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Evidence-based practice Flashcards

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1
Q

evidence based practice

A

integrating best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care

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2
Q

Evidence based practice (tanner)

A

Analytical processes
Intuition
Narrative thinking

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3
Q

Analytical processes

A

Measurable phenomena yielding measurable patient outcomes

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4
Q

Intuition

A

Experience, observation, expectations

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5
Q

Narrative thinking

A

Stories and accounts of patient experiences, nurses’ experience

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6
Q

Evidence based practice requires…

A 
The need for nurses and nursing students to be capable of “locating and critiquing research studies including systematic reviews, identify gaps between current practice and best practice, and develop the skill set to address these gaps and make the appropriate changes in nursing practice”
EBP knowledge and skills 
Belief in the value of EBP
Saltire and