Best Practices Bsu

8/6/2019 Best Practices Bsu

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Developing Best Practices for the

Nursing Profession through Research

(Evidence-Based Practice in Nursing and

Health Care)

22ndnd Collegiate Nursing Research CongressCollegiate Nursing Research Congress

Erlinda Castro-Palaganas, PhD, RN

Benguet State University

November 27, 2010


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ObjectivesObjectives

At the end of the presentation, theAt the end of the presentation, the

participants will be able to:participants will be able to:

Explain the role of developing bestExplain the role of developing bestpractices vispractices vis----vis evidencevis evidence--based practicebased practice

in patient care outcomes in the context ofin patient care outcomes in the context of

research;research;

Appreciate role ofEBP in individual,Appreciate role ofEBP in individual,

organizational and community dynamics.organizational and community dynamics.


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Research Teaching

Community-

Engaged

Service

Practice-based

research

Community/community-oriented service

Academic community

practice

Community-

based learning

Practice-based

learning

Service-learning

Community-Engaged Teaching, Research and Service

Scholarship in discovery, integration, application and teaching.


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What is Nursing ResearchWhat is Nursing Research

Systematic inquiry designed to develop knowledgeSystematic inquiry designed to develop knowledge

about issues of importance to the nursingabout issues of importance to the nursing

professionprofession It is a diligent, systematic inquiry or study thatIt is a diligent, systematic inquiry or study that

validates and refines existing knowledge andvalidates and refines existing knowledge and

develops new knowledge; indicates planning,develops new knowledge; indicates planning,

organization and persistence.organization and persistence. The ultimate goal of research is the developmentThe ultimate goal of research is the development

of a research body of knowledge for a discipline orof a research body of knowledge for a discipline or

profession, such as nursing.profession, such as nursing.


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Why Nursing Research?Why Nursing Research?

Nursing is a practice profession, thus research isNursing is a practice profession, thus research isessential to develop and refine knowledge thatessential to develop and refine knowledge that

can be used to improve clinical practice.can be used to improve clinical practice.

Professional Nurses need to be able to:Professional Nurses need to be able to:

-- read research reports,read research reports,

-- identify effective interventions for practice, andidentify effective interventions for practice, and

-- implement these interventions to promoteimplement these interventions to promotepositive outcomes for patients and familiespositive outcomes for patients and families


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What is your role in nursingWhat is your role in nursing

research?research?

BSN: Critique research findings for use inBSN: Critique research findings for use in

practice; use research findings in practicepractice; use research findings in practice

MSN/MAN: Collaborate in research projects;MSN/MAN: Collaborate in research projects;

provide clinical expertise for researchprovide clinical expertise for research

PhD: Develop nursing knowledge throughPhD: Develop nursing knowledge through

research and theory development; conductresearch and theory development; conductfunded independent research projectsfunded independent research projects

PostDocPostDoc: Develop and coordinate funded: Develop and coordinate funded

research programsresearch programs


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How do we acquire knowledge inHow do we acquire knowledge in

Nursing?Nursing?

Knowledge is essential informationKnowledge is essential information

acquired in a variety of ways, expected toacquired in a variety of ways, expected to

be accurate reflection of reality, andbe accurate reflection of reality, and

incorporated and used to direct a personsincorporated and used to direct a persons

actions.actions.

The quality of nursing practice depends onThe quality of nursing practice depends on

the quality of the knowledge that youthe quality of the knowledge that you

acquired.acquired.


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How do we acquire knowledge inHow do we acquire knowledge in

Nursing?Nursing?

TraditionsTraditions

AuthorityAuthority

BorrowingBorrowing

Trial and ErrorTrial and Error

Personal Experience (Novice, advancedPersonal Experience (Novice, advanced

beginner, competent, proficient, expert)beginner, competent, proficient, expert) Role Modeling (mentorship)Role Modeling (mentorship)

IntuitionIntuition

Reasoning (Inductive vs. Deductive)Reasoning (Inductive vs. Deductive)


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For nursing as a discipline to beFor nursing as a discipline to beeffective in research, the focuseffective in research, the focus

of researchof research--directed activitydirected activity

should beshould be creating a culturecreating a culturewithin nursing that values,within nursing that values,

uses, and supportsuses, and supportsresearch.research.


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As practitioners of aAs practitioners of a

discipline, nurses mustdiscipline, nurses must

perceive that research isperceive that research isimportant in developingimportant in developing

evidenceevidence--based nursingbased nursing

practice in all settings andpractice in all settings andspecialties.specialties.


