO Host• First run: Diabetes
– 57,163 results• Second run: narrow dates
– 35,672• Third run: add ‘education’
– 1,623• Fourth run: add ‘tool’
– 1 study
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ABCs of EBP
= Ask
= Books
= Consider= Develop
= Evaluate
= Facilitate
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C = Consider
• Evaluate the research• Tool developed• Using the tool
(Boswell & Cannon, Ch.5, Burns & Grove, Ch.2 4; Mantzoukas; Melnyck &
Fineout-Overholt, 2005, Ch. 5)
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Research Evaluation ToolArticle Title
Target Population/is it applicable here?
What was tested/ is it applicable
Dates Strengths of Study
Weaknesses of study
Other comments/citation if indicated
Dick & Jane look for
Spot.
2 children looking for dog.N/A we don’t have pediatrics here.
Ф
Tested methods to look for dogs.N/A we don’t have dogs here.
Ф
This study is not dated. I would guess 1940’s.
Ф
In-depth casestudy.
Ф
Only 2 subjects. Needs larger sample size.
Ф
Citation if the study is going to be used to build a paper, or develop further research.Comments if the study might be used for something in the future.
ФAny other brief memory joggers you want to add.
Boswell & Cannon, p.108; Mantzoukas)
You might get ideas for other search parameters
Use them as a pilot study
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ABCs of EBP
= Books
= Ask
= Consider
= Develop= Evaluate
= Facilitate
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D = Develop & Apply
• Develop and apply the intervention being considered
• Use specific steps, specific details in order to make the project manageable
• Specific to your patient population
(Melnyk & Fineout-Overholt, Ch.10)
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Develop the EBP Project
• Does this tool help my diabetic patients reduce their A1c in six months compared to the current process we use?– Tool adjusted for your patient population– Instructions for staff – Instructions for patients
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ABCs of EBP
= Ask
= Books
= Consider
= Develop
= Evaluate= Facilitate
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E = Evaluate
• Evaluating care delivery should be second nature for nurses
• Familiar from the nursing process
• Collecting data to drive the evaluation
• Statistical analysis may be necessary
• Decide what is going to be measured
(Boswell & Cannon, Ch.9; Melnyk & Fineout-Overholt, Ch.10 & 11)
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Chocolate
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Evaluate Results of the Project
• Does this tool help my diabetic patients reduce their A1c in six months compared to the current process?– Run A1c– Count – Pre/Post Test– Questionnaires
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Note
• Research
• Ethics
• Privacy
• Institutional Review Board
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ABCs of EBP
= Ask
= Books
= Consider
= Develop
= Evaluate
= Facilitate
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F = Facilitate
• Facilitate EBP
• Academic Growth
• Professional Growth
• Skills Development
• Share Project Findings
(Melnyk & Fineout-Overholt, Ch.14)
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Evidence at Work in Practice
• Fact sheets for nurses
• Publish research article reviews
• Share findings
• Attend conferences
• Support other staff development
• Culture changes
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Getting EBP to the Staff
• Power Point Presentation
• New employee orientation
• Introduces new staff to our cultural environment
• EBP not in original curricula
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Thank You
• “Let whoever is in charge keep this simple question in her head:– Not how can I always do this right thing
myself, but how can I provide for this right thing to be always done?”
– Florence Nightingale, 1860
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The Answer is EBP!
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Questions?
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References
• Boswell, C. & Cannon, S. (Eds.) (2007). Introduction to nursing research: Incorporating evidence-based practice, p.108. Sudbury, MA: Jones & Bartlett.
• Burns, N., & Grove, S. (2005) The practice of nursing research ch.2, (5th ed.), Elsevier.
• Bradshaw, W. (2010). Importance of nursing leadership in advancing evidence-based practice. Neonatal Network, 29(2), 117-122.
• Dontje, K. (2008). Evidence-based practice: Understanding the process. Topics in Advanced Practice Nursing eJournal, 7(4). Retrieved May 13, 2010 from http:www.medscape.com/viewarticle/567786.
• Hockenberry, M., Walaen, M., Brown, T., Barrera, P. (2008). Creating an evidence-based practice environment: One hospital’s journey. Journal of trauma nursing, 15(3) p.136-142.
• Ireland, M. (2008) Assisting students to use evidence as a part of reflection on practice. Nursing Education Perspectives, 29(2) p.90-93.
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References
• Melnyk, B, & Fineout-Overholt, E. (Eds.). (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. (Ch1) Philadelphia:Lippincott Williams & Wilkins
• Nightingale, F. (1860). Notes on nursing: What it is and what it is not. Dover edition, NY, 1969 (original work published by D. Appleton and company, 1860).
• Seben, S., March, K., Pugh, L. (2010). Evidence-based practice: The forum approach. American Nurse Today, 5(11) p.32-34.
• Titler, M. (2010). Chapter 7, The evidence for evidence-based practice implementation.
• Retrieved Sep. 29, 2010 from http://wwwahrq.gov/qual/nurseshdbk/docs/TitlerM_EEBPI.pdf