Ch. 6 4205 Evidence-Based Practice, Advocacy, & Bill of Rights

Ch. 6 4205Evidence-Based Practice, Advocacy, & Bill of Rights Presented by Pamela Roberts, MSN RN

EBP Defined The process of providing clinically competent care, supported by the best scientific evidence available, such as outcomes research and expert advisers.

EBP Characteristics • Framework for clinical practice • Considers internal and external influences on practice • Encourages critical thinking • Judicious use of evidence for broad-based thinking • Numerous studies cited

Critical Thinking and EBP Translating theory to practice Posing answerable questions Broad-based critical thinking Analysis, synthesis, interpreting, and drawing conclusions

Using Evidence-Based Practice • Asking the right questions • Why was the research done, what setting was used? • Applying innovation to practice • Innovation is originality • Evaluating the effect of predetermined outcome • Was success achieved? • How were the results disseminated? • Disseminated – dispersed, distributed

Why are we using Evidence-Based Practice? • Increased rate of information distribution • You can google anything you want on the internet • Nontraditional • EBP moves away from tradition. “This is the way we’ve always done it.” Well, maybe that way has been wrong all these years • Decision making based on comprehensive body of knowledge • Patient care improvement • Implementing the Fallen Star program has decreased the rate of falls • Conscientious use of current best evidence in making decisions about nursing care • By educating clients based on what’s current

Why use EBP? • Efficacy • The ability to reach the desired result • Efficiency • Desired result timely with minimal effort • Effectiveness • The ability to produce the desired result

The Nurses Role in EBP • Active in the evolution of EBP in the organization • Promote ways to systemize evidence at the bedside • Remained enlightened about the use of EBP • We do CEU’s, take classes, read articles and what not

How do we use EBP? • Translating evidence into practice • PET • P – Practice question • PICO • E - Evidence • T – Translation • Are the changes in practice feasible? If so, actions are taken to put the change into practice, this is when a plan is developed

PICO for practice question Patient, population, or problem Intervention Comparison with other treatments Outcomes

Searching for Evidence PubMed (MEDLINE) CINAHL (The Cumulative Index to Nursing and Allied Health Literature) The Cochrane Library

CINAHL EBSCO 2700 nursing, allied health, biomedical, and consumer health journals ANA and NLN journals Various depths of coverage References dissertations, books, standards of practice, legal cases, critical paths…etc.

MEDLINE (PubMed) Produced by the National Library of Medicine Premier source for biomedical literature 5000 journal with 300 nursing specific Evidence-based filters in clinical queries

The Cochrane Library A collection of seven databases Contains evidence summaries and synthesizes reviews Reviews are based on the best available information in health-care interventions Structured to minimize bias Good evidence-based source

Search tips • Use controlled vocabulary for keywords and phrases • Use AND, OR, and NOT Ex: Clinical competence AND Intravenous therapy

More search tips Think of alternative spellings such as tumour, behaviour, gynaecology American vs. British) Use limits such as age, date of publication, and language

Reviewing the search Who wrote it? Who sponsored the research? When was it published? Has it been reviewed? If so by whom? Why was it published? Has it been cited?

Advocacy Workplace Patient Whistle-Blowing Professional

Advocacy • Advocacy is the foundation and essence of nursing and nurses have a responsibility to promote human advocacy • Advocacy is helping people grow and self actualize • Nurses must advocate for themselves, clients, family members, subordinates, and their profession

Goals of the Advocate • Inform • Autonomy (enhance this) • Respect • To respect the decisions of others, even if you don’t agree with it.

How Nurses Can Act as Advocates • Helping others make informed decisions • Cultural and ethnic diversity and sensitivity • Directly intervening on behalf of others • Continuing care of DNR client

Advocating for Clients • Client’s needs and goals are paramount • Advocate the distribution of resources • Leadership must be willing to take risks • Time out procedures (right pt, right site, right surgery) • DNRs • Ethics Committee for Staff • Must be willing to accept conflict

Bills of Rights • Passed by the National League for Nurses and American Hospital Association in the 1960’s • Privacy law primarily protects the rights of the patient • Guide professional practice

Subordinate Advocacy What is it? The manager helps subordinates resolve ethical problems and live with the solutions at the unit level Like if you have a problem on E5, you should try to solve the problem and live with the consequences on E5

PromotingSubordinate Advocacy Staff needs, (listen to) Empower staff Promote autonomy (for the nurses) Face challenges (and solve problems together) “Go to bat” for the staff (when needed)

Workplace Advocacy Manager insures safe, growth oriented environment Occupational health and safety must be assured

Internal vs. External Whistle-Blowing • Internal whistle-blowing • Within the organization, reporting up the chain of command • External whistle-blowing • Reporting outside the organization, such as the media or an elected official • Public awareness has increased • People are more likely to complain when they feel wronged • Nurses must act individually or collectively

Professional Advocacy Leader-managers also must be advocates for the nursing profession Professional duty is assumed by entering the profession of nursing Speak out on consumer issues, continuing and expanding attempts to influence legislation, and increasing membership on governmental health policy-making boards and councils Speak out on staffing issues

Ch. 6 4205 Evidence-Based Practice, Advocacy, & Bill of Rights