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Created by Terran Mathers, PhD, RN
There is no conflict of interest in the creation of this education program.
Objectives Explain the importance of Evidence Based
Practice (EBP) in nephrology nursing. List the steps of EBP. Identify four internet resources/databases
where previous research or guidelines may be located.
Recognize potential barriers to EBP within an organization so that strategies may be planned to overcome them.
Introduction
Historical Background of EBP 1837: Pierre Louis 1970’s: Cochran Collaboration 1972: Briggs Report (DHSS) 2004: ANNA Nursing Research
Committee Survey
What isEvidence-Based Research?
EBR defined: Clinically relevant research based on medical science; this research is patient-centered.
Research Utilization: Use of the knowledge found from research, usually based on a single study.
Cochrane Center (meta-analysis reviews)
(Melnyk & Fineout-Overholt, 2005; Sackett et al, 2000)
What IsEvidence-Based Practice?
Patient Preferences& Values
Clinical Experience And Expertise
Assessment
Search and Appraisal Of Evidence
Evidence Based Practice**
Clinical Decision Making
Sackett et al, 2000; Melnyk & Fineout-Overholt, 2005
Why Evidence-Based Practice?
Quality Care
Positive Patient
Outcomes
EnhanceProfessionalEnvironment
Cost Containment
Centers forEvidence-Based Practice
Blue Cross and Blue Shield Association Duke University ECRI John Hopkins University McMaster University Oregon Health & Science University RTI International – University of North Carolina Southern California Stanford University – University of California, San
Francisco Tufts University – New England Medical Center University of Alberta, Edmonton, Alberta, Canada University of Minnesota, Minneapolis, MN University of Ottawa, Ottawa, Canada
www.ahrq.gov/clinic/epc/epcenters.htm
Steps ofEvidence-Based Practice
Step 1:Step 1: Step 1:Step 1:
Melnyk & Fineout-Overholt, 2005
What is theclinical question?
P = Patient Population / Disorder
I = Intervention or Interest Area
C= Comparison
O= Outcome
Ask the clinical questionin the “PICO” format
PICO
P = Elderly nephrology patients
I = Psychosocial issues
C = Effect on compliance
O = Patient will be able to adapt tochanges related to diagnosisand treatment
Example:
Steps ofEvidenced-Based Practice
Step 2: Step 2: Step 2: Step 2: Find the best evidence toanswer the question
Systematic review of the literature Meta-analysis or clinical practice
guidelines Rigorous process Preset criteria Overcomes bias Valid / credible results
Guideline Databases
National Guideline Clearinghouse (NGC)http://www.guideline.gov
National Institute for Clinical Excellence (NICE)http://www.nice.org.uk/catcg2.asp?c=20034
National Kidney Foundation K/DOQI Guidelines:http://www.kidney.org/professionals/doqi/guidelineindex.cfm
Steps ofEvidence-Based Practice
Step 3:Step 3:Step 3:Step 3: Appraise the evidence
1. What were the results of the study?2. Are the results valid?3. Will the results facilitate patient care?
Critical Questions to Ask:
Step 4: Step 4: Step 4: Step 4:
Steps ofEvidence-Based Practice
Integrate the evidence, patient assessment information, clinical expertise, patient preferences and values.
Steps ofEvidence-Based Practice
Evaluate the change in the clinical area.
Step 5: Step 5: Step 5: Step 5:
Implementing EBP:The Barriers
Translating the meaning and relevance of EBP
Knowledge deficit Being overwhelmed by the
evidence The need for dedicated time Negative views about research Organizational constraints
VanBuskirk, 2005; Melnyk & Fineout-Overholt, 2005
Facilitation of EBPPromote Acceptance
Access with surveys; focus groups
Identify baseline knowledge Identify real case scenarios Analyze the culture of the
environment
Facilitation of EBPCorrect Misperceptions
Have key leaders attend nursing centers
Teach the basics of EBP (Online Tutorials)
Expose to useful databases
EBP Online Tutorials Evidence-Based Clinical Practice Tutorial
http://www.urmc.rochester.edu/hslt/miner/digital_library/evidence_based_resources.cfm
Texas Health Science Center: Academic Center for Evidence-Based Nursinghttp://www.acestar.uthscsa.edu/
Evidence-Based Nursinghttp://www.hsl.unc.edu/Services/Tutorials/EBN/index.htm
Facilitation of EBPQuestion Clinical Practices
Prioritize problems Utilize clinical practice
guidelines and research Promote a culture of
organizational acceptance for EBP
References Honor Society of Nursing, Sigma Theta Tau
International (2005). Honor Society of Nursing, Sigma Theta Tau International: Position statement on evidence-based nursing. Indianapolis: Sigma Theta Tau International.
Cowan, P. (2004). Advancing evidence-based practice through meta-analysis. Nephrology Nursing Journal, 31(3), 343-345.
Gagan, M., & Hewitt-Taylor, J. (2004). The issues for nurses involved in implementing evidence in practice. British Journal of Nursing, 13(20), 1216-1220.
References Gillis, A., & Jackson, W. (2002). Research for nurses:
Methods and interpretation. Philadelphia: F.A. Davis.
Larrabee, J. (2004). Advancing quality improvement through using the best evidence to change practice. Journal of Nursing Care Quality, 19(1). 10-14.
Malloch, K., & Porter-O’Grady, T. (2006). Introduction to evidence-based practice in nursing and health care. Boston: Jones and Bartlett.
Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott, Williams, & Wilkins.
References Pape, T. (2003). Evidence-based nursing practice:
To infinity and beyond. The Journal of Continuing Education in Nursing, 34(4), 154-164.
Paramonczyk, A. (2005). Barriers to implementing research in clinical practice. The Canadian Nurse, 101(3), 12-18.
Portney, L. (2004). Evidence-based practice and clinical decision making: It’s not just the research course anymore. Journal of Physical Therapy Education, 18(3), 46-51.
References Tod, A., Palfreyman, S., & Burke, L. (2004). Evidence-
based practice is a time of opportunity for nursing. British Journal of Nursing, 13(4), 211-216.
VanBuskirk, S. (2005). The value of evidence-based practice in nephrology nursing. Nephrology Nursing Journal, 32(2), 134-135.
Sackett, D. L., Straus, S. E., Richardson, W. S. et al. (2000). Evidence-based medicine: how to practice and teach EBM. London: Churchill, Livingstone.