10/31/2017. Research & Evidence-Based Practice: Making It All Work. Disclosures. Objectives

Transcription

1 & Evidence-Based Practice: Making It All Work C. Monturo, PhD, MBE, ACNP-BC Professor & Interim Chair of Nursing/West Chester University Senior Nurse Scientist/Penn Medicine, Chester County Hospital Disclosures I have no commercial relationships relevant to the topic being presented. Objectives The participant will be able to: 1. Describe the reason to conduct research 2. Describe the process by which EBP is conducted 3. Outline the challenges to putting evidence into practice 4. Q & A 1

2 Show of hands 1. I am a staff nurse 2. I am a manager or director 3. I am a nurse executive 4. I am an advanced practice nurse 5. I am an educator or researcher 6. Or ANA Standards of Practice: Standard 9. Evidence-Based Practice and The registered nurse integrates research findings into practice. ANA Social Policy Statement (2010) Human responses include any observable need, concern, condition, event, or fact of interest to nurses that may be the target of evidence-based practice (p. 10) Nursing actions are theoretically derived, evidence-based, and require well-developed intellectual competencies (p.11) Assurance of safe, quality, and evidence-based practice (p. 19) 2

3 Early History of in Nursing Florence Nightingale s Nursing Education Studies 1960 s Theoretical & Conceptual Frameworks s Practice & Patient Care Improvement Did you know That just over half of the US population receives recommended care? That more women than men receive recommended care? That the rate of recommended care depends on income level and age? Asch, SM, Kerr, EA, Keesey, J., et al (2006). Who is at greatest risk for receiving-poor quality health care? NEJM, 354, Institute of Medicine Report (2008) 3

4 A comparison Goal Relationship with knowledge Inquiry driven problem solving approach Generate or confirm new knowledge EBP Evidence driven problem solving approach Synthesize, translate and new knowledge Time required Time consuming Moderate IRB required Yes Sometimes Funding Often external Usually internal, maybe external Making It All Work: The Challenges Making it all work Example Centers for Medicare & Medicaid Services: Hospital acquired conditions Foreign object retained after surgery Air embolism Blood incompatibility Pressure ulcer stages III and IV Falls and trauma Vascular catheter-associated infection Catheter-associated urinary tract infection Manifestations of poor glycemic control 4

5 Catheter-associated urinary tract infection rates Evidence-Based Practice Systematic problem-solving approach that is evidence driven Translates new knowledge into clinical, administrative and educational practice Moderate time use, institutionally driven process resulting in knowledge that is generalizable. Shirey MR, Hauck SL, Embree JL, Kinner TJ, Schaar GL, Phillips LA, Ashby SR, Swenty CF, McCool IA. (2011). Showcasing differences between quality improvement, evidence-based practice, and research, p. 60. Evidence-Based Practice 0. Cultivate a spirit of inquiry 1. Ask the clinical question 2. Search for the best evidence 3. Critically appraise the evidence 4. Integrate the evidence 5. Evaluate the outcome 6. Disseminate EBP Results Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step: The seven steps of evidence-based practice. The American Journal of Nursing, 110(1), doi: /01.naj d2 5

6 Evidence-Based Practice: CAUTI 0. Cultivate a spirit of inquiry Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step: The seven steps of evidence-based practice. The American Journal of Nursing, 110(1), doi: /01.naj d2 Search for Best Evidence: CAUTI Critically Appraise the Evidence: CAUTI 6

7 The Evidence Source Equation Clinician Experience + + Patient Preferences Scientific Findings = Evidence-Based Guidelines Systematic problem-solving approach that is inquiry driven Generates new knowledge for a discipline and assists in scientifically testing theories or interventions. Time consuming, tightly controlled process resulting in knowledge that is generalizable. Shirey MR, Hauck SL, Embree JL, Kinner TJ, Schaar GL, Phillips LA, Ashby SR, Swenty CF, McCool IA. (2011). Showcasing differences between quality improvement, evidence-based practice, and research, p. 60. Problem statement Data collection, analysis & interpretation Synthesis of findings Framework Sampling technique Knowledge dissemination question or hypothesis design 7

8 : CAUTI Problem: increased rate of CAUTIs. Sampling: All patients on unit divided into experimental or controlled group Hypothesis: Using antimicrobial impregnated catheters will decrease the CAUTI rate. Design: Quantitative random controlled trial Making It All Work Questions? EBP 8