How to Develop an Evidence-Based Nursing Research Project for Home Health Care Important Information About Receiving CE You must attend 90% of the session to be eligible for CE. If attending as part of a group, you must sign-in and the group leader must send the sign-in sheet to marquita.williams@elsevier.com. The evaluation survey URL is provided at the conclusion of the webinar. The webinar will begin shortly
How to Develop an Evidence- Based Nursing Research Project for Home Health Care Lois S. Marshall, PhD, RN Nurse Education Consultant May 19, 2015
3 Disclosure This continuing education webinar is provided by Elsevier/Mosby* To earn 1 contact hour* for this presentation, you MUST: 1) Register to attend the webinar. 2) Log-in to the webinar or sign-in if participating in a group. The group leader sends the sign-in sheet to marquita.williams@elsevier.com 3) Attend 90% of the session. 4) Complete and submit an evaluation of this presentation by the designated deadline. The evaluation survey URL is provided at the conclusion of the webinar. Speaker, Lois Marshall, PhD, RN and planner, Marilu Kelly, MSN, RN, CNE have disclosed no relevant financial relationships. *Elsevier/Mosby is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation
4 Speaker Profile Dr. Lois Marshall, a nurse educator for over 35 years, has held a variety of faculty/administration positions, and been actively involved in the professional research community serving as a mentor, consultant, author & editor Among her accomplishments and current activities: Providing research expertise on test taking strategies, outcomes assessment and evaluation related to the NCLEX-RN examination and nursing curricula. Acting as a consultant for the Honor Society of Nursing, Sigma Theta Tau International promoting the advancement of national and international research Serving as coordinator of the National Student Nurses Association Career Development Center Mentors nurses in areas of grant writing and promotion of research and evidence-based nursing projects Writing a quarterly column or the Journal of Radiology Nursing on topics of research and grant writing Dr. Marshall has received numerous awards for her teaching throughout her career and in 2004, she was selected as a Helene Fuld Fellow by the American Association of Colleges of Nursing.
5 Learning Objectives Indicate the steps to develop an Evidence-Based Nursing research project Describe practical guidelines for developing and implementing an Evidence-Based Nursing research project broadly and more specifically in home health care Discuss a potential Evidence-Based Nursing research project that has relevance to his/her practice setting in the home health care environment
6 Translational Research: Theory to Practice: Why? Improved/high quality patient/family care and outcomes Provides implementation care that is patient/population/system/organization specific Reduces health care costs Increases patient/family satisfaction Increases nursing/health care provider satisfaction Decreases actual risks/complications/potential for same
7 Some Evidence-Based Nursing Research Facts Research suggests that less than 15% of clinicians are believed to consistently use evidence-based practice guidelines. (Makic, M, et al. 2014) Well established evidence-based practice associated with higher quality care and better outcomes for patients when compared with care steeped in tradition. (Mick J. 2011) Analysis of CMS outcome data shows that Joint Commission accredited home health agencies (that now look at evidence-based approaches) have fewer hospital readmissions. (The Joint Commission, 2011)
8 Some Evidence-Based Nursing Research Facts Home health care agencies will be linchpin in National Health Care Quality Strategy. (The Joint Commission, 2011) Evidence-based approaches will enable home care to contribute greatly toward achieving this national strategy. (Berman, 2011) Translational Care Model (Naylor, et al, 2011; 1999; Funded by NIH) demonstrated reductions in preventable hospital readmissions, improved health outcomes, enhanced patient satisfaction, reduced costs when evidence-based care is employed. There is no current Evidence-Based Nursing Model specific to home health care nursing. Home health care nurses cannot be left out of loop as integral to promotion/maintenance of health of patients/families/populations cared for in home environment.
9 Some Evidence-Based Nursing Research Facts (Cont.) Clinicians continue to practice based on tradition (Mick, J 2011) Educational background/experience often fails to prepare to use/evaluate research Acuity of patients hinders ability to apply research findings Lack of nurse researchers in house who conduct EBN research and/or assist staff to do same Lack understanding of value of EBN research
10 Making a Change: Evidence-Based Nursing Research Considerations: Desire to conduct/evaluate evidence-based nursing research specific to home health care Identify problem(s) specific to home health care where evidence-based nursing research project could make difference in practice and outcomes Understanding of change process (Lewin, 1950) Unfreezing, Moving/Change, Refreezing
11 Making a Change: Evidence-Based Nursing Research (Cont.) Understanding of scientific/research process Application of steps of nursing process Nurses do this daily collecting evidence>analyze evidence> plan care> implement plan>evaluate outcomes Time constraints managed/removed Resources, including but not limited to: Library Nurse Researcher or other personnel expertise Funding, if applicable
12 Making a Change: Steps to Take Identify a problem where change is necessitated and/or practice may be made more efficient/improve patient outcomes Acute/Critical Care vs. Home Health What is history of proposed clinical change from literature review perspective? Evaluating Literature/Past Evidence What is agency perspective? What is staff perspective?
13 Making a Change: Steps to Take (Cont.) Make a plan with steps for change Are there policies or procedures you need to follow? Human Subjects Institutional Review Board(s) Are there anticipated roadblocks? Are there anticipated helpful hands?
14 Making a Change: Steps to Take (Cont.) What are the expected outcomes of change: Patient/Family Outcomes Cost Outcomes, if applicable Organizational Outcomes, if applicable
15 Creating an Evidence-Based Practice Proposal Framework for systematically proposing what/who/how you are to carry out change. Consider your goals/objectives for change. What type of sample do you need? What procedures/materials do you need for data collection? How will you maintain patient/family confidentiality? Do you have a particular time frame for change/research? What types of statistical analyses are needed? Resources for statistics, i.e. personnel, software
16 Other Evidence-Based Process Project Formats Seven Steps of Evidence-Based Process (Melnyk & Fineout- Overholt, 2011) Cultivate spirit of inquiry Ask clinical question in PICOT (Patient population; intervention/area of interest; comparison intervention; outcome; time) Search relevant and best evidence to answer question Critically appraise evidence Integrate evidence with one s clinical expertise and patient preferences Evaluate outcomes of practice decision/change based on evidence Disseminate outcomes of evidence-based practice decision/change
17 Other Evidence-Based Process Project Formats ACE Star of Knowledge Transfomation (Stevens, 2004) Discovery/Research Evidence Summary Translation into Guidelines Practice Integration Process/Outcome Evaluation
18 Other Evidence-Based Process Project Formats Disciplined Clinical Inquiry (DCI) (Sanares-Carreon, et al, 2015; 2010) ASK a focused question ACCESS the evidence APPRAISE the evidence APPLY the best evidence ALERT peers
19 Other Evidence-Based Process Project Formats Rosswurm and Larrabee (1999) Evidence-Based Model Assess need for change in practice Link problem to interventions/outcomes Synthesize best evidence Design practice change Implement/Evaluate change in practice Integrate/Maintain change in practice Other Models Johns Hopkins Evidence-Based Nursing Model Iowa s Model of Evidence-Based Nursing Model
20 Evidence-Based Project Research Ideas for Home Health Long term medication compliance Reducing medication errors by caregivers Decreasing catheter related infections Falls/Patient safety/home safety issues Infection control w/pos devices Decreasing hospital readmissions Decreasing pressure ulcers Increasing nursing/health care provider communication in home environment
21 Evidence-Based Project Research Ideas for Home Health Hand hygiene in home health environment Projects related to instituting evidence-based nursing practice in home health settings/initiating an evidence-based culture Needs assessment projects related to EBN in home health Cost reduction studies in home health based on initiating evidencebased model of practice Studies that examine how to lower costs in home health care and/or incentivize savings Adaptation studies from acute/critical care to home health
22 References Gallagher-Ford, L., Fineout-Overholt, E., Melnyk, B., and Stillwell, S. (2011). Evidence-based practice, step by step: Implementing an evidence-based practice change. American Journal of Nursing, Volume 111, 3, 54-60. Jarrin, O., Flynn, L., Lake, L., and Aiken, L. (2014). Home health agency work environments and hospitalizations. Medical Care, 52(10), 877-883. Joint Commission, The. (2011). Home: The best place for health care: A positioning statement from the Joint Commission on the state of the home care industry. http://www.jointcommission.org (Accessed May 5, 2015). Makic, M., Rallen C., Watson, R., Poteet, A. (2014). Examining the evidence to guide practice: Challenging practice habits. Critical Care Nurse, 34(2): 28 DOI 10.4037/ccn/2014262. Melnyk, B. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and health care: A guide to best practice. Lippincott, Williams, & Wilkins: Philadelphia, PA. Melnyk, B., Fineout-Overholt, E., Stillwell, S., and Williamson, K. (2010). Evidence-based practice: Step by step: The seven steps of evidence-based practice. American Journal of Nursing, Volume 110, 1, 51-53.
23 References Naylor, M. (2006). Transitional care: A critical dimension of the home healthcare quality agenda. Journal of Healthcare Quality, 2(5), 287-290. Rosswurm, M. & Larrabee, J. (1999). A model for change to evidence-based practice. Image of Journal of Nursing Scholarship, 31(4), 317-322. Transitional Care Model website. http://www.transitionalcare.info/ (Accessed May 5, 2015). U.S. Department of Health and Human Services. National Healthcare Quality Strategy and Plan. http://www.hhs.gov/news/reports/quality/nhcqsap.html (Accessed May 5, 2015). Sanares-Carreon, D., Comeau, O., Heliker, D., Marshall, D., Machner, C., Bell, L., Kwarciany, G. & Sandridge, J. (2015). An educational pathway to fast track evidence-based practice at the bedside. Journal for Nurses in Staff Development, 31(1), E1-E6. DOI: 10.1097/NND.0000000000000113 Stevens, K. R. (2004). ACE Star Model of EBP: Knowledge Transformation. Academic Center for Evidence-Based Practice. The University of Texas Health Science Center San Antonio. www.acestar.uthscsa.edu
24 Time to Get Started Speaker Contact Information: Lois Marshall, PhD, RN boomeister4556@aol.com
25 Disclosure This continuing education webinar is provided by Elsevier/Mosby* To earn 1 contact hour* for this presentation, you MUST: 1) Register to attend the webinar. 2) Log-in to the webinar or sign-in if participating in a group. The group leader sends the sign-in sheet to marquita.williams@elsevier.com 3) Attend 90% of the session. 4) Complete and submit an evaluation of this presentation by the designated deadline. The evaluation survey URL is provided at the conclusion of the webinar. Speaker, Lois Marshall, PhD, RN and planner, Marilu Kelly, MSN, RN, CNE have disclosed no relevant financial relationships. *Elsevier/Mosby is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation
Thank You! Speaker Contact Information: Lois Marshall, PhD, RN boomeister4556@aol.com Elsevier Clinical Solutions www.elsevierclinicalsolutions.com elsevierclinicalsolutions@elsevier.com 1.866.416.6697