Transcript Excellence in Nursing Practice Through Research, EBP

Excellence in Nursing
Practice Through Research,
EBP & Application to
Bedside Patient Care
Chesapeake Bay Society of PeriAnesthesia Nurses
Saturday, February 8th, 2014
Kim A. Noble, PhD., RN, CPAN
© Copyright Kim A. Noble; use prohibited without permission
Part II
The Beginning: The PICO
Question; An EBP Start
Kim A. Noble, PhD., RN, CPAN
[email protected]
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Objectives
Following participation in this lecture,
the learner will:
 Discuss the steps in the EBP process;
 Describe examples of EBP changes in
perianesthesia nursing;
 Develop, compare and refine a
PICOT question.
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A Little History…
A paradigm shift…
 Moved from an age of experts,
wisdom and experience…
 To evidence…
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A Little More History…
Nursing education
 Diploma entry 
 ADN
 BSN entry
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Final History…
Medical research history…
 Archie Cochrane (1909-1988)
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Effectiveness and Efficiency: Random
Reflections on Health Sciences (1972)
Evidence Based Medicine (1992)
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A History of Nursing Research
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1900: AJN first published;
1923: First doctoral program in nursing at Teachers College:
Columbia;
1929: First masters program in nursing: Yale;
1950: ANA conducted study of nursing that led to 1959 first
standards;
1952: Journal of Nursing Research established;
1960-1970’s: Nursing models researched;
1970: ANA Commission on Nursing Research;
1970’s: Research added to BSN curriculum;
1972: Cochrane EBP established; qualitative research begins;
1980: First nursing research received federal funding.
1986: Nursing research included in NIH; 1993: NINR
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Evidence Based Practice
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What is Evidence Based
Practice (EBP)?
The Same as research….
 Based in research…
 But also Different from research…
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http://guides.mclibrary.duke.edu/content.php?pid=431451&sid=3529499
Look Closer at EBP
A foundation in Critical Thinking
 Explosion of journals
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http://sundayresources.net/neil/2013/01/03/evidence-based-practice-in-the-church-2/
Why Evidence?
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http://www.nsttac.org/content/evidence-based-practices
Why EBP Now?
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Why is nursing evidence so important:
High visibility of quality and safety
movement;
 Tremendous growth of new knowledge;
 Identification of delay in application of new
evidence;
 Decline in best-care knowledge for pt care;
 Tremendous consumer pressure.
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White & Dudley-Brown, 2012, p. 4-5.
EBP Process Begins with Ideas
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Come from your experience:
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Sacred cows?
Questions?
Ideas?
Guide practice change.
Base nursing practice on
research findings;
As the name implies…
What is YOUR question?
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Your Idea Leads to a Question:
PICO(T)
The Question guides the process.
 Define your question:
 P:
Population.
 I:
Intervention.
 C:
Comparison.
 O:
Outcome.
 T:
Timing.
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So…Where Do We Start?
Begin with a question…
 Your assignment…
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Let’s Look at the Question:
PICOT: Population
P:Population
 Gender
 Ethnicity
 Disease
 Think
about…
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PICOT: Intervention
 I:
Intervention (Indicator):
 Disease
exposure
 Risk behavior
 Prognostic factor
 Think
about…
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PICOT: Comparison
 C:Comparison
(Control)
 Placebo
 “Normal”
Treatment
 No disease
 No risk
 Think
about…
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PICOT: Outcome
 O:Outcome:
 Risk
of disease
 Accuracy of Diagnosis
 Rate of occurrence
 Think
about…
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PICOT: Timing
 T: Timing:
 Time
for outcome
 Length of study
 __# of sample
 Think
about…
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Types of Questions
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Therapy/Intervention:
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I
P
O
In __,
what is the effect of __
on __
compared
C
T
with__
within __?
Etiology
Diagnosis
Prevention
Prognosis/Prediction
Meaning
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The Question Forms the
Literature Review
Keywords.
 Exclusion & inclusion criteria.
 Search:
 CINHAL, Medline,
Cochrane, JBI.
 Records.
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YOUR new best friend!
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Research Review
Challenging!
 Strategies:
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 Spread
the
terror.
 Consistency
(tools).
 Practice improves ease.
 Mentoring process.
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Review Consensus
“Many hands makes light work.”
 This
case many eyes.
 Discuss the research.
 Consensus for ranking of research
evidence.
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Practice Recommendations
Translation of research
 practice.
 EBP recommendations
answer your question.
 Process can be used to
guide policy.
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References
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Boswell, C. & Cannon, S. (2007).
Introduction to Nursing Research:
Incorporating Evidence-Based Practice,
Sudbury, MA: Jones & Bartlett.
Malloch, K. & Porter-O’Grady, T. (2006).
Introduction to Evidence-Based Practice in
Nursing and Health Care, Sudbury, MA:
Jones & Bartlett.
White, K. M. & Dudley-Brown, S. (2012).
Translation of Evidence Into Nursing and
Health Care Practice, New York: Springer.
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