laura banfield, nursing librarian health sciences library
DESCRIPTION
Introduction to Evidence-Informed Decision Making (EIDM). Laura Banfield, Nursing Librarian Health Sciences Library. September 2010. Learning Objectives. Review the definition of Evidence (Informed) Based Practice and the steps in the process Formulate questions using PICO and PS models - PowerPoint PPT PresentationTRANSCRIPT
Insp
ire.
Lead.
Enga
ge.
Laura Banfield, Nursing LibrarianHealth Sciences Library
September 2010
Introduction to Evidence-Informed Decision Making (EIDM)
Insp
ire.
Lead.
Enga
ge.
•Review the definition of Evidence (Informed) Based Practice and the steps in the process•Formulate questions using PICO and PS models•Introduce the concept of preprocessed evidence and the hierarchy of evidence•Identify databases and sources for locating pre-processed evidence
Learning Objectives
Insp
ire.
Lead.
Enga
ge.
“The integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making”
(Sackett et al., 2000)
Evidence-Informed Decision Making (EIDM)
Insp
ire.
Lead.
Enga
ge.
Clinical state, setting, and circumstances
Patient preferences and actions
Research evidence
Health care resources
Clinical ExpertiseClinical Expertise
Clinical Decisions
Insp
ire.
Lead.
Enga
ge.
1. Construct a relevant, answerable question from a clinical case.
2. 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.
Steps of EIDM
Insp
ire.
Lead.
Enga
ge.
1. Construct a relevant, answerable question from a clinical case.
2. 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.
Steps of EIDM
Insp
ire.
Lead.
Enga
ge.
Two Types of Clinical Questions:
1. Background
2. Foreground
Asking Clinical Questions
Insp
ire.
Lead.
Enga
ge.
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
Foreground questions are:• focused on the particular patient scenario, and
• ask for specific knowledge to manage the patient
Background & Foreground Questions
Insp
ire.
Lead.
Enga
ge.
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
Background & Foreground Questions
Insp
ire.
Lead.
Enga
ge.
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?
Background & Foreground Questions
Inspir
e.
Lead.
Enga
ge.
Two Major Research ‘Categories:’Quantitative Research
& Qualitative Research
Inspir
e.
Lead.
Enga
ge.
Two Major Research ‘Categories’
Quantitative Research is an “objective, systematic process to describe and test relationships and, examine cause and effect interactions among variables” (Burns & Grove, 1993, p. 777)
Qualitative Research is a systematic, subjective approach used to describe life experiences and give them meaning” (Burns & Grove, 1993, p. 777)
Insp
ire.
Lead.
Enga
ge.
•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
Quantitative Research
Insp
ire.
Lead.
Enga
ge.
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
Insp
ire.
Lead.
Enga
ge.
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
Quantitative Research Designs
Insp
ire.
Lead.
Enga
ge.
(Quantitative)
P -- Population/SituationI -- Intervention/ExposureC -- Comparison/Counter ExposureO -- Outcome
Formulating the Question
Insp
ire.
Lead.
Enga
ge.
Intervention
Is exercise more effective than rest for relieving chronic back pain?
Question
Insp
ire.
Lead.
Enga
ge.
PopulationInterventionComparisonOutcome
Question
People with back painExerciseBed restReduced pain
Insp
ire.
Lead.
Enga
ge.
Causation
Does the presence of hand sanitizer stations in nursing homes reduce the number of infections transferred to
residents?
Question
Insp
ire.
Lead.
Enga
ge.
PopulationExposureComparisonOutcome
Question
Nursing home residentsHand sanitizer stationsNo hand sanitizer Reduced infection
Insp
ire.
Lead.
Enga
ge.
• Aim is to discover meaning or gain understanding of a phenomena• Investigates a phenomena in-depth
Roberts & Burke (1989)
Qualitative Research
Insp
ire.
Lead.
Enga
ge.
•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
Insp
ire.
Lead.
Enga
ge.
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
Qualitative Research
Insp
ire.
Lead.
Enga
ge.
Formulating the Question
(Qualitative)
P -- PopulationS -- Situation
Insp
ire.
Lead.
Enga
ge.
How do people with HIV/AIDS living in a rural community feel about disclosing their status to
their health care provider?
Question
Insp
ire.
Lead.
Enga
ge.
PopulationSituation
Question
People with HIV/AIDSDisclosing their status
to their health care providers
Insp
ire.
Lead.
Enga
ge.
Hierarchy of Pre-processed Evidence
(Haynes, 2007)
Insp
ire.
Lead.
Enga
ge.
Support clinical decision making through linking all relevant best research evidence about a clinical situation
directly to a patient’s record.(Haynes 2008)
Sources of Systems•Integrative Electronic Patient Records
Systems
Insp
ire.
Lead.
Enga
ge.
“Summaries integrate best available evidence from lower layers … to provide a full range of evidence concerning
management options for a given health problem.”(Haynes, 2007)
Sources of Summaries•Clinical Practice Guidelines•Evidence Based Texts
Summaries
Insp
ire.
Lead.
Enga
ge.
Consolidate the literature on a specific topic:• comprehensive identification of studies• review of study relevance• evaluate methodologic quality• extraction and analysis of data• draw of conclusions
Sources of Synthesis•The Cochrane Library •Health Care Journals
Syntheses: Systematic Reviews
Insp
ire.
Lead.
Enga
ge.
Synopses
“Synopses of individual studies or systematic reviews encapsulate the key methodologic details and results required to apply the evidence to individual patient care.”
(Haynes, 2001)
Sources of Synopses • Database of Abstracts of Reviews of Effects (DARE)• health-evidence.ca• Evidence-based abstraction journals
Insp
ire.
Lead.
Enga
ge.
Single Studies are used:• To keep up with the literature• To update summaries and systematic
reviews• To contribute to clinical decisions if no
higher preprocessed level is available
Sources of Single Studies
•CINAHL•Medline
Single Studies
Insp
ire.
Lead.
Enga
ge.
Insp
ire.
Lead.
Enga
ge.
EBN Resources Page
http://hsl.mcmaster.ca/resources/topic/eb/nurse.html
Insp
ire.
Lead.
Enga
ge.
Dates to be announced…
Library Sessions