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Evidence-based PracticeWhat Does it Mean for Nursing?
Nancy WellsVanderbilt Medical CenterOctober, 2007
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What is evidence-based practice?
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Evidence-based Practice
Process by which clinical decisions are made using:
Best available research evidence
Clinical expertise
Patient preference
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Historical Perspective
Variation in practice leads to:
Variable quality of care
Higher cost of care
Potential for errors that may cause harm
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Translating research into practice
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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
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Identifying Practice Problem
Why are we doing this?
Why are we doing it this way?
Can we produce better outcomes with greater consistency?
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Clinical practice problems in your setting?
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Critically Evaluating Research
Literature review
Integrative literature review
Systematic literature review
Meta-analysis
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Strength of the Evidence
Level I – systematic review, met-analysis, well-designed RCTs
Level VII - opinion
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Resources for Reviews
Nursing journals
Clinical work station sitesUp-to-dateZynx
Eskind Digital LibraryCochrane Reviews
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Clinical Practice Guidelines
Agency for Healthcare Research & Quality (AHRQ)
Early examplesSkin integrityAcute pain guidelineUrinary incontinence
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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)
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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
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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?
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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
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Planned Change
Assess current practice (processes and outcomes)
Identify and implement changes to modify processes
Evaluate effects on processes and/or outcomes
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Evaluation
Processes of care
Outcomes of care
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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
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Groin Site Documentation
0
20
40
60
80
100
% d
ocu
men
ted
15 min 30 min 1 hour
Time Post-catheterization
Pre
Post
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Summary
Reduce variations in practice
Improve the quality of care provided
Maintain or improve patient outcomes