Chapter 5: Understanding EBP Flashcards
The Institute of Medicine documented…
A gap between what we know and do between the care people should receive and the care they receive, between published evidence and healthcare practice.
EBP is the use of…
EBP is the use of best research evidence in conjunction with clinical expertise, patient values, and clinical circumstances, to inform clinical decisions.
What are the 3 primary issues related to quality of care?
Overuse of procedures without justification
Underuse of established procedures
Misuse of available procedures.
Healthcare providers rely on what 3 typical sources of knowledge?
Tradition: We inherit knowledge and accept precedent without further validation.
Authority: When an authority states that something is true, we often accept it. We may also find ourselves committed to one approach based on what we were taught without finding out if knowledge has expanded or changed.
Experience: Sometimes a product of trial and error, experience is a powerful teacher. Occasionally, it will be the experience of a colleague that is shared. The more experienced the clinician, the stronger the belief in that experience.
What is a key element in the EBP definition?
inclusion of the patient in decision-making
What is the EBP process?
- Ask a question
- Acquire relevant literature
- Appraise the literature
- Apply the evidence
- Assess the effectiveness of the evidence
Describe the first step in the EBP process: Ask a question.
The question should be relevant to a patient’s problem and structured to provide direction for searching for the answer.
Can be a background or foreground question.
What is a foreground question?
The more common type of clinical question for EBP is one that focuses on specific knowledge to inform decisions about patient management
Four components:
- Population or Problem
- Intervention
- Comparison
- Outcome
What is a background question?
A background question is related to etiology or general knowledge about a patient’s condition, referring to the cause of a disease or condition, its natural history, its signs and symptoms, or the anatomical or physiological mechanisms that relate to pathophysiology.
Describe step 2 in the EBP process: Acquire relevant literature.
The question leads to a search for the best evidence that can contribute to a decision about the patient’s care, guided by the PICO terms.
Different types of studies will be explored, depending on the nature of the clinical question.
- systematic reviews
- meta-analyses
- scoping review
- clinical practice guidelines
What is a systematic review?
Systematic reviews are studies in which the authors carry out an extensive and focused search for research on a clinical topic, followed by appraisal and summaries of findings, usually to answer a specific question.
What is a meta-analysis?
Meta-analyses are systematic reviews that use quantitative methods to summarize the results from multiple studies. Summary reviews are also used to establish clinical practice guidelines (CPGs) for specific conditions, translating critical analysis of the literature into a set of recommendations.
What is a scoping review?
A scoping review also includes a review of literature but with a broader focus on a topic of interest to provide direction for future research and policy considerations.
Describe step 3 in the EBP process: Appraise the literature.
Once pertinent articles are found, they need to be critically appraised to determine whether they meet quality standards and whether the findings are important and relevant to the clinical question.
Three major categories should be addressed for each article:
- Is the study valid?
- Are the results meaningful?
- Are results relevant to my patient?
Describe step 4 in the EBP process: Apply the evidence.
Once the literature is reviewed, analyzed, and interpreted, the clinician must then determine whether research results can be applied to a given clinical situation, with integration of expertise, patient values, and the context of the clinical setting.
Putting it all together to inform a clinical decision.
- Evidence
- Clinical expertise
- Patient values
- Clinical circumstances
