Transcript Ventilator Assisted Pneumonia - LSU Health Sciences Center

Clinical Science Investigator’s Toolkit:
An Evidence Based Practice
Resource for the Bedside Nurse
Beth Lacoste RN, APRN, CNS, MSN, CCRN
Nicole Jones RN-BC, APRN, CNS-BC, MN, CCRN, CCNS
Clinical Nurse Specialists, Critical Care Division
East Jefferson General Hospital
The presenters have no financial or
commercial conflicts of interest to
disclose.
Objective:
At the end of this presentation, the
participant will be able to:
• Describe the development and
implementation of a toolkit to engage
bedside nurses in applying a model
for EBP.
Evidence Based Practice
What we had in place at EJGH:
• Research Committee
• EBP Model
• EBP initiatives ongoing (quality improvement
focused)
• Center for Nursing Knowledge and Research
• Doctoral prepared Nurse Researcher
• ANCC Magnet re-designation survey
2006
• Surveyor feedback:
– It was evident that our practice was based
on research, however, many staff nurses
could not clearly articulate their
involvement in EBP initiatives
With this valuable feedback
our magnet journey continues.
Follow-up
Center for Nursing Knowledge and Research
• Nurse Researcher presented Unit-based
introduction to EBP throughout the
organization
• Staff nurses were encouraged to initiate unitbased clinical inquiry Projects
• Focus on staff level implementation of our
existing EBP model
CNS Assessment of Staff
Nurse Readiness:
• What was needed was a practical tool
to guide the staff nurse in the process of
changing or confirming current practice
based on evidence.
CNS Action:
The CSI
toolkit was
developed
as a stepby-step
guide to
applying
the EBP
model.
EBP Toolkit
• Intended for use by nurses with varied
educational preparation
• Serves to link the nurse with appropriate
experts
• Workbook that provides practical tips for how
and when to consult the nurse researcher,
Advanced Practice Nurse, Librarian and
leadership resources during the investigation
• Serves as a template for systematic
documentation so that the findings and
outcome of the process can be shared
Steps 1 and 2: Identify a Clinical
Question and Clarification/Prioritization
• Identifying a clinical problem
– Record background, event, or data that led
to this issue
• Clarifying it in the form of a focused
clinical question
• Identifying other clinicians/leaders who
may already be asking the same
question
Step 2: Engage Stakeholders
Calling all Detectives…..
Step 3: Evidence Review
• First: Institutional Evidence
– Search hospital intranet site for current
policy/ procedure/ protocol
• Second: Evidence-Based Practice
Guidelines
– Clinical Guidelines
• Internet search www.guidelines.gov
• Professional organization links on hospital
intranet
• Third: Research Literature
– EBSCO, Ovid resources
Step 3: Evidence Review
Research / Literature
“People” EJGH Resources for Searching:
– Hospital Librarian
– Nurse Researcher (Dr. Bihm x 4854)
– Clinical Educators (Center for Nursing
Knowledge and Research x 4279)
– Clinical Nurse Specialists in your area
Step 4: Evidence Synthesis
Do we have GOOD EVIDENCE to answer our clinical
question?
No
1. See EBP
Model
2. Consult Nurse
Researcher
3. Discuss
Findings
4. Consider
Research
Yes
Is the evidence applicable to your
patient population and practice
setting?
No
Yes
Do we need a
practice change?
No
Report Your FindingsInform
Go to Step VII
Yes
Planning Practice
Change
Go to Step V
Merged statistical results from
a number of related studies
Levels of Evidence
Comprehensive unbiased
analysis using a strict scientific
design to assess related studies
Research studies in which treatment and
control groups are randomly assigned
“gold standard of experimental design”
Systematically developed
statements by a group of experts
to assist practitioner decisions
Scholarly analysis of a body of research
about a specific issue or topic
Research studies where a
design other than random
sampling is used.
Step 5:
Planning Practice Change
• Meet with your leadership
– How do we go about implementing this evidence into
our hospital practice?
– Should we:
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Change an existing policy?
Create a new policy?
Purchase new equipment?
Do staff education?
– Resource: Planning Practice Change Worksheet
Step 6: Implement and Evaluate
EBP Change
• Record pertinent info about:
– How and when you made the change
– Any outcomes you might have measured
following the change
– Overall outcome of the change
Step 7: Inform and Integrate
into Practice Standards
• Make a poster to share
the results of your
investigation
• Bring suggestions for
policy changes to the
appropriate Shared
Governance Council
• Bring your toolkit to the
Center for Nursing
Knowledge and
Research – a copy will
be made as a lasting
resource
Encouraged staff to:
• Be Creative
• Share your CSI Journey
• Convince others that the change is based
on good evidence!
• Help others bridge the gap between
research and practice.
• Consider presenting findings at a local or
national conference.
CSI-EJ
(Clinical Science Investigation)
Objectives
At the end of today, you will be able to:
1. Apply the EJGH EBP Model in clinical
practice.
2. Gain skills to effectively search
scientific literature using EJGH online
resources.
3. Evaluate literature for strength of
evidence and applicability to practice.
Step 3 – Evidence Review
Evidence Critique
Journal Club
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Title
Date and Publication
Purpose
Setting
Population
Were the methods used logical and well carried out?
Was the study well designed?
Do you think the author’s conclusions are valid?
How does this study relate to your clinical population?
EBP Detective Training
Workshop Outcomes
• Over 60 interdisciplinary team members
attended
• Identified areas for further education
• Research Critique class offered – staff
nurses and leadership attended
• Statistics class planned for the future
Toolkit Evaluation
• Many units have completed Clinical Science
Investigations using the toolkit
• EBP Day conducted to share results
– Staff posters and completed toolkits
• Toolkit presented at National Magnet and
Critical Care Nurses Conferences
• Ongoing use of the toolkit allows us to refine
the toolkit as a resource to engage the
bedside nurse in application of the EJGH
EBP model.