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Evidence Based NursingProcess to PracticeBracken Health Sciences Library(adapted from a presentation of Dr. Norma MacIntyre,
School of Rehabilitation Therapy, Queen’s University)
The importance of evidence
The importance of evidence
N. MacIntyre, 2005
What is Evidence-Based Practice?
An approach to clinical practice
A way to keep current with new developments
Centre for Evidence-Based Medicine
What is Evidence-Based Practice?
… a methodological approach to clinical practice where evidence is used to inform decision-making about making a diagnosis (or interpreting a diagnostic test), selecting an intervention, or evaluating prognostic indicators
Health Information Research Unit, McMaster, 2002
What is Evidence-Based Practice?
… an approach to health care practice in which the clinician is aware of the evidence that bears on her clinical practice, and the strength of that evidence
J. A. Muir Gray, 1997
What is Evidence-Based Practice?
… an approach to decision making in which the clinician uses the best evidence available, in consultation with patient, to decide upon the option which suits that patient best
D. Sackett et al, 1996
What is Evidence-Based Practice?
Evidence based health care is
the integration of individual clinical expertisewith
the best available external clinical evidence and the values and expectations of the patient
N. MacIntyre, 2005
Evidence-Based Practice Involves life-long, self-directed, problem-
based learning
Involves exploring the relationship between clinical reasoning and research evidence
Involves practice
N. MacIntyre, 2005
Keeping Up? Do nothing … and get out of date Depend solely on courses/conferences Choose the main professional journal(s) and
read them cover to cover every month
Learn how to find and appraise the evidence to answer questions that come from clinical practice
Ontario College of Nurses, 2002
Evidence Based Nursing PracticeKnowledge Standard
Each nurse possesses, through basic education and continuing learning, knowledge relevant to her/his professional practice
Ontario College of Nurses, 2002
Evidence Based Nursing PracticeKnowledge 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
Ontario College of Nurses, 2002
Evidence Based Nursing PracticeKnowledge Standard Indicators
Seeking and reviewing research in nursing, health sciences and related disciplines
Using research to inform practice/professional service
Ontario College of Nurses, 2002
Evidence Based Nursing PracticeKnowledge Application Standard
Each nurse continually improves the application of professional knowledge
Ontario College of Nurses, 2002
Evidence Based Nursing PracticeKnowledge 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
Ontario College of Nurses, 2002
Evidence Based Nursing PracticeKnowledge Application Standard Indicators
Evaluating/describing the outcome of specific interventions and modifying the plan/approach
Integrating research findings into professional service and practice
Copyright ©2004 BMJ Publishing Group Ltd.
Thompson, C. et al. Evid Based Nurs 2004;7:68-72
The cognitive continuum.
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 and Relevance
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
PICO A clinical question should incorporate at least
three elements
Patient Age, sex, ethnicity, etc. Condition, diseases, general health status
Intervention Education, diagnostics, treatment plan, self-care,
etc.
PICO
Comparison Intervention Placebo, etc.
Outcome Expected and actual effects on patient
PICO
Do nurse led tobacco cessation interventions result in decreased smoking rates after hospital admission for coronary heart disease?
PICO
PATIENT (Adult) coronary heart patients Smokers Discharged from hospital
INTERVENTION Nurse led tobacco cessation programmes
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
PICO
Not all questions are of a clinical nature
Intervention can be interpreted very broadly
SUNY Downstate Medical Center, 2003
Evidence Pyramid
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.”
Claude Moore Health Sciences Library, 2003
Evidence Based Resources Models
Usefulness = Relevance x Validity Work
Claude Moore Health Sciences Library, 2003
Evidence Based Resources Models
Claude Moore Health Sciences Library, 2003
Evidence Based Resources Models
See you at the Search Sessions!
Mon. Sept. 24 OR Wed. Sept. 268:30 – 9:30
Bracken Library eLab