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NURS 3550 - Research > Week 12 > Flashcards

Week 12 Flashcards

1
Q

moving from evidence to practice change is about.. (2)

A
  • transdisciplinary HCP collaborations w pts/families in decision-making
  • combining external evidence w pt preferences & clinical expertise
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2
Q

the competent clinician (CC) is expected to…

A
  • deliver the best care possible supported by evidence that can be demonstrated by pt outcomes
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3
Q

the context of caring is…

A
  • the integration of pt preferences, values, and clinical expertise w evidence from well-conducted studies
  • should be everyday practice
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4
Q

why is evidence in healthcare considered complex?

A
  • as HCP we seek info across a wide range of interventioned and situations calling for different research designs
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5
Q

clinicians rely on …..for nursing practice

A
  • both internal and external evidence that needs to be understood within the context of the pt’s unique situation/context
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6
Q

evidence in healthcare is more than research but _________ is central in decision making

A
  • external evidence
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7
Q

clinical judgement focuses on…

A
  • weighing risks and benefits based on your assessment, clinical data, research, and pt preference
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8
Q

define: experiential learning

A
  • learning from past or present experiences that help us to examine evidence to consider practice changes – the heart of EBP!
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9
Q

what does clinical expertise require? how is this acquired?

A
  • Continuous self-improvement via application of: external evidence, experiential clinical learning (consists of use of internal evidence and clinical expertise)
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10
Q

clinical expertise consists of: (4)

A
  1. specialized body of knowledge or skill
  2. extensive experience in the field of practice
  3. highly developed lvls of pattern recognition
  • and then uses the above w external evidence in specific clinical contexts
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11
Q

describe clinical expertise over times

A
  • develops over time
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12
Q

what are the characteristics of pt centered care (3)

A
  • intentional focus by clinicians on pt values
  • including pt values in shared decision-making
  • pt engagement resulting in better perceived care outcomes

“talk less, listen more… no decision for them without them”

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13
Q

what are some barriers to pt centered care (5)

A
  • time constraints
  • competing care obligations
  • range of discharge communication strategies (eg. instruction to shared decision making, different nurses may provide diff education, can miss details which might have been useful to pt)
  • pts not feeling prepared for discharge, non-individualized
  • discharge process influenced by pressure for use of available beds
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14
Q

what can clinicians ask to provide pt-centered care

A
  • “Is there anything at all that could have gone better today from your point of view in the care your experienced?”
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15
Q

EBP nursing practice is more than “helping people” it is….

A
  • It is big picture thinking = integrating research, clinical expertise, and patient preferences in decisions.
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16
Q

describe what is meant by “EBP nursing practice is intentional”

A
  • evidence needs to be sought out and appraised to provide best possible care
17
Q

what are the 4 components to an EBP clinical enviro

A
  • vision
  • engagement
  • integration
  • evaluation
18
Q

describe the “vision” component of an EBP enviro (5)

A

create a vision for EBP:

  • what are the goals & shared mental framework (goals & values r/t pt care should be similar on a unit)
  • small group of passionate people
  • early involvement of clinical experts and EBP mentors
  • knowledge of change strategies (change theory?)
  • administrative support (ex. if doing research on a topic and find that the unit strategy is not best practice = need support from management)
19
Q

describe the “engagement” component of the EBP enviro model (5)

A
  • involve all staff in high priority clinical issues including admin (ownership)
  • assess/eliminate barriers (assess strengths, weaknesses, threats, opportunities to change)
  • prioritize clinical issues (focus on how steps for change “fit” routine clinical practice, cost, staffing, time)
  • evaluate infrastructure (time to do the 5 A’s?, access to a library/clinical research database?)
  • develop or seek experts in the EBP process
19
Q

describe the “engagement” component of the EBP enviro model (5)

A
  • involve all staff in high priority clinical issues including admin (ownership)
  • assess/eliminate barriers (assess strengths, weaknesses, threats, opportunities to change)
  • prioritize clinical issues (focus on how steps for change “fit” routine clinical practice, cost, staffing, time)
  • evaluate infrastructure (time to do the 5 A’s?, access to a library/clinical research database?)
  • develop or seek experts in the EBP process
20
Q

what are common barriers to EBP implementation (7)

A
  • Resistence to change: Breaking traditional practice, not knowing how evidence improves outcomes, misconceptions about time and effort for change
  • Inadequate knowledge and skill about EBP process
  • Weak beliefs about the value of EBP
  • Poor attitudes toward EBP
  • Lack of EBP mentors
  • Organizational and social influences
  • Economic restrictions
21
Q

describe the “integration” component of the EBP enviro model (8)

A
  • establish formal integration teams
  • build excitement, create compelling case, create discomfort w status quo
  • disseminate evidence (tailored and multi-faceted approaches)
  • develop clinical tools (ex. summaries, CPGs, pathways, “up to date” search question)
  • pilot the test EBP change in practice (trialing a new intervention on your unit for a small period of time)
  • preserve energy (small phased projects, patients, perseverance, persistance –> massive changes are rarely retained as they overwhelm people and make them closed to implementing it = intro small things at a time)
  • setting timelines (be aware of enviro issues)
  • celebrate success (early ones too)
  • leadership plays imp role
22
Q

what are 3 key factors to successful integration of EBP

A
  1. evidence is robust (reliable and valid)
  2. physical enviro is receptive to change
  3. change process is appropriately facilitated
23
Q

describe the “evaluate” component of the EBP enviro model (3)

A
  • at all lvls: pt, clinician, and organization/system
  • often overlooked step in the EBP practice
  • ask if the findings from research are the same when translated into your “real world” of practice
24
Q

what are the 6 areas of EBP evaluation indicators

A
  1. outcome measures
  2. quality care improvement
  3. pt-centered quality care
  4. efficiency of processes
  5. enviro changes
  6. professional expertise
25
Q

describe the “outcome measures” area of EBP evaluation indicators

A
  • measureable medical outcomes

ex. health status, death, disability, etc.

26
Q

describe the “quality care improvement” area of EBP evaluation indicators

A
  • managing common systems like pain, fatigue caused by diseases but have direct impact on pts/families
  • enhancing QOL
27
Q

describe the “pt centered quality care” area of EBP evaluation indicators

A
  • reflect the value placed on health care received by pts and families
    ex. effective communication, open discussion about illness, sensitivity to pain & distress, consideration of religious beliefs, being respectful, nonavoidance of specific issues, empathy, patience, equitable access, caring attitude

see page 285, exam question

27
Q

describe the “pt centered quality care” area of EBP evaluation indicators

A
  • reflect the value placed on health care received by pts and families
    ex. communication, options for care, etc.

see page 285, exam question

28
Q

describe the “efficiency of processes” area of EBP evaluation indicators

A
  • about health care delivery methods in the organization
    ex. appropriate timing of interventions, effective discharge plannig, efficient utilization of hospital beds, elimination of waste such as duplication of tests

*** know this

29
Q

describe the “environmental changes” area of EBP evaluation indicators

A
  • a culture that promotes EBP throughout the organization
    ex. evaluate policy and procedure adherence, unit resource availability, use of supplies and materials essential to implement EBP
30
Q

describe the “professional expertise” area of EBP evaluation indicators

A
  • staff knowledge and expertise helps w setting expectations for adhere to accepted standards of care for best practice
31
Q

know the pressure injury stuff?

A

….

NURS 3550 - Research (12 decks)

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