Using Evidence in Practice Christina Ryan, MSN, RN, CPN Nurse Researcher/Education Coordinator
Objectives At the completion of this presentation, the participant will: Identify differences between EBP and Research Identify elements of practice change Identify how to develop a EBP culture change 2
What is the difference between EBP and Research? Research: Diligent, systematic inquiry or investigation to validate and refine existing knowledge and generate new knowledge* EBP incorporates theory, clinical decision making, judgment, and knowledge of research techniques, followed by application of the best, most effective and clinically meaningful evidence** Must also integrate patient preferences * Burns & Grove (2004). The Practice of Nursing Research: Conduct, Critique & Utilization ** Melnyk & Fineout-Overholt (2005). Evidenced Based Practice in Nursing and healthcare: A guide to best practice. 3
Evidenced Based Practice (EBP) Definition: A problem solving approach to clinical decision making within a healthcare organization integrating scientific evidence with the best available experiential evidence. Uses the latest research to produce high quality healthcare. Provides a systematic approach to decision making that achieves best practices and demonstrates accountability. 4
Key Assumptions of EBP in Nursing Nursing is both science and an applied profession; Knowledge is important to professional practice, there are limits to knowledge that must be identified; Establishes causality between events or variables; Evidenced Based Practice contributes to improved outcomes Newhouse et al (2007). Johns Hopkins Nursing Evidenced-Based Practice Model and Children s Guidelines. Healthcare of Atlanta 5
How can EBP be used in Nursing? Incorporate into every phase of the nursing process: Assessment of patient conditions Diagnosis of patient problems Planning patient care Interventions to improve patient s function, condition or prevent complications Evaluate the patient responses to interventions Provides foundations for Policies & Procedures Basis for patient care management tools Care maps; Protocols Standard order sets 6
Barriers to EBP Implementation Lack of EBP knowledge and skills Curriculum focuses on research practices not translation Care is based on skills learned in academic programs and outdated policies and procedures Lack of time Lack of mentors Belief that EBP is burdensome Belief that the organizational culture does not support EBP Collegial resistance to EBP implementation Including physicians 7
Strategies to overcome barriers Self-assessment to identify facilitators and barriers of EBP practices; Education and training to improve knowledge and increase practioners belief s and benefits of EBP; Create an environment that encourages an inquisitive approach Identify opportunities for best practices Create a culture that values support and expects a culture of EBP 8
Unique Elements of EBP success Design clinical environments to support best practices Provide time Educational building sessions Focus on how to implement evidence from research Resources for implementation: mentors Identify organizational priorities for implementation Cultivate team of staff nurses with senior executives who support the project 9
Integration of EBP Critical to meeting Magnet standards 5 Steps*: Establish a foundation for EBP Identify areas of concern Create internal expertise Implement evidence based practice Contribute to research evidence Ongoing, Concrete Support Formal systems for finding, prioritizing and answering EBP * Turkel, M., Reidinger, G., Ferket, K., & Reno, K. (2005). An essential component of the Magnet Journey: Fostering an environment for evidenced based practice and nursing research. Nursing Administration Quarterly, 29(3), 254-262. 10
Examples of EBP outcomes Sacred Cow Neonate and infants should sleep in prone position to prevent aspiration H2O2 is an effective antibacterial cleaning agent when applied to wounds: Bubbling means bacteria is present Evidence Eagles Prone sleeping among blankets and pillows increased SIDS: supine position with minimal contact with blankets and pillows dressed in warm sleepwear Concentrated H2O2 is caustic and hinders neodermal development. Bubbling occurs when H2O2 is exposed to air 11
References Burns, N. & Grove, S. K. (2004) The practice of nursing research: Conduct, critique & utilization 5 th Ed. Philadelphia: W.B. Saunders. Melnyk, B. M & Fineout-Oveholt, E. (2005) Evidenced Based Practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott, Williams & Wilkins. Melnyk, B. M & Fineout-Oveholt, E.; Gallagher-Ford, L; Kaplan, L. (2012). The state of evidenced-based practice in US nurses: Critcal implications for nurse leaders and educators. JONA, 42(9): 410-417. Newhouse, R. P., Dearholt, S. L., Poe, S. S., Pugh, L. C. & White, K. M. (2007). Johns Hopkins Nursing evidenced based practice model and guidelines. Indianapolis: Sigma Theta Tau International. Turkel, M., Reidinger, G., Ferket, K., & Reno, K. (2005). An essential component of the Magnet Journey: Fostering an environment for evidenced based practice and nursing research. Nursing Administration Quarterly, 29(3), 254-262. 12