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Presented by:
Billy Bevill, MSN, RN
=bjectives
1. Introduce and discuss the concept of
Evidence Based Practice.
2. =verview the state and national trends
in Evidence Based Practice.
3. Share local efforts to improve
Evidence Based Practice.
Klash Poll: EBN
‡ How many of you
could give me a
definition of
Evidence Based
Nursing?

‡How many of you


believe your employers
support EBN?
‡ Evidence-based
practice in practice

‡ Teaching Evidence-
based practice

‡ Evidence Based
Practice in North
Carolina
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In Clinical Practice
@efining EVP
‡ Sackett:
± "Evidence based medicine is the
conscientious, explicit, and judicious use of
current best evidence in making decisions
about the care of individual patients. The
practice of evidence based medicine
means integrating individual clinical
expertise with the best available external
clinical evidence from systematic
research."
ëessenich
‡ EBP involves an ability to access,
summarize, and apply information from
the literature to day-to-day clinical
problems. EVP also requires an
emphasis on systematic observation
and experience and a reliance on
research literature to substantiate
nursing decisions.
Klash Poll: Process
‡ How many of you
can recite the steps
in the nursing
process?
‡How many of you can recite
the steps for Evidence Based
Practice?

‡How many of you can


state the elements of a
clinical question for EBP?
Steps to
Evidence-Based Nursing

1. Kormulate answerable clinical


questions
2. Search for the best evidence
3. Critically appraise the evidence
4. Integrate evidence into practice
5. Evaluate the results
6. @isseminate the evidence
Kormulate answerable clinical
questions

Essential Elements to a Good


Question
‡ Situation
‡ Intervention
‡ =utcome
Situation
The patient or problem being addressed

± Individual (a client
with«)
± Group (clients
with«)
± Population (children
with . . .)
± May be aspect of
care delivery
± Managing an aspect
of organizing care
Intervention
The dimension of health care of interest

‡ Therapeutic
‡ Preventive
‡ @iagnostic
‡ Managerial
‡ Economic
=utcomes
What you want to know

Situation
+
Intervention
=
=utcome
@o Children have fewer site reactions
When Klu vaccine is administered with a
1/2 inch or a 1/4 inch needle?

Situation = children
Intervention =needle size in administration of flu vaccine
=utcome = site reactions
Evidence Based
Practice
@oes not equal
Research
Klash Poll-Information Search
‡ How many of you
search the internet
for information to
help you nursing
practice?
‡How many use Google
or other generic search
engines?

‡How many use


CINAHL or Medline?
r

r    


| 
Textbooks and Journals
‡ Textbooks
± Gross anatomy
± Basic principals
± Symptoms
‡ Journals
± Current research
± Current practice
± Changing practice
±  r 
Bibliographic @atabases
‡ CINAHL-
± Cumulated Index to Nursing and
Allied Health Literature
‡ @atabase roots in 1940
‡ 650 English Language Journals
‡ Citations and abstracts not full articles
Acquire the Information
Bibliographical @atabases
‡ Medline-
± US National Library of Medicine
‡ Publications from 1966
‡ 3500 journals
‡ Citations and abstracts
‡ Covers all areas of healthcare, esp. research
Kull Text @atabases
‡ Most universities and colleges
subscribe to various databases that
allow access to full text articles
‡ Many health care organizations will
carry subscriptions as well
‡ Individuals can subscribe to providers
such a the AHEC on-line library access
_ ADL Individual Membership
‡ This core membership package is for clinical health
professionals of any discipline and is also useful for
health administrators, practice managers and
researchers.
‡ Contains the following resources:
‡ =nline databases such as ME@LINE, CINAHL,
Cochrane,
‡ 300+ full-text journals,*
‡ 50+ full-text books,
‡ Patient education materials, links to continuing
education, evidence-based medicine tools, P@A
resources and other clinical and teaching tools.
‡ Price: $100 per year
Step 3

Critical Appraisal
Klash Poll: Analysis
‡ How many nurses
feel comfortable
evaluating the
validity of a research
article?

‡How many nurses were


taught how to critique
research articles in school?
2004 Nursing Workforce
by @egree earned (n=71,030)

D ct rate
427 (6.0%)
Other r
1845 (2.5%)
rN
4822 (6.8%)
Other BrB
3527 (5.0%)
BrN
21721 (30.6%)
ss ciate
29028 (40.9%)
Dipl ma
9659 (13.6%)
0 5000 10000 15000 20000 25000 30000 35000

N rth Car lina Trends in Nursing: 1983-2004 W rk rce Dem graphics
r urce: RN license renewal, NC B ard  Nursing
Critical Appraisal
‡ Are the findings of this study valid?

‡ What are the findings?

‡ How do the findings


apply to patient care?
Step 4

Integrate Evidence into your


Practice
Integrate evidence
into practice-

Application
Step 5

‡ Evaluate the Results


Evaluate the Results
Step 6

@isseminate
@issemination
‡ Unit level
‡ =rganizational level
‡ Professional Level
Evidence-Based Practice
‡ Pravikoff et al

± RNs in the United States aren¶t ready for


evidence-based practice.
Clinicians must:
‡ Recognize the gaps in their own information
skills
‡ Look for and obtain continuing education to
enhance the lacking skills
‡ @emand access to high-quality info resources
in the workplace
‡ @emonstrate a commitment to use info
resources
‡ Set goals for integrating evidence-based
practice that link patient and organizational
outcomes
Pravikoff, et al, (2005)
Need More?

