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Research Application in Nursing Practice

Research Application in Nursing Practice. Hana Rizmadewi Agustina, S.Kp, MN Department of Fundamental of Nursing Universitas Padjadjaran Nursing Research Methodology. Why need to use research?.

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Research Application in Nursing Practice

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  1. Research Application in Nursing Practice Hana Rizmadewi Agustina, S.Kp, MN Department of Fundamental of Nursing Universitas Padjadjaran Nursing Research Methodology

  2. Why need to use research? • Tenaga kesehatan kadang dipenuhi oleh rasa ketidakpastian tindakan apa yang paling efektif untuk mendapatkan hasil yg terbaik untuk pasien  Evidence base practice (EBP) • EBP  pendekatan yg dpt membantu praktisi untuk memberikan kualitas pelayanan yang terbaik dalam memenuhi kenutuhan pasien dan keluarganya

  3. What is EBP? • Penggunaan secara sungguh-sungguh dari evidence terbaik dengan menggabungkan keahlian klinik dan nilai/lingk untuk perawatan bagi pasien (Straus, et al., 2005) • Membantu praktisi untuk memberikan kualitas pelayanan yang tinggi dlm rangka memenuhi kebutuhan pasien dan klg yang multifacet (Melnyk & Fineout-Overholt, 2005) • Meningkatkan kualitas intervensi keperawatan dari yang berbasis tradisi atau kebiasaan menjadi intervensi berbasis fakta dan hasil riset

  4. The importance of evidence

  5. The importance of evidence

  6. EBP & Evidence • EBP menggunakan “Best Evidence” yang didapat melalui : • Scientific knowledge from randomized clinical trials, observational studies • Expert opinion • Expert consensus • Other

  7. The cognitive continuum. Thompson, C. et al. Evid Based Nurs 2004;7:68-72

  8. Research Utilization Menggunakan hasil penelitian Diambil secara Random Mendukung tindakan keperawatan Kurang systematic Evidence-Based Practice Mempertimbangkan semua riset Menggunakan hasil riset berdasarkan review yg terintegrasi Dikaitkan dengan keahlian klinik dan sistem nilai dari pasien Lebih sistematik systematic Research utilization & EBP

  9. Goals of EBP • Memecahkan masalah di klinik • Mencapai pelayanan yang terbaik • Mengenalkan inovasi • Mengurangi variasi dalam pelayanan keperawatan • Membantu dengan efektif dan efisien dlm membuat keputusan • Memecahkan masalah dlm sistem regulasi • Mencapai sistem pengaturan yang terbaik

  10. Who are the Users of Evidence-Based Practice • Nurses (RN, LVN, NP) • Nursing assistants • Physicians • Physical Therapists • Pharmacists • Nutritionist • Others

  11. Steps in EBP • Menentukan masalah pasien • Identifikasi informasi yg diperlukan untuk memecahkan masalah • Mencari literature • Penilaian secara kritis terhadap evidence yg ada • Melakukan extraksi sbg jawaban klinik • Membuat protokol • Evaluasi

  12. Problem Focused Triggers 1. Risk Management Data 2. Process Improvement Data 3. Internal/External Benchmarking Data 4. Financial Data 5. Identification of Clinical Problem Knowledge Focused Triggers 1. New Research or Other Literature 2. National Agencies or Organizational Standards & Guidelines 3. Philosophies of Care 4. Questions from Institutional Standards Committee Is this Topic a Priority For the Organization? Consider Other Triggers No Yes = a decision Point Form a Team The Iowa Model ofEvidence Based Practice to Promote Quality Care

  13. The Iowa Model ofEvidence Based Practice to Promote Quality Care Assemble Relevant Research & Related Literature Critique & Synthesize Research for Use in Practice Is There a Sufficient Research Base? Yes No Pilot the Change in Practice 1. Select Outcomes to be Achieved 2. Collect Baseline Data 3. Design Evidence-Based Practice (EBP) Guideline(s) 4. Implement EBP on Pilot Units 5. Evaluate Process & Outcomes 6. Modify the Practice Guideline Conduct Research Base Practice on Other Types of Evidence 1. Case Reports 2. Expert Opinion 3. Scientific Principles 4. Theory

  14. Questions example • Apakah air kran (tap water) bisa dipakai untuk membersihkan luka? • Apakah semua luka harus dibersihkan dengan cairan yang steril?

  15. Source of literatures • CINAHL • OVID/MEDLINE • www.joannabriggs.edu.au

  16. OVID

  17. Cinahl

  18. EBP Sample • EBP kateter.pdf • EBP Skin care.pdf • EBP Surgical.pdf • water for wound cleansing.pdf

  19. Barriers in EBP utilization • Health care organizations  culture, policy, multi professional team, working load • Lack of skills and knowledge • Lack of support, motivation, and incentives

  20. Steven’s ACE Star Model • Discovery • Summary • Translation • Implementation • Evaluation

  21. Discover • Riset asli • Melakukan pencarian literatur • Summary • Melakukan sintesa semua riset kedalam satu makna yg mencakup keseluruhan  Ini yg membedakan dg “research utilization” dari Evidence-based practice  Dpt disebut sintesa evidence • Meningkatkan kekuatan dan efek data • Mengurangi bias • Mengkaji konsistensi • Memelihara generalizability

  22. Translation • Evidence yg ada dipertimbangkan dg keahlian klinik dan nilai-nilai • Menghasilkan panduan praktek, praktik yg terbaik, protokol, standar, klinikal atau pathway • Implementation • Translation diwujudkan kedalam praktik • Dimana perubahan akan dilakukan • Evaluation • Dampak dari perubahan terukur • Kaji variabel (hasil kesehatan, efisiensi, biaya atau kepuasan)

  23. SUMBER EBP ? • Journal • Organisasi khusus • Publikasi pemerintah • Organisasi komersial • Database • Medline • National Guidelines Clearinghouse (NCG) • Cinahl • HAPI (Health and Pyschosocial Instruments) • Cochrane Reviews • PsychInfo • Sport Discus • Message services

  24. SUMBER EBP(LANJUT) • Background InformationUptoDateHarrison’s OnlineE-books • Filtered ResourcesACP PierCochraneNatural StandardInfoPOEMSMDConsult (First Consult)Natural Medicines Comprehensive DatabaseOTseekerPhysiotherapy Evidence Database (PEDro)National Guideline Clearinghouse • Unfiltered ResourcesOVID MEDLINEPubMedCINAHLPsycINFOBIOSIS

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