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Distinguishing Between Quality Improvement, Evidence-Based Practice, and Nursing Research

Distinguishing Between Quality Improvement, Evidence-Based Practice, and Nursing Research

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Distinguishing Between Quality Improvement, Evidence-Based Practice, and Nursing Research

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  1. Distinguishing Between Quality Improvement, Evidence-Based Practice, and Nursing Research Maria R. Shirey, PhD, MBA, RN, NEA-BC, ANEF, FACHE, FAAN Professor, Community Health, Outcomes & Systems Assistant Dean, Clinical Affairs & Partnerships University of Alabama at Birmingham School of Nursing North Dakota Center for Nursing Conference October 23, 2014 • Bismarck, North Dakota

  2. Introduction 2

  3. 3

  4. So … How Did You Get Here? “Showcasing Differences Between Quality Improvement, Evidence-Based Practice, and Research” Shirey et al., (2011) Winner of the inaugural JCEN Innovation Award for 2011 4

  5. Impact 5

  6. Presentation Objectives • Differentiate among quality improvement (QI), evidence-based practice (EBP), and nursing research Realistic Expectation: Gain general understanding of concepts and their application Reflect and brainstorm to use information more broadly 6

  7. Road Map • Overview of the Shirey et al., (2011) article • Application of article by others • Reflective dialogue with next steps • Key takeaways with Q&A 7

  8. Overview of the Article 8

  9. Why Is There Need to Know? • Recent meta-analysis identified all concepts as essential for Magnetic, healthy nursing workplace (Kramer, Schmalenberg & Maguire, 2010) 9

  10. Important Definitions Quality Improvement Data driven systematic approach by which individuals work together to improve specific internal systems, processes, costs, productivity, and quality outcomes with an organization Note: Terms QI and Performance Improvement (PI) used interchangeably 10

  11. Important Definitions Evidence-Based Practice Problem-solving approach that integrates a systematic search for and critical appraisal of the best available evidence (may or may not be research based) to answer a burning clinical, education, or administrative question Clinician expertise and patients’ unique circumstances and preferences 11

  12. Important Definitions Research Scientific process that generates new knowledge and validates/refines existing knowledge that directly and indirectly influences nursing practice or health systems 12

  13. Background and Overview of the Article • Started as discussion board assignment in DNP course • Intent of assignment was to compare and contrast all 3 concepts of QI, EBP, Research across multiple dimensions • No article available with extensive side-by-side comparative data, so … we created one!!! 13

  14. Building The Comparative TableSynthesis of the Literature Shirey et al. (2011) 14

  15. Highlights of Comparative Table 15

  16. Highlights of Comparative Table 16

  17. Highlights of Comparative Table 17

  18. Highlights of Comparative Table 18

  19. Highlights of Comparative Table 19

  20. Highlights of Comparative Table 20

  21. Understanding Check 21

  22. Understanding Check Question #1 If the intent of a project is to establish a cause-and-effect relationship, the best approach to use would be a/an: • Evidence-Based Practice Project. • Quality Improvement Project. • Research Project. • Institutional Project. 22

  23. Understanding Check Question #2 Given the following choices to develop an EBP project, the best methodology to use would be: • Six Sigma. • Plan Do Check Act. • The Academic Model. • The Iowa Model. 23

  24. Understanding Check Question #3 Given the choice between various approaches, a team developing a clinical work flow process using limited resources and time would likely select: • Nursing Research. • Evidence-Based Practice. • Quality Improvement. • Clinical Inquiry. 24

  25. Understanding Check Question #4 The definitive dimension the distinguishes between quality improvement, evidence based practice, and research is: • Historical Evolution. • Definition. • Rigor. • Purpose. 25

  26. Application of the Article 26

  27. The ApplicationTool for Academia • Guide for teaching QI, EBP, Research in academic programs • Incorporated in teaching QSEN principles (American Association of Colleges of Nursing QSEN Institute Faculty Resources) • Referenced in numerous professional websites 27

  28. The ApplicationTool for Clinical Nursing Excellence • Support Nursing Standards of Practice (ANA, 2010) At fundamental level, the registered nurse participates in QI activities and integrates EBP and research into practice • Accelerate Hospital Magnet Journey → Guide to decipher which approach to use → Identify need for IRB approval → Create Magnet evidence • Form foundation for additional user-friendly staff development resources for clinical practice (Ryan & Rosario, 2012) 28

  29. The ApplicationTool for Clinical Nursing Excellence Performance Improvement/Research Differentiation Form (Ryan & Rosario , 2012) • Identify title of project • Answer series of questions • Determine pattern of responses • Identify emerging dominant study category 29

  30. 30

  31. 31

  32. The ApplicationTool for Dissemination Different Formats for Publication of QI, EBP, Research Oermann, Turner & Carman (2014) 32

  33. The ApplicationTool for Dissemination 33

  34. Application Check 34

  35. Application Check Scenario #1: QI • The hospital examines its monthly run charts on key quality indicators • In reviewing these data, the hospital determines the incidence of falls in hospitalized elderly patients is trending upward • To act on this information, what should happen next? 35

  36. Application Check Scenario #1: QI • Formulate QI question: Why is the unit level fall rate so high? • Apply QI methodology P Identify and analyze problem D Develop and test solutions C Check effect of pilot solution A Implement solution fully 36

  37. Application Check Scenario # 2: EBP • There is a desire to initiate a practice change that would prevent falls in hospitalized elders • To initiate a practice change, what should happen first? 37

  38. Application Check Scenario # 2: EBP • Formulate clinical question using PICOT format: P Population I Intervention C Comparison O Outcome T Timeframe In hospitalized elders (P), how does a bed alarm (I) compared to use of sitters (C) affect fall rates (O) during a 3 month time period (T)? 38

  39. Application Check Scenario # 2: EBP • Specify key search terms to retrieve evidence that best answers PICOT question and meets inclusion criteria • Generate evidence table and determine level of evidence • Critically appraise the evidence (look at flaws and worth) • Make practice recommendations based on best evidence 39

  40. Application Check 40 Melnyk & Fineout-Overholt (2011)

  41. Application Check Scenario # 3:Research • You have searched the literature to obtain information about the incidence of falls in hospitalized elders • You find the literature is not current and it does not incorporate cultural aspects pertinent to your unique elderly patient population • How do you go about developing a permanent solution for elderly patient falls in your patient population? 41

  42. Application Check Scenario # 3: Research • Identify problem statement • Formulate research question: What factors contribute to falls in non-English speaking hospitalized elderly patients? • Use research question to guide methodology (design, sampling, data collection, data analysis methods) 42

  43. Reflection with Next Steps 43

  44. Stretch and Energize to Focus 44

  45. Reflective Question Now that you have heard this presentation, what ideas do you have for HOW you would immediately begin using the information in your practice and work setting? 45

  46. Think, Pair & Share • Turn to person next to you • Discuss the following for 5-minutes: How would you begin to immediately use theinformation from this presentation in your practice and/or work setting? What partnerships or networks might you leverage? Why? • Take 5-minutes to share your ideas with the broader audience 46

  47. Synthesis Check 47

  48. Key Takeaway Points • Correctly differentiating among QI, EBP, and research = → Essential for patient care quality/safety → Needed to advance nursing practice and science • Understanding concept differences enhances applicability, integration, collaboration opportunities, and ultimately our IMPACT • Proficiency comes from learning and doing 48

  49. Closing 49

  50. Questions & Answers Maria R. Shirey, PhD, MBA, RN, NEA-BC, ANEF, FACHE, FAAN Professor, Community Health, Outcomes & Systems Assistant Dean, Clinical Affairs & Partnerships University of Alabama at Birmingham School of Nursing mrshirey@uab.edu 50