evidence-based practice what does it mean for nursing?
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Evidence-based Practice What Does it Mean for Nursing?. Nancy Wells Vanderbilt Medical Center October, 2007. What is evidence-based practice?. Evidence-based Practice. Process by which clinical decisions are made using: Best available research evidence Clinical expertise - PowerPoint PPT PresentationTRANSCRIPT
Evidence-based PracticeWhat Does it Mean for Nursing?
Nancy WellsVanderbilt Medical CenterOctober, 2007
What is evidence-based practice?
Evidence-based Practice
Process by which clinical decisions are made using:
Best available research evidence
Clinical expertise
Patient preference
Historical Perspective
Variation in practice leads to:
Variable quality of care
Higher cost of care
Potential for errors that may cause harm
Translating research into practice
Skills Required for EBP
Clearly identify practice problem or new knowledge ( innovation)
Find research literature
Critically evaluate research findings
Apply to practice through change process
Identifying Practice Problem
Why are we doing this?
Why are we doing it this way?
Can we produce better outcomes with greater consistency?
Clinical practice problems in your setting?
Critically Evaluating Research
Literature review
Integrative literature review
Systematic literature review
Meta-analysis
Strength of the Evidence
Level I – systematic review, met-analysis, well-designed RCTs
Level VII - opinion
Resources for Reviews
Nursing journals
Clinical work station sitesUp-to-dateZynx
Eskind Digital LibraryCochrane Reviews
Clinical Practice Guidelines
Agency for Healthcare Research & Quality (AHRQ)
Early examplesSkin integrityAcute pain guidelineUrinary incontinence
AHRQ Evidence-based Reports
Examples of reports availableCancer symptom management (2002)Coronary heart disease in women,
systematic review (2003)Mechanical ventilator criteria for weaning
(2000)Wound healing, laser treatment and
vitamin-assisted closure (2004)
Evidence-based Nursing Practice
AHRQ clinical nursing practice guidelines To be released in December
Joanna Briggs Institute (JBI) JBI Connect
National Guideline Clearinghouse Guidelines.gov
Application to Practice
Does the research apply to my patient population?
Would this practice change improve process of care? Patient outcomes?
Is there support for this practice change?
EBP Models
CURN project Research utilizationReview, synthesis, application, evaluation
Stettler Model of Research UtilizationCritical thinking & decision making
Iowa Model of Research in PracticeQuality assurance meets research utilization
Planned Change
Assess current practice (processes and outcomes)
Identify and implement changes to modify processes
Evaluate effects on processes and/or outcomes
Evaluation
Processes of care
Outcomes of care
Documentation of Groin Sites
Investigators: Stacy Sherrard, Grace Vincente & Felicia Lowe
1 month trial of education and coaching to improve documentation of groin sites post-catheterization
Groin Site Documentation
0
20
40
60
80
100
% d
ocu
men
ted
15 min 30 min 1 hour
Time Post-catheterization
Pre
Post
Summary
Reduce variations in practice
Improve the quality of care provided
Maintain or improve patient outcomes