Process to PracticeRoxanne L. Ebo

An approach to clinical practice

A way to keep current with new developments

An integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served.

… a methodological approach to clinical practice where evidence is used to inform decision-making about making a diagnosis (or interpreting a diagnostic test), selecting an intervention, or evaluating prognostic indicators

… an approach to health care practice in which the clinician is aware of the evidence that bears on her clinical practice, and the strength of that evidence

… an approach to decision making in which the clinician uses the best evidence available, in consultation with patient, to decide upon the option which suits that patient best

Evidence based health care is

the integration of individual clinical expertise

with the best available external

clinical evidence and the values and

expectations of the patient

Involves life-long, self-directed, problem-based learning

Involves exploring the relationship between clinical reasoning and research evidence

Involves practice

Do nothing … and get out of date Depend solely on courses/conferences Choose the main professional journal(s)

and read them cover to cover every month

Learn how to find and appraise the evidence to answer questions that come from clinical practice

Knowledge Standard

Each nurse possesses, through basic education and continuing learning, knowledge relevant to her/his professional practice

Knowledge Standard Indicators

Providing a theoretical and/or evidence-based rationale for all decisions

Understanding the knowledge required to meet the needs of complex clients

Knowing where/how to access learning resources when necessary

Knowledge Standard Indicators Seeking and reviewing research in nursing,

health sciences and related disciplines Using research to inform practice/professional

service

Knowledge Application Standard

Each nurse continually improves the application of professional knowledge

Knowledge Application Standard Indicators

Ensuring practice is based in theory and evidence and meets all relevant standards/guidelines

Assessing/describing the client situation using a theory, framework or evidence-based tool

Managing multiple nursing interventions simultaneously

Knowledge Application Standard Indicators

Evaluating/describing the outcome of specific interventions and modifying the plan/approach

Integrating research findings into professional service and practice

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

The cognitive continuum.

Define the Question Identify Question ~ Search and Screen

Literature ~ Refine Question Collect the Evidence Critically Appraise the Evidence for

Validity and Relevance

Integrate the Evidence and Patient Factors Make & Carry Out the Decision

Evaluate the Process Results ~ Self-reflection

A clinical question should incorporate at least three elements

Patient Age, sex, ethnicity, etc. Condition, diseases, general health status

Intervention Education, diagnostics, treatment plan, self-

care, etc.

Comparison Intervention Placebo, etc.

Outcome Expected and actual effects on patient

Do nurse led tobacco cessation interventions result in decreased smoking rates after hospital admission for coronary heart disease?

PATIENT (Adult) coronary heart patients Smokers Discharged from hospital

INTERVENTION Nurse led tobacco cessation programmes

COMPARISON (Non-nurse led tobacco cessation programmes

Self-administered, non-nurse administered, etc.) No comparison

OUTCOME Lower rates of tobacco use among Patient

group

Not all questions are of a clinical nature

Intervention can be interpreted very broadly

“Important medical questions are typically studied more than once, often by different research teams in different locations. A meta-analysis combines results from different studies, hopefully averaging out any differences caused by random change or local variation and getting at something close to the real truth. In general a meta-analysis, if you can find one, will be a better guide to practice than an individual article.”

SUNY Downstate Medical Center, 2003

Usefulness = Relevance x Validity  Work