EBN Application

1. EBN Application 莊情惠, MSN, RN Head Nurse, Chang Gung

2. QualityofCare • Broad topic • Critically important • Implementation key concern • Many component parts

3. Component Parts • Patient, clinicians, systems • Problem identification and refinement • Use of evidence • Interventions • Implementation • Adoption into practice

4. Quality of Care • Similar to: • Evidence based nursing (EBN) • Quality improvement • Uses evidence & clinical expertise • Patient outcomes and preferences • Within systems of care

5. Why is EBN important? • Manage explosion • Literature • Technology • New way to think • Practice • Research • Knowledge development

6. EBN Promotes Translation Research Literature into Individualized care

7. What Nurses Do with EBN Obtain valid information Search for, assess & use literature Use information (evidence) Develop interventions and Apply to clinical situations

8. EBN Promotes: Systematic observation plus Experience and Research literature to support Nursing decisions

9. Origins of EBM in 1970s • Started in Medicine • Synthesis of research literature • Guidance for practice

10. EBP History in Nursing • First (1970’s) called • Research utilization • Translation into practice • Now called • EBN • Evidence based nursing

11. Our Outline • What is evidence based nursing (EBN) • Goals of EBN • Products • Procedures for EBN reviews • Strengths and Weaknesses

12. EBN Goals • Improve patient outcome • Reduce healthcare costs

13. EBN Growing Rapidly • Nursing - 2,500 citation • Medicine - 21,000 citations

14. Types of EBN Reports • EBN to guide clinical decisions • How to do EBN Can be confusing to newcomer

15. Where Are EBN Reports ? • Professional journals • World Wide Web (WWW) • Books

16. How Do I Get EBN Reports? • Your library • Web Many are free

17. Professional Journals • Evidence Based Nursing • World Views on EBN- Sigma Theta Tau product • Your professional journal?

18. Book Most Cited DiCenso, Ciliska & Guyatt(2005). Evidence-based nursing; A guide to clinical practice. St. Louis, Elsevier Mosby.

19. Other Sources on Web • Practice guidelines • Governmental sources • Cochrane Database

20. Our Outline • What is evidence based nursing (EBN) • Goals of EBN • Products – A model and an example • Procedures for EBN reviews • Strengths and Weaknesses

21. EBN – Example • Problem • Type II Diabetes Mellitus • Clinic management • Goal - Process improvement

22. Assess Support • Nursing management • Other departmental leaders • Nursing team

23. Problem or Question • Current guidelines not followed • Lacked measures • Glycosylated hemoglobin (HbA1c) • Lipids (LDL) • Lacked performance • Blood pressure checks • Annual foot exams • Monofilament testing

24. Establish Desired Patient Outcomes • Control of HbA1c and LDL • Improve performance to >80% • Foot exams • Filament testing • Improve patient involvement

25. Challenges Encountered Data base accuracy Staff turnover Computer software upgrades Sustainability

27. Our Outline • What is evidence based practice (EBN) • Goals of EBN • Products • Procedures for EBN reviews • Strengths and Weaknesses

28. How Do I Get Started? • Read research reports • Develop skills for research critique • Understand research reports • Concepts • Terminology

29. Develop Internet Skills • Use data bases • Use major EBN sources • PubMed • CIHAHL • Google Scholar

30. Ask for Helpand Help Yourself • Librarian • WWW • Lectures • Conferences

31. Work with Others • Sharing helps refine process • Improves reliability • Increase commitment

32. Steps in a EBN review • Ask • Access • Appraise • Implement • Evaluate

33. Ask the question • Identify a question • Define and refine the question

34. Sources of Questions • Practice question, problem or practice • Basis for question • Concern about adverse outcomes • Cost • Time use • Patient complaint

35. Components of Question - PICOT • Patients • Intervention • Comparison (current practice) • Outcome • Time frame

36. Access the Literature • Search literature – Reports are sample • Develop sample criteria • Inclusion • Exclusion • Obtain reports

37. PICOT Advantages • Pushes clear definitions • Population • Comparison • Outcome • Focuses search • Too narrow – miss important ones • Too broad – not apply to context

38. Appraise literatureAnswer 3 Questions • Quality high enough to use (valid)? • Findings fit my setting? • What impact would EBN have on my patients?

39. Is Report Quality Good Enough (Valid)? • Use research critique skills • Consider statistical significance

40. Does Report Fit My Setting? • Comparison = Current practice • Consider • Patients • Colleagues • Setting • Resources

41. Extract Data from Each Report • Write a summary • Include specific information • Develop data collection forms • Establish a code book

42. Code Book Includes • Methodological features • Quality assessment

43. Code Methods • Study source • Publication year • Research design • Authors/investigators characteristics

44. Quality Assessment • Scientific merit • Intervention description • Study outcomes

45. Steps in a EBN review • Ask • Access • Appraise • Implement • Evaluate

46. Critical Appraisal • Uses individual report/articles • Assembles body of evidence • Focuses on a single practice issue

47. Critical Appraisal Two Goals • Internal consistency • Clinical significance

48. Internal Consistency Questions • Did authors • Answer the question? • Measure variables as planned? • Were measurements • Reliable? • Valid?

49. Internal Consistency(continued) • Were analyses appropriate? • Were conclusions • Reasonable? • Supported by results? • Matched to initial question/aim?

50. Hierarchy of Evidence • Single-case report • Case series report • Case-control studies • Cohort studies • Nonrandom trials • Randomized controlled trials (RCT) • Meta-analysis and evidence reviews