7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
1/31
Evidence Based NursingProcess to PracticeBracken Health Sciences Library(adapted from a presentation of Dr. Norma MacIntyre,
School of Rehabilitation Therapy, Queens University)
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
2/31
The importance of evidence
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
3/31
The importance of evidence
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
4/31
N. MacIntyre, 2005
What is Evidence-Based Practice?
An approach to clinical practice
A way to keep current with newdevelopments
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
5/31
Centre for Evidence-Based Medicine
What is Evidence-Based Practice?
a methodological approach to clinical practice
where evidence is used to inform decision-makingabout making a diagnosis (or interpreting adiagnostic test), selecting an intervention, orevaluating prognostic indicators
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
6/31
Health Information Research Unit, McMaster,2002
What is Evidence-Based Practice?
an approach to health care practice in which the
clinician is aware of the evidence that bears on herclinical practice, and the strength of that evidence
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
7/31
J. A. Muir Gray, 1997
What is Evidence-Based Practice?
an approach to decision making in which theclinician uses the best evidence available, inconsultation with patient, to decide upon the optionwhich suits that patient best
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
8/31
D. Sackett et al, 1996
What is Evidence-Based Practice?
Evidence based health care
isthe integration of individual clinical expertise
with
the best available external clinical evidence and
the values and expectations of the patient
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
9/31
N. MacIntyre, 2005
Evidence-Based Practice
Involves life-long, self-directed, problem-basedlearning
Involves exploring the relationship between clinicalreasoning and research evidence
Involves practice
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
10/31
N. MacIntyre, 2005
Keeping Up?
Do nothing and get out of date
Depend solely on courses/conferences
Choose the main professional journal(s) and readthem cover to cover every month
Learn how to find and appraise the evidence to
answer questions that come from clinical practice
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
11/31
Ontario College of Nurses, 2002
Evidence Based Nursing Practice
Knowledge Standard
Each nurse possesses, through basic education and
continuing learning, knowledge relevant to her/hisprofessional practice
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
12/31
Ontario College of Nurses, 2002
Evidence Based Nursing 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
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
13/31
Ontario College of Nurses, 2002
Evidence Based Nursing Practice
Knowledge Standard Indicators
Seeking and reviewing research in nursing, health sciences
and related disciplines
Using research to inform practice/professional service
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
14/31
Ontario College of Nurses, 2002
Evidence Based Nursing Practice
Knowledge Application Standard
Each nurse continually improves the application of
professional knowledge
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
15/31
Ontario College of Nurses, 2002
Evidence Based Nursing Practice
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
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
16/31
Ontario College of Nurses, 2002
Evidence Based Nursing Practice
Knowledge Application Standard Indicators
Evaluating/describing the outcome of specific interventions
and modifying the plan/approach
Integrating research findings into professional service andpractice
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
17/31
Copyright 2004 BMJ Publishing Group Ltd.
Thompson, C. et al. Evid Based Nurs 2004;7:68-72
The cognitive continuum.
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
18/31
N. McKibbon, 1999
Five Steps of Evidence-Based Practice
Define the Question
Identify Question ~ Search and Screen Literature ~Refine Question
Collect the Evidence
Critically Appraise the Evidence for Validity andRelevance
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
19/31
N. McKibbon, 1999
Five Steps of Evidence-Based Practice
Integrate the Evidence and Patient Factors
Make & Carry Out the Decision
Evaluate the Process Results ~ Self-reflection
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
20/31
PICO
A clinical question should incorporate at least threeelements
Patient Age, sex, ethnicity, etc.
Condition, diseases, general health status
Intervention Education, diagnostics, treatment plan, self-care, etc.
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
21/31
PICO
Comparison Intervention
Placebo, etc.
Outcome
Expected and actual effects on patient
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
22/31
PICO
Do nurse led tobacco cessation interventions result
in decreased smoking rates after hospital admissionfor coronary heart disease?
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
23/31
PICO
PATIENT
(Adult) coronary heart patients
Smokers
Discharged from hospital
INTERVENTION
Nurse led tobacco cessation programmes
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
24/31
PICO
COMPARISON
(Non-nurse led tobacco cessation programmes
Self-administered, non-nurse administered, etc.)
No comparison
OUTCOME
Lower rates of tobacco use among Patient group
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
25/31
PICO
Not all questions are of a clinical nature
Intervention can be interpreted very broadly
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
26/31
SUNY Downstate Medical Center, 2003
Evidence Pyramid
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
27/31
SUNY Downstate Medical Center, 2003
Evidence Pyramid
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.
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
28/31
Claude Moore Health Sciences Library, 2003
Evidence Based Resources Models
Usefulness = Relevance x ValidityWork
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
29/31
Claude Moore Health Sciences Library, 2003
Evidence Based Resources Models
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
30/31
Claude Moore Health Sciences Library, 2003
Evidence Based Resources Models
7/28/2019 2007 Fall - Nursing 305 - Evidence Based Nursing Presentation
31/31
See you at the Search Sessions!
Mon. Sept. 24 ORWed. Sept. 26
8:30 9:30Bracken Library eLab