evidenced based nursing care process

8/2/2019 Evidenced Based Nursing Care Process

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With the advent of modern technology one

can have access to information at the tipof his fingers. Thus, we have a more

informed public who usually demand

quality services- services worth every

count of their money spent. In the healthcare scene, there is an increasing

emphasis on efficient, effective and safe

care. Nowadays, our patients expect care

based on best practice evidence. With thisexpectation, evidence-based practice was

born.


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Evidenced-based practice is the

implementation of evidence-based decisions.

Evidence-based decision making is the

conscientious, explicit and judiciousconsideration of the best available evidence

in the provision of health care.

Decision-making is an important element of

quality nursing practice. Many lives weresaved due to sound and timely decisions

made by the professional nurse.


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Is the process by which nurses make clinical

decisions using the best available expertise

and patient preferences.

Its aim is to promote the best nursing carepractice with regards to a particular area of

care. Expected outcome is a protocol of care

for the commonly met nursing problems in

any setting where the students have theirRLE.


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1. to identify common nursing problems met

in the clinical areas/community. 2. to search the literatures for relevant

researches.

3. to evaluate the research evidences using

established criteria for scientific merit. 4. to chose intervention and justify the

selection with the most valid evidence.

5.to develop an implementation strategy for

achieving the desired changes to nursing

care practice.


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Prerequisites needed for the practiceof EBN care process are:

Patient interviewing

Physical assessment

Application of the nursing process

And the practice of the continuouslife-long, self directed learning


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1. Interpreting and usingresearch findings in the care

of the patient2. Evaluating nursing care

practices

3. Conducting research


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Interpreting and using research findings in thecare of patient.

A. Related activities

A.1. identify a clinical problem questionrelated to the case assigned to thestudent.

Evidence-based practice always begins andends with the patient. A clinicalproblem/question arises out of the care of thepatient. The student identifies a clinical

problem/question. Out of the identifiedproblem the student constructs a well-builtquestion, phrased in such a way as to facilitatefinding an answer.


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Anatomy of a good clinical question consist

of:

1. patient or problema. How would you describe a group of

patients similar to yours?

b. What are the most important

characteristics of the patient? This may

include the primary problem, disease or co-

existing conditions.

c. Sometimes the sex, age, or race of apatient may be relevant to the diagnosis or

treatment of a disease.


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2. intervention, prognostic factor, or

exposure.

a. What main intervention, prognosticfactor or exposure are you considering

b. What do you want to do for the patient?

b.1. prevent a complication?

b.2. promote a healthy life style?

b.3. resolve a nursing problem?

b.4. facilitate nursing intervention?

c. What factor may influence theprognostic of the patient?

c.1. age?

c.2. co-existing problems?


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d. What was the patient exposed to?

d.1. cigarette smoke?

d.2. pollens?

d.3. asbestos?

d.4. others?


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3. Comparison

a. What is the main alternative to

compare with the intervention?

b. Are you trying to decide between two

interventions?

Note:

The clinical question does not always

need a specific comparison.


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4. Outcomes

a. What can you hope to accomplish,

measure or affect?

b. What are you trying to do for the

patient?

b.1. relieve or eliminate thesymptoms/discomfort?

b.2. reduce the number of adverse

events?

b.3. improve functions or testscores?


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The structure of the question may look like

this:

Patient/Problem Immediate post-partum

patient/distended bladderIntervention Acupressure

Comparison, if any Application of hot and

cold

Outcome/s Promotes urination; preventspost partum bleeding


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From the example, you can

construct a clinical question:

the immediate post-partum

patient, is acupressure more

effective than the application of hot

and cold in promoting urination and

preventing post-partum bleeding?


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Another example:

Patient/Problem Adult/ High Blood Pressure

Intervention Guided Imagery

Outcome Lowered blood pressure


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A.2. Literature search through the internet and

other sources.

The students searches for

constructed clinical question. The main

objective of this activity is to look for the best

evidence to answer the clinical question.

Rules of evidence

1. well-designed studies evidence

hierarchies

2. end-points important to patients- the

intervention makes the patient feel better or let

them live longer.


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3. clinical expertise

Requirement:

Journal report or Critical Appraisal of aTopic (CAT). Journal report is a tool to

assess, whether the journal is worth reading

or not. The student make a judgment about

an articles scientific merit and ultimateworth.


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1. Clinical Question

2. Citation: (Title of the Journal/Article on a

research related to your case)

3. Study Characteristics1. patients included (population and

sample)

2. interventions compared

3. outcomes monitored

4. does the study focus on a significant

problem in clinical practice?


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4. Methodology/Design

1. Methodology Used

2. Design

3. Setting4. Data Sources

5. Subject selection

a. Inclusion Criteria

b. Exclusion Criteria

6. Has the original study been replicated?

7. What were the risks and benefits of the

nursing action/intervention tested in the study?


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5. Results of the study

Discuss briefly the results of the study.

If the original study has been replicated,

are the findings similar in a variety ofsituations?

6. Authors Conclusions/Recommendations

1. What contribution to client health

status does the nursing action/interventionmake?

2. What overall contribution to nursing

knowledge does the study make?


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7. Applicability

1. Does the study provide a direct

enough answer to your clinical question in

terms of type of patients, intervention andoutcome?

2. Is it feasible to carry out the nursing

action in the real world?

8. Reviewers Conclusion/Commentary


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Evaluating Nursing Care Practices

The following aspect of quality are

considered when evaluating nursing care:

1. safety2. competence of the care provider

3. acceptability

4. effectiveness

5. appropriateness

6. efficiency

7. accessibility


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Conducting Research

Simple action, replicated researches will

be done by the students in partnership with

clinical instructors


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END

Thank you for listening

GOD Bless Us All!!!

Arceli C. Victoria RN MSN

evidenced based nursing care process

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