Start with Evidence Based Medicine


http:www.hsl.unc.eduservicesTut rialsBMindex.htm

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http:www.hsl.unc.edurervicesTut rialsBNsplash.htm
End of 101
Klash Poll: Education
‡ How many of you
took a research
course in your entry
program?
‡ How many of you
believe it was relevant to
your nursing practice?
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Education

Nursing Kaculty
Ohy Not Teach EVP
_ EVP is just the new ³Flavor of the Month´

_ I use examples of research in my class so I


already do teach EBP

_ I have taught it but students quickly learn


that there is no place for it in actual
practice.
EVP is just the new ³Klavor
of the Month´
‡ New Kad

‡ Primary vs. Team

‡ Holistic vs. System

‡ Real vs. Simulation


³I use examples of research
in my class (A@N)/ we have
a research course (BSN) so
I do teach EBP.´
³I have taught Evidence-
Based Practice but
students quickly learn that
there is no place for it in
actual practice.´
Kirst Nursing Semester

‡ Construct
answerable clinical
questions.
Second Semester
Searching for
Evidence:

Using CINAHL and


PubMed
Third Semester

Critical Appraisal:

Interventions
Systematic Reviews
Qualitative Research
Kourth and Kifth Semesters
Making Change:

‡ Using change theory


to incorporate new
evidence into
practice
End of Evidence for Nursing
Kaculty
Examples of Evidence-Based
Practice
‡ Rex Hospital
‡ New Hanover Regional Medical Center
‡ NC Baptist Wake Korest Hospital
‡ The Moses Cone Health System
Oake Forest University Baptist
Medical Center
‡ Magnet @esignation 1999/2003
‡ Center for Evidence-Based
Practice/Research (2003)
± Ph.@ Nurse Researcher
± KT Program Coordinator
± KT MS Nurse Research Associate
± Unit based education
± Annual EBP Conference for staff
Cynthia R. ëing, Ph@, NP,
MSN, RN, KAAN

‡ Program @irector for Nursing Research


‡ Wake Korest University Baptist Medical
Center
‡ Medical Center Boulevard
‡ Winston-Salem, NC
‡ email: cking@wfubmc.edu
New Hanover Regional
Medical Center

‡ Magnet Status-2003

‡ Nursing Congress

‡ Staff Nurse driven research


± Patient perceptions of certified nurses
± Resolve through sharing-neonatal grief support
  

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Mary Beth ëoehler, RN,C,BSN

‡ Nursing Congress, Immediate past Chair


‡ Coordinator Pediatrics
‡ New Hanover Health Network

‡ Marybeth.koehler@nhhn.org
The Moses Cone Hospital

‡ Magnet @esignation 2005


‡ Entire Health System designated Magnet
‡ Evidence Base is cross discipline
@aria ëring, RN, BC, MSN

‡ Magnet/ Retention Coordinator


‡ Moses Cone Health System
‡ 501 N Elam Ave
‡ Greensboro, NC 27403
‡ 336.832.0311
‡ daria.kring@mosescone.com
Rex Hospital
‡ Magnet Status - 2006
‡ Evidenced Based Procedures
‡ Research Council
± Staff nurses
± CNS
± Management
‡ Research Projects- mentor driven
Rex Hospital Contacts

‡ Gail Sturtevant,
±919-784,3080

‡ Joanne ëuszaj,
±919-784-3097
Evidence-Based Practice in
Your World
Bibliography
_ oyal J, Blythe J.(1998). Promoting research
utilization in nursing: the role of the individual,
organization, and environment. Evidence-Based
Nursing; 1, 71 - 72.

_ essenich C. ., Guyantt, G.H. & DiCenso, A.


(1997) Teaching nursing students evidence-based
nursing." Nurse Educator, 22(6): 25-29.
p2
_ Upton, D. (1999). How can we achieve evidence-
based practice if we have a theory-practice gap in
nursing today? ournal of Advanced Nursing,
29(3), 549-555.

_ Pravikoff, D, Tanner, A, & Pierce, S. (2006).


eadiness of U.S. nurses for evidence-based
practice. American ournal of Nursing, 105(9), 40
± 52.
p3
_ Matula, P. (2005). Evidence-based practice
at the bedside: igniting the spirit of inquiry.
( e Pennsylvania Nurse, 22

_ Ciliska, D. (2005). Educating for evidence-


based practice. ournal of Professional
Nursing, 21(6), 345-350.
p4
_ acey,  & Nooney, J. (2005). North Carolina
Trends in Nursing: 1985-2004, Oorkforce
Demographics. etrieved August 18, 2006 from
http://www.nursenc.org/research/Trends2005/ N
%20and%20PN%20Supply%20Trends.pdf

_ Mcibbon, A & Marks, S.(1998). Searching for


the best evidence. Part 1 where to look. Evidence-
Based Nursing, 1, 68-70.
p5
_ Mckibbon, A & Marks, S. (1998).
Searching for the best evidence. Part 2:
searching CINAH and Medline. Evidence-
Based Nursing, 1, 105-107

_ Flemming, . (1998). Asking answerable


questions. Evidence Based Nursing. 1, 36-
37.
p6
_ Estabrooks, C. (1998) Oill evidence-based
nursing practice make practice perfect? Vanadian
ournal of Nursing Researc . 30(1), 15-36.

_ Engelke, M.E. & Marshburn, D. M. (2006)


Collaborative strategies to enhance research and
evidence-based practice. ( e ournal of Nursing
Administration. 36(3), 131-135.