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.