Transcript 688-307 Nursing Research

Application of Research
into Practice: Using
Evidence-Based Practice
T. Heather Herdman, RN; PhD
Executive Vice President
Matousek & Associates, Inc.
[email protected]
Research in Practice
Evidence-based practice
A problem solving approach to practice
that involves the conscientious use of
current best evidence in making
decisions about patient care
Problem-Solving Approach
Incorporates:
Systematic search for and critical
appraisal of the most relevant
evidence to answer a burning
clinical question
One’s own clinical expertise
Patient preferences and values
Why Evidence-Based Practice?
If your child was born prematurely, would you want her
healthcare providers to give you information about how
other parents have coped with parenting a preterm infant,
based on evidence from well-designed qualitative and/or
descriptive studies?
If your mother was diagnosed with breast cancer and
needed to decide what type of treatment to choose, would
you want to know the evidence regarding the risks and
benefits of each treatment option as determined from
clinical trials with other similar cancer patients?
If you were in a car crash and were paralyzed, would you
want to know and use the most effective, empirically
supported treatment established through randomized
controlled trials to increase your chances of regaining
mobility and sensation?
Clinical Decision Making
Health care professionals face complex
decisions daily regarding patient care—and
must do so with decreased resources (less
staff—less money for equipment and
supplies—less TIME!!!)
What is an appropriate outcome for this
patient?
What intervention is most effective for getting
this patient to meet that outcome?
What is the most efficient method for providing
appropriate care for this patient?
Research – Practice Gap
Evidence indicates that patients
receiving care based on most up-todate information from research
studies experience 28% better
outcomes than those patients
receiving non-research based care
Only a small percentage of healthcare
providers incorporate research
findings into patient care
» Melnyk & Fineout-Overholt (2005)
Research – Practice Gap
It can take as long as 17 years to
translate research findings into
practice
How many lives are lost?
How many unnecessary
hospitalizations?
How many ineffective treatments?
How much unnecessary cost?
How much time wasted out of your work
day?
Patient Satisfaction
There is some evidence to indicate
that healthcare providers using
evidence-based practice receive
higher patient satisfaction scores that
those who do not
Provides more ability for nurses to
control their own practice
Increases nurse morale
Decreases nurse turnover
Key Steps of
Evidence-Based Practice
Ask the burning question (PICO
format whenever possible)
Patient population of interest
Intervention of interest/Interest area
Comparison of interest
Outcome of interest
Collect the most relevant and best
evidence to answer the clinical
question
Key Steps of
Evidence-Based Practice
Critically appraise the evidence for its
validity, relevance and applicability
Integrate the evidence with one’s own
clinical expertise, assessment of
patient condition & available
healthcare resources, along with
patient preferences and values to
implement a clinical decision
Evaluate the change resulting from
implementing evidence into practice
Barriers to
Evidence-Based Practice
“I’m a practitioner not a researcher!”
Lack of knowledge regarding EBP strategies
Misperceptions/negative views about research
Lack of time and resources to look for, read,
critique and implement research
Peer pressure—”We’ve always done it this
way”
Too much information to process
Lack of belief that EBP can improve outcomes
of care
Facilitators of
Evidence-Based Practice
Support/encouragement from
administration
Time to critically appraise studies and
implement their findings
Clearly written research reports
Implementation infrastructure
Shared vision/mission within the
healthcare team
Credibility of the research/guidelines
Questioning Clinical Practice
Encourage clinicians to ask questions
about their clinical practice (rather than
penalize them for being “difficult”!!!)
Does sucrose decrease pain in neonates?
Does nonnutritive sucking decrease pain in
neonates?
Does kangaroo care decrease pain in
neonates?
Which of these treatments is most effective?
Is one more effective than the others?
What does a cost-benefit analysis show when
comparing one treatment to the other?
Can we make a good clinical case for one treatment
over the other?
Questioning Clinical Practice
Encourage a reflective, inquiring
approach in all professional and
assistive staff
“Asking the right questions
takes as much skill
as giving the right answers!”
Robert Half
Questioning Clinical Practice
Use staff meetings more effectively to
discuss key areas of clinical practice
How do patients respond to interventions being
used?
Are there alternative treatments you can think
of that might have a better impact?
Are there things that you find really
dissatisfying about your practice?
What things cause patients the most
dissatisfaction?
Questioning Clinical Practice
Identify staff that are responsible for
scanning research literature on certain
topics and bringing in new articles for
clinical practice review
Consider research taking place in other
clinical practice settings
Look to the Centers for Evidence-Based
Practice that exist around the world
Germany, New Zealand, Australia, United
Kingdom, United States, Canada
Adopting Practice Change
Critique and synthesize research studies
and evidence-based clinical practice
guidelines
Team up with academicians
Find win-win situations for practice settings and
university settings
Decide whether or not findings should be
implemented into practice in your setting,
given your organization’s resources and
patient population
Adopting Practice Change
Consider:
How relevant is the research to practice?
Are the findings consistent across
studies?
Are there adequate studies and/or
sample sizes to make the findings
meaningful?
Is this change practical for your setting?
What is the risk of harm for the patients
and how does that compare to the
potential benefit for them?
Developing EBP
Protocols or Guidelines
Protocols or Guidelines provide:
Comfort for practitioners that the practice
changes are based on evidence versus
opinion or cost factors
The level of evidence available on the
topic
Guidance on how to implement the
practice change, and what parts of that
change are based on what level of
evidence
Implementing Practice Change
Diffusion of an innovation
Nature of the innovation
Manner in which it is communicated to
healthcare providers
Barriers include:
Conflicting research results
Research reports that are hard to understand
Lack of compilation of research evidence
Lack of providers knowledgeable about
research
Changing Clinical Practice
Results of 44 systematic reviews focused on the
effectiveness of strategies to change practice of
healthcare professionals
Passive dissemination of research is ineffective
Range of interventions found effective in changing
behaviors
Multifaceted interventions more likely to be effective than
single intervention
Individual provider beliefs, attitudes & knowledge impact
behaviors but organizational, economic and community
environments are also important
Diagnostic analysis should be done to identify barriers
and supportive factors likely to influence proposed
changes in practice
Successful strategies to change practice need to be
adequately resourced and require people with
appropriate knowledge and skills
Strategies for
Changing Clinical Practice
One-on-one sessions with health care educators
and staff to explain desired change
Manual & computerized reminders to prompt
behavior change
Educational meetings or in-services requiring
active participation of learners
Computerized information sources that are
interactive in nature
Audits & feedback in which clinical performance is
monitored through electronic database or chart
review
Direct observation and feedback
Conclusions
EBP is critical if we are to provide the
best care at the right time and at the
lowest cost
Efficiency
Effectiveness
Best outcome