INTRODUCTION TO EVIDENCE BASED NURSING Assoc Prof Majda Pajnkihar, PhD Winter School 2015 Introduction Every day nurses perform interventions e.g. administering medication, educating clients, provide therapeutic interventions etc; This should stimulate questions about the evidence supporting their use of various
interventions. 2 Winter School 2015 What do we base our decision on? 3 Winter School 2015 How nurses base their nursing care? Pravikoff et al., 2005 surveyed 760 USA registered nurses working in clinical practice and found that:
67% get information for practice from other nurses, 58% do not use research reports to support their practice, 82% never used a hospital library, 54% were not familiar with term Evidence Based Practice, 67% never searched CINAHL Database, 72% hadnt evaluated research reports. 4 Winter School 2015 Evidence Based Practice Integration of best research evidence with clinical expertise and patient values
(Dave Sackett, 1996) Doing the right thing in the right way for the right patient at the right time. (Royal College of Nursing 1996, p. 3) 5 Winter School 2015 Evidence Based Practice EVIDENCE BASED MEDICINE EVIDENCE
BASED NURSING EVIDENCE BASED HEALTHCAR E Evidence Based Practice 6 Winter School 2015
Evidence Based Nursing BEST RESERCH EVIDENCE EBN EBN Context CLINICAL EXPERIENCE/ EXPERTISE PATIENT VALUES
7 Winter School 2015 What do you understand by the word evidence? 8 Winter School 2015 Evidence Evidence is a collection of facts that are belived to be true (Melnyk, & FineoutOverholt, 2011). Current best
research: evidence from clinical implies hierarchy of evidence. 9 Winter School 2015 Hierarchy of Evidence
10 Winter School 2015 Hierarchy of Evidence Is this hierarchy of evidence suitable for grading the evidence for a question: What is the perception of pain in patients with multiple sclerosis? Clinical question determines the type of research required for searching. We cannot reserach experiencing pain in patients with RCT.
detection intervention outcome control outcome Patients An experimental comparison study in which participants are allocated to treatment/intervention or control/placebo groups using a random mechanism. Best for
study the effect of an intervention. 12 Winter School 2015 Archie Cochrane supporter of RCT I had considerable freedom of clinical choice of therapy: my trouble was that I did not know which to use and when. I would gladly have sacrificed my freedom for a little knowledge. I had never heard then of 'randomised controlled trials', but I knew there was no real evidence that anything we had to offer had any effect on tuberculosis, and I was afraid that I shortened the lives of some of my friends by
unnecessary intervention." 13 Winter School 2015 Systematic review Sum up ov the best available research on a specific question; using transparent procedures to find, evaluate and
synthesize of relevant research. 14 Winter School 2015 15 Winter School 2015 Why EBN? Patients experience 28% better outcomes if they receive care based on the best and latest
evidence from well-designed studies compared to traditional practice (Heater et al. 1988). Without current best evidence practice is rapidly outdated often can be the detriment of patients (Melnyk & Fineout-Overholt, 2005) 16 Winter School 2015 Why is EBN important? Main aim is to improve client outcomes;
Ensure clinically effective health care; Improve peoples experience of illness & health care; Clients expect it; Improves clinicians knowledge; Communicates a professions research base; Stimulates clinically relevant research; Accountability. 17 Winter School 2015 Why is EBN important? Failing to use available science is costly and harmful. It leads to overuse of unhelpful
care, underuse of effective care and errors in execution 18 Winter School 2015 Overarcing Goal Safe, Effective Nursing Care. Our nursing care is only safer if we put into practice what we learn from research. 19 Winter School 2015
Why EBP matter to you? Higher level of satisfaction among healthcare providers who use evidencebased approach in delivering patient care than those who deliver care steeped in tradition (Dawes 1996). 20 Winter School 2015 I wonder e h
t lly a e r at h t ? e Is s a c
Having two nurses check medication orders prior to dispensing medication reduces the incidence of medication errors. e c n e d i v E
e h t e Show m 21 Winter School 2015 I wonder ? o s How
A Group therapy programme is more effective than a self help programme in promoting smoking cessation. e c n e d i v
E e h t e Show m 22 Winter School 2015 I wonder do e w
ld ? u s o i h h t , s bout H S GO ting a e m
o s Special toileting needs such as incontinence, urgency or diarrhoea is a factor that increases the likelihood of a patient falling in hospital. e c n e
d i v E e h t e Show m 23 Winter School 2015 Keeping up to date Nurses need to keep up to date and offer
best practice from the best evidence. EBN processes focus on incorporating good information seeking habits into daily routine (Melnyk & Fineout-Overholt, 2005). 24 Winter School 2015 EBN process (Polit, & Beck, 2012) 25
Winter School 2015 Asking the right question In patients living in a long-term care facility who are at risk for pressure ulcers (P), how does a pressure ulcer programme (I) compared to the standard of care (e.g. turning every 2 hours) (C) affect signs of emerging pressure ulcers (O)? 26 Winter School 2015 Asking the right question
27 Winter School 2015 Search for the best evidence Systems for Clinical Decision Support S-model (Haynes, 2006) Evidence Based Clinical Evidence, UpToDate
textbooks Evidence Based journal abstracts Systematic reviews Other reviews in DARE-database (Cochrane Library) Evidence Based Journals Cochrane Reviews (Cochrane Library), Clinical Queries (Ovid, Pubmed),
Original journal articles CENTRAL (Cochrane Library) Clinical Queries (Ovid, Pubmed) 28 Winter School 2015 Cochrane Library 29
Winter School 2015 Critically appraise evidence 30 Winter School 2015 Critically appraise evidence Using different critical appraisal questions, checklist and tools: CASP ... 31
Winter School 2015 Integrate the evidence Research evidence alone is not sufficient to justify a change in practice. Implementation of EBN is highly influenced by institutional and clinical variables. 32 Winter School 2015 Evaluate the evidence After implementing EBN, its important to
monitor and evaluate any changes in outcomes so that positive effects can be supported and negative ones remedied. 33 Winter School 2015 Evidence lost in translation Studies on evidence based recommendations in practice: 30-50% is not used. Studies on compliance: 30-50% of patients do not adhere well. For some clinical care and public health recommendations 50-75% of patients may not
profit (enough) from evidence. Many best practices in quality and safety are not adopted widely in health care (Flottorp, 2015). 34 Winter School 2015 Barriers of EBN (Melnyk & Fineout-Overholt, 2011) 35 Winter School 2015
Barriers of EBN (Melnyk & Fineout-Overholt, 2011) 36 Winter School 2015 Knowledge: the enemy of disease The application of what we know already will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade. Sir Muir Gray Director UK NHS
National Knowledge Service & NHS Chief Knowledge Officer 37 Winter School 2015 Viva La Evidence Never stop questioning! (Susan L. Hendrix) https:// www.youtube.com/watch?v=QUW0Q8tXV Uc 38
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