Evidence Based Practice - American Nephrology Nurses Association
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Transcript Evidence Based Practice - American Nephrology Nurses Association
Created by Terran Mathers, PhD, RN
There is no conflict of interest in the creation of this education program.
Objectives
Explain the importance of Evidence Based
Practice (EBP) in nephrology nursing.
List the steps of EBP.
Identify four internet resources/databases
where previous research or guidelines
may be located.
Recognize potential barriers to EBP within
an organization so that strategies may be
planned to overcome them.
Introduction
Historical Background of EBP
1837: Pierre Louis
1970’s: Cochran Collaboration
1972: Briggs Report (DHSS)
2004: ANNA Nursing Research
Committee Survey
What is
Evidence-Based Research?
EBR defined: Clinically relevant research
based on medical science; this research is
patient-centered.
Research Utilization: Use of the
knowledge found from research,
usually based on a single study.
Cochrane Center (meta-analysis reviews)
(Melnyk & Fineout-Overholt, 2005; Sackett et al, 2000)
What Is
Evidence-Based Practice?
Assessment
Clinical Experience
And Expertise
Search and Appraisal
Of Evidence
Patient Preferences
& Values
Evidence Based Practice
**
Clinical Decision Making
Sackett et al, 2000; Melnyk & Fineout-Overholt, 2005
Why Evidence-Based Practice?
Quality Care
Cost
Containment
Positive
Patient
Outcomes
Enhance
Professional
Environment
Centers for
Evidence-Based Practice
www.ahrq.gov/clinic/epc/epcenters.htm
Blue Cross and Blue Shield Association
Duke University
ECRI
John Hopkins University
McMaster University
Oregon Health & Science University
RTI International – University of North Carolina
Southern California
Stanford University – University of California, San
Francisco
Tufts University – New England Medical Center
University of Alberta, Edmonton, Alberta, Canada
University of Minnesota, Minneapolis, MN
University of Ottawa, Ottawa, Canada
Steps of
Evidence-Based Practice
Step 1:
What is the
clinical question?
Melnyk & Fineout-Overholt, 2005
Ask the clinical question
in the “PICO” format
P=
I =
C=
O=
Patient Population / Disorder
Intervention or Interest Area
Comparison
Outcome
PICO
Example:
P = Elderly nephrology patients
I = Psychosocial issues
C = Effect on compliance
O = Patient will be able to adapt to
changes related to diagnosis
and treatment
Steps of
Evidenced-Based Practice
Step 2:
Find the best evidence to
answer the question
Systematic review of the literature
Meta-analysis or clinical practice
guidelines
Rigorous process
Preset criteria
Overcomes bias
Valid / credible results
Guideline Databases
National Guideline Clearinghouse (NGC)
http://www.guideline.gov
National Institute for Clinical Excellence (NICE)
http://www.nice.org.uk/catcg2.asp?c=20034
National Kidney Foundation K/DOQI Guidelines:
http://www.kidney.org/professionals/doqi/guidelineindex.cfm
Steps of
Evidence-Based Practice
Step 3:
Appraise the evidence
Critical Questions to Ask:
1. What were the results of the study?
2. Are the results valid?
3. Will the results facilitate patient care?
Steps of
Evidence-Based Practice
Step 4:
Integrate the evidence,
patient assessment
information, clinical
expertise, patient
preferences and values.
Steps of
Evidence-Based Practice
Step 5:
Evaluate the change
in the clinical area.
Implementing EBP:
The Barriers
Translating the meaning and
relevance of EBP
Knowledge deficit
Being overwhelmed by the
evidence
The need for dedicated time
Negative views about research
Organizational constraints
VanBuskirk, 2005; Melnyk & Fineout-Overholt, 2005
Facilitation of EBP
Promote Acceptance
Access with surveys; focus
groups
Identify baseline knowledge
Identify real case scenarios
Analyze the culture of the
environment
Facilitation of EBP
Correct Misperceptions
Have key leaders attend nursing
centers
Teach the basics of EBP (Online
Tutorials)
Expose to useful databases
EBP Online Tutorials
Evidence-Based Clinical Practice Tutorial
http://www.urmc.rochester.edu/hslt/miner/digital_library/eviden
ce_based_resources.cfm
Texas Health Science Center: Academic
Center for Evidence-Based Nursing
http://www.acestar.uthscsa.edu/
Evidence-Based Nursing
http://www.hsl.unc.edu/Services/Tutorials/EBN/index.htm
Facilitation of EBP
Question Clinical Practices
Prioritize problems
Utilize clinical practice
guidelines and research
Promote a culture of
organizational acceptance
for EBP
References
Honor Society of Nursing, Sigma Theta Tau
International (2005). Honor Society of Nursing, Sigma
Theta Tau International: Position statement on
evidence-based nursing. Indianapolis: Sigma Theta
Tau International.
Cowan, P. (2004). Advancing evidence-based practice
through meta-analysis. Nephrology Nursing Journal,
31(3), 343-345.
Gagan, M., & Hewitt-Taylor, J. (2004). The issues for
nurses involved in implementing evidence in practice.
British Journal of Nursing, 13(20), 1216-1220.
References
Gillis, A., & Jackson, W. (2002). Research for nurses:
Methods and interpretation. Philadelphia: F.A. Davis.
Larrabee, J. (2004). Advancing quality improvement
through using the best evidence to change practice.
Journal of Nursing Care Quality, 19(1). 10-14.
Malloch, K., & Porter-O’Grady, T. (2006). Introduction
to evidence-based practice in nursing and health care.
Boston: Jones and Bartlett.
Melnyk, B. M., & Fineout-Overholt, E. (2005).
Evidence-based practice in nursing and healthcare: A
guide to best practice. Philadelphia: Lippincott,
Williams, & Wilkins.
References
Pape, T. (2003). Evidence-based nursing practice:
To infinity and beyond. The Journal of Continuing
Education in Nursing, 34(4), 154-164.
Paramonczyk, A. (2005). Barriers to implementing
research in clinical practice. The Canadian Nurse,
101(3), 12-18.
Portney, L. (2004). Evidence-based practice and
clinical decision making: It’s not just the research
course anymore. Journal of Physical Therapy
Education, 18(3), 46-51.
References
Tod, A., Palfreyman, S., & Burke, L. (2004). Evidencebased practice is a time of opportunity for nursing.
British Journal of Nursing, 13(4), 211-216.
VanBuskirk, S. (2005). The value of evidence-based
practice in nephrology nursing. Nephrology Nursing
Journal, 32(2), 134-135.
Sackett, D. L., Straus, S. E., Richardson, W. S. et al.
(2000). Evidence-based medicine: how to practice
and teach EBM. London: Churchill, Livingstone.