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Developing Best Practices

for the Nursing Profession

through Research: Buildingan Evidence-Based Practice


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From best evidence to bestFrom best evidence to best

practice: effectivepractice: effective

implementation of change inimplementation of change inpatients carepatients care

RichardRichard GrolGrol, Jeremy, Jeremy GrimshawGrimshaw


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What is Best Practice?What is Best Practice?

A best practice is aA best practice is a techniquetechnique,,

method, process, activity,method, process, activity,

incentive, or reward whichincentive, or reward whichconventional wisdomconventional wisdom regards asregards as

more effective at delivering amore effective at delivering a

particular outcome than any otherparticular outcome than any othertechnique, method, process, etc.technique, method, process, etc.

when applied to a particularwhen applied to a particular

condition or circumstance.condition or circumstance.


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Best Practices and EvidenceBest Practices and Evidence--

Based PracticeBased Practice

An approach to clinical practiceAn approach to clinical practice

A way to keep current with newA way to keep current with newdevelopmentsdevelopments


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What is EvidenceWhat is Evidence--BasedBased

Practice?Practice?

an approach to health carean approach to health carepractice in which the clinician ispractice in which the clinician is

aware of the evidence that bearsaware of the evidence that bears

on her/his clinical practice, andon her/his clinical practice, and

the strength of that evidencethe strength of that evidence


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What is EvidenceWhat is Evidence--BasedBased

Practice?Practice?

an approach to decision an approach to decision

making in which the clinician usesmaking in which the clinician uses

the best evidence available, inthe best evidence available, in

consultation with patient, toconsultation with patient, todecide upon the option whichdecide upon the option which

suits that patient bestsuits that patient best


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Therefore:

Evidence-Based Practice

is the use of the

best research, theory

or expert opinion, plusthe patients unique

circumstances and

personal values,combined with clinical

judgment to achieve

the best outcomes.


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Best Practice and EvidenceBest Practice and Evidence

Based Nursing PracticeBased Nursing Practice

Knowledge StandardKnowledge Standard

Each nurse possesses, through basicEach nurse possesses, through basic

education and continuing learning,education and continuing learning,

knowledge relevant to her/hisknowledge relevant to her/hisprofessional practiceprofessional practice


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Based Nursing PracticeBased Nursing PracticeKnowledge Standard IndicatorsKnowledge Standard Indicators

Providing a theoretical and/or evidenceProviding a theoretical and/or evidence--

based rationale for all decisionsbased rationale for all decisions

Understanding the knowledge requiredUnderstanding the knowledge requiredto meet the needs of complex clientsto meet the needs of complex clients

Knowing where/how to access learningKnowing where/how to access learning

resources when necessaryresources when necessary


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Knowledge Standard IndicatorsKnowledge Standard Indicators

Seeking and reviewing research inSeeking and reviewing research in

nursing, health sciences and relatednursing, health sciences and related

disciplinesdisciplines

Using research to informUsing research to inform

practice/professional servicepractice/professional service


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Knowledge ApplicationKnowledge Application

StandardStandard

Each nurse continually improvesEach nurse continually improves

the application of professionalthe application of professional

knowledgeknowledge


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Based Nursing PracticeBased Nursing PracticeKnowledge Application Standard IndicatorsKnowledge Application Standard Indicators

Ensuring practice is based in theory andEnsuring practice is based in theory and

evidence and meets all relevantevidence and meets all relevant

standards/guidelinesstandards/guidelines

Assessing/describing the client situation using aAssessing/describing the client situation using atheory, framework or evidencetheory, framework or evidence--based toolbased tool

Managing multiple nursing interventionsManaging multiple nursing interventions

simultaneouslysimultaneously


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Based Nursing PracticeBased Nursing PracticeKnowledge Application StandardKnowledge Application Standard

IndicatorsIndicators

Evaluating/describing the outcome ofEvaluating/describing the outcome of

specific interventions and modifying thespecific interventions and modifying the

plan/approachplan/approach

Integrating research findings intoIntegrating research findings into

professional service and practiceprofessional service and practice


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

The cognitive continuum.


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How to we derive evidence

best practice and EBP?Systematic reviews often involve

statistical integration of findings through

meta-analysis, a procedure whose

advantages include objectivity,

enhanced power, however, for broad

questions or when there is substantial

inconsistency of findings.Polit and Beck, 2008


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A Model for Evidence-based Practice

by Rosswurm & Larrabee (1999)

1.AssessNeed for

change

Includestakeholders

Collect internaldata aboutcurrent practice

Compare internaldata with externaldata

Identify problem

2.2. LinkProblem,interventions,outcomes

3.3.SynthesizeBest evidence

4.4. DesignPracticechange

5.Implement& evaluatechange in practice

Usestandardizedclassificationsystems andlanguage

Identifypotentialinterventionsand activities

Selectoutcomesindicators

Searchresearchliteraturerelated to majorvariables

Critique andweigh evidence

Synthesize

best evidenceAssessfeasibility,benefits andrisks

Defineproposedchange

Identifyneededresources

Planimplementation

processDefineoutcomes

Pilot studydemonstration

Evaluateprocess andoutcome

Decide toadapt, adopt,or reject

practicechange

Rosswurm, M. A. & Larrabee, J. H. (1999). A model for change to evidence-based practice. Image: Journal of Nursing Scholarship, 31(4), 317-322.doi: 10.1111/j.1547-5069.1999.tb00510.x

6.Integrate &Maintain change inpractice

Communicaterecommendedchange tostakeholders

Present staff inserviceeducation onchange inpractice

Integrate intostandards ofpractice

Monitorprocess andoutcomes


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SUNYDownstate Medical Center, 2003

Evidence PyramidEvidence Pyramid


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Evidence Based Resources ModelsEvidence Based Resources Models


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Evidence Based Resources ModelsEvidence Based Resources Models


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Best Practice and DecisionsBest Practice and Decisions

Towards ChangeTowards Change Make decisions about patient careMake decisions about patient care

Implement proven and accepted bestImplement proven and accepted best

practicepractice

Utilize to its maximum availableUtilize to its maximum available

resourcesresources

Advance profession, enhance quality ofAdvance profession, enhance quality of

life and learning, keep practice uplife and learning, keep practice up--toto--

date and currentdate and current


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Things that make us say,Things that make us say,

hmmmhmmm The use of evidence is critical toThe use of evidence is critical to

the novice and experienced nursethe novice and experienced nurse

Nursing practices are rooted inNursing practices are rooted intradition=outdatedtradition=outdated

Tradition and the oldTradition and the old--way do notway do not

lead to best practicelead to best practice

Research findings are notResearch findings are not

integrated into practiceintegrated into practice


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Reasons why Best Practices andReasons why Best Practices and

EBP is taking too long to take rootEBP is taking too long to take root

Attitudes: lack of value for researchAttitudes: lack of value for research

Presence of other goals with higherPresence of other goals with higher

priorities: money, leadership gradientpriorities: money, leadership gradient

Huge gap between information literacyHuge gap between information literacy

and computer skillsand computer skills

Limited access to high qualityLimited access to high qualityinformation resources (whats going oninformation resources (whats going on

with the rest of the world?)with the rest of the world?)


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The TasksThe Tasks--at Hand for theat Hand for the

developing best practice and EBPdeveloping best practice and EBP

Obtain knowledge and skillsObtain knowledge and skills

Disseminating that EBP improves careDisseminating that EBP improves careand outcomesand outcomes

Believing in the ability to foment changeBelieving in the ability to foment change

in the front line among healthcarein the front line among healthcare

practitionerspractitioners

Developing mentorship and practiceDeveloping mentorship and practice


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Gain administrative andGain administrative and

organizational buyorganizational buy--in in orderin in orderto be able to change policyto be able to change policy

where it is identified andwhere it is identified and

neededneeded

Develop common terms andDevelop common terms andprocesses to make EBP one ofprocesses to make EBP one of

the global languages of nursingthe global languages of nursing


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A Global LanguageA Global Language

Nursing researchNursing research

Nursing educationNursing education

EvidenceEvidence--based practicebased practice


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Congratulations !Congratulations !

You are doing your shareYou are doing your sharetowards developing besttowards developing best

practices and evidencepractices and evidencebasedbased--practice.practice.


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Thank You for Your Attention!


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ReferencesReferences

1. Ackley B,1. Ackley B, LadwickLadwick G, Swan B, TuckerS. EvidenceG, Swan B, TuckerS. Evidence--BasedBased

Nursing Care guidelines, MedicalNursing Care guidelines, Medical-- Surgical Interventions.Surgical Interventions.

Mosby ElsevierSt Louis Missouri, 2008.Mosby ElsevierSt Louis Missouri, 2008.

2.2. FineoutFineout--OverholtOverholt E,E, MelnykMelnyk B. Building a culture of bestB. Building a culture of bestpractice. Nurse Leader. 3:6, Dec 2005, pp 26practice. Nurse Leader. 3:6, Dec 2005, pp 26--3030

3.3. PolitPolit, D.F and Beck, C.T. Nursing Research: Generating, D.F and Beck, C.T. Nursing Research: Generating

and Assessing Evidence forNursing Practice. Lippincottand Assessing Evidence forNursing Practice. Lippincott

Williams and Wilkins, USA. 2008Williams and Wilkins, USA. 2008

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