Evidence based practice an integration of research based knowledge into clinical practice

Transcription

1 Evidence based practice an integration of research based knowledge into clinical practice Lisbet Narvestad Grenager, professional development nurse/icu nurse, Akershus University Hospital, Norway. Irene Randen, lecturer, intensive care nurse education, Lovisenberg Diaconal University College, Oslo, Norway. 1

2 INTRODUCTION Do students bring their knowledge about how to search for and use evidencebased knowledge into clinical practice? How do intensive care nurses and students in collaboration develop their research data gathering skills in the clinical field? 2

3 THE RESEARCH QUESTION Can systematic work, change attitudes and behaviors of intensive care nurses and students in searching for and using research-based knowledge in clinical practice? 3

4 RESEARCH SHOWS Teaching alone does not make nurses gather or utilize research based knowledge in clinical practice Thompson et al. 2007, 2008 Head nurses participation - important when research is to be integrated in nursing care Cummings et al. 2007, Default et al The use of mixed interactive and didactic formats and focus on outcomes is the most effective way to change behaviors in health care professionals Forsetlund et al. 2009, Cochrane review 4

5 METHOD Action research including; planning, action, observation and reflection Pre-focus group interviews Implementation Following the steps in EBP and a modified pyramid of Haynes Documentation of activities Regulary meetings Post-focus group interviews Figure: The steps of EBP 5

6 A modified pyramid of Haynes 5S pyramid T O P D O W N T H I N K I N G Synopsis Syntheses Studies EB journal abstracts Best Practice, UpToDate, Joanna Briggs Institute, Clinical Evidence Systematic reviews Joanna Briggs Institute, Cochrane Library Original journal articles Cinahl, Ovid Nursing, Medline, Embase 6

7 PRE - FOCUS GROUP INTERVIEWS How do you find answers to nursing care questions in your clinical practice? Use my experiences and intuition Ask and discuss with more experienced nursing colleagues Utilize literature in the unit and the Electronic Quality System (EQS) Ask the physicians but never where they find their answers Some used net resources (Health Library, Medline, Google) Google most user friendly other data bases time consuming One said: Culture and attitudes in the unit are important for acceptance and use of evidencebased knowledge. 7

8 Experiences from the implementation phase Nine weeks from October December 2009 The project group members worked systematically at each of the EBP steps at designated times once a week They furthermore spent some time gathering research based knowledge while in the patients rooms More time than anticipated was spent on practicing data base searches Less time than anticipated was spent on critical assessment of the obtained information and articles 8

9 POST - FOCUS GROUP INTERVIEWS The project group members had through their experience learned: To understand EBP and share their insights That it was useful to select spesific databases for searching (as a starting point) That knowledge of the field was important to find useful key words (subject headings) That doing searches was time consuming, but practice made them quicker 9

10 POST - FOCUS GROUP INTERVIEWS The project group members furthermore found that: It was a little scary that the research data they gathered was used for decisions by the physicians in clinical questions They had become motivated and committed with an enhanced feeling of responsibility towards the use of EBP The relationship between intensive care nurses and the students had become more balanced/equal 10

11 POST - FOCUS GROUP INTERVIEWS Little change in skill and attitude in the reference group, but: They wanted more in-service education on data gathering procedures by the project group members They perceived that the way they do their jobs will have to change to integrate research results in nursing care practice They said: How to find time to work knowledge based in a busy unit like ours? 11

12 CONCLUSION All project group participants acquired greater data gathering skills and the utilization of research results grew markedly It is particularly important to develop nurses competency regarding critical assessment of the quality of the research findings obtained and the utilization thereof in clinical practice There is a general need for continual effort to develop the unit s culture regarding working research based and developing different ways for working research based 12

13 ONE YEAR AFTER The project group has taught the nursing staff in EBP, especially to search in different databases In May, the project group will teach the nursing staff to make search in the Cochrane Library Several of the unit s intensive care nurses have become motivated to apply for extended education i.e. master level education 13

14 Working together achieving more Thank you! 14