2007 Fall - Nursing 305 - Evidence Based Nursing Presentation

7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation

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Evidence Based NursingProcess to PracticeBracken Health Sciences Library(adapted from a presentation of Dr. Norma MacIntyre,

School of Rehabilitation Therapy, Queens University)


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The importance of evidence


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The importance of evidence


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N. MacIntyre, 2005

What is Evidence-Based Practice?

An approach to clinical practice

A way to keep current with newdevelopments


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Centre for Evidence-Based Medicine


a methodological approach to clinical practice

where evidence is used to inform decision-makingabout making a diagnosis (or interpreting adiagnostic test), selecting an intervention, orevaluating prognostic indicators


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Health Information Research Unit, McMaster,2002


an approach to health care practice in which the

clinician is aware of the evidence that bears on herclinical practice, and the strength of that evidence


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J. A. Muir Gray, 1997


an approach to decision making in which theclinician uses the best evidence available, inconsultation with patient, to decide upon the optionwhich suits that patient best


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D. Sackett et al, 1996


Evidence based health care

isthe integration of individual clinical expertise

with

the best available external clinical evidence and

the values and expectations of the patient


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N. MacIntyre, 2005

Evidence-Based Practice

Involves life-long, self-directed, problem-basedlearning

Involves exploring the relationship between clinicalreasoning and research evidence

Involves practice


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N. MacIntyre, 2005

Keeping Up?

Do nothing and get out of date

Depend solely on courses/conferences

Choose the main professional journal(s) and readthem cover to cover every month

Learn how to find and appraise the evidence to

answer questions that come from clinical practice


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Ontario College of Nurses, 2002

Evidence Based Nursing Practice

Knowledge Standard

Each nurse possesses, through basic education and

continuing learning, knowledge relevant to her/hisprofessional practice


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Knowledge Standard Indicators

Providing a theoretical and/or evidence-based rationale for all

decisions Understanding the knowledge required to meet the needs of

complex clients

Knowing where/how to access learning resources when

necessary


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Knowledge Standard Indicators

Seeking and reviewing research in nursing, health sciences

and related disciplines

Using research to inform practice/professional service


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Knowledge Application Standard

Each nurse continually improves the application of

professional knowledge


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Knowledge Application Standard Indicators

Ensuring practice is based in theory and evidence and meets

all relevant standards/guidelines Assessing/describing the client situation using a theory,

framework or evidence-based tool

Managing multiple nursing interventions simultaneously


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Knowledge Application Standard Indicators

Evaluating/describing the outcome of specific interventions

and modifying the plan/approach

Integrating research findings into professional service andpractice


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Copyright 2004 BMJ Publishing Group Ltd.

Thompson, C. et al. Evid Based Nurs 2004;7:68-72

The cognitive continuum.


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N. McKibbon, 1999

Five Steps of Evidence-Based Practice

Define the Question

Identify Question ~ Search and Screen Literature ~Refine Question

Collect the Evidence

Critically Appraise the Evidence for Validity andRelevance


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N. McKibbon, 1999

Five Steps of Evidence-Based Practice

Integrate the Evidence and Patient Factors

Make & Carry Out the Decision

Evaluate the Process Results ~ Self-reflection


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PICO

A clinical question should incorporate at least threeelements

Patient Age, sex, ethnicity, etc.

Condition, diseases, general health status

Intervention Education, diagnostics, treatment plan, self-care, etc.


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PICO

Comparison Intervention

Placebo, etc.

Outcome

Expected and actual effects on patient


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PICO

Do nurse led tobacco cessation interventions result

in decreased smoking rates after hospital admissionfor coronary heart disease?


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PICO

PATIENT

(Adult) coronary heart patients

Smokers

Discharged from hospital

INTERVENTION

Nurse led tobacco cessation programmes


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PICO

COMPARISON

(Non-nurse led tobacco cessation programmes

Self-administered, non-nurse administered, etc.)

No comparison

OUTCOME

Lower rates of tobacco use among Patient group


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PICO

Not all questions are of a clinical nature

Intervention can be interpreted very broadly


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SUNY Downstate Medical Center, 2003

Evidence Pyramid


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SUNY Downstate Medical Center, 2003

Evidence Pyramid

Important medical questions are typically studied more than

once, often by different research teams in different locations.

A meta-analysis combines results from different studies,hopefully averaging out any differences caused by random

change or local variation and getting at something close to

the real truth. In general a meta-analysis, if you can find one,

will be a better guide to practice than an individual article.


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Claude Moore Health Sciences Library, 2003

Evidence Based Resources Models

Usefulness = Relevance x ValidityWork


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See you at the Search Sessions!

Mon. Sept. 24 ORWed. Sept. 26

8:30 9:30Bracken Library eLab

Documents

2007 Fall - Nursing 305 - Evidence Based Nursing Presentation