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Evidence-based Practice What Does it Mean for Nursing?

Nancy Wells Vanderbilt Medical Center October, 2007

What is evidence-based practice?

Evidence-based Practice
Process by which clinical decisions are made using:

Best available research evidence Clinical expertise Patient preference

Historical Perspective
Variation in practice leads to:

Variable quality of care Higher cost of care Potential for errors that may cause harm

Translating research into practice

Skills Required for EBP

Clearly identify practice problem or new knowledge ( innovation) Find research literature Critically evaluate research findings Apply to practice through change process

Identifying Practice Problem

Why are we doing this? Why are we doing it this way? Can we produce better outcomes with greater consistency?

Clinical practice problems in your setting?

Critically Evaluating Research

Literature review Integrative literature review Systematic literature review Meta-analysis

Strength of the Evidence


Level I systematic review, met-analysis, well-designed RCTs

Level VII - opinion

Resources for Reviews

Nursing journals Clinical work station sites


Up-to-date Zynx

Eskind Digital Library

Cochrane Reviews

Clinical Practice Guidelines

Agency for Healthcare Research & Quality (AHRQ) Early examples


Skin integrity Acute pain guideline Urinary incontinence

AHRQ Evidence-based Reports


Examples of reports available Cancer symptom management (2002) Coronary heart disease in women, systematic review (2003) Mechanical ventilator criteria for weaning (2000) Wound healing, laser treatment and vitamin-assisted closure (2004)

Evidence-based Nursing Practice

AHRQ clinical nursing practice guidelines

To be released in December

Joanna Briggs Institute (JBI)

JBI Connect

National Guideline Clearinghouse

Guidelines.gov

Application to Practice

Does the research apply to my patient population? Would this practice change improve process of care? Patient outcomes?

Is there support for this practice change?

EBP Models

CURN project Research utilization

Review, synthesis, application, evaluation

Stettler Model of Research Utilization

Critical thinking & decision making

Iowa Model of Research in Practice

Quality assurance meets research utilization

Planned Change

Assess current practice (processes and outcomes) Identify and implement changes to modify processes

Evaluate effects on processes and/or outcomes

Evaluation

Processes of care Outcomes of care

Documentation of Groin Sites

Investigators: Stacy Sherrard, Grace Vincente & Felicia Lowe 1 month trial of education and coaching to improve documentation of groin sites post-catheterization

Groin Site Documentation


100 80 60 40 20 0 15 min 30 min 1 hour Time Post-catheterization Pre Post

% documented

Summary

Reduce variations in practice Improve the quality of care provided Maintain or improve patient outcomes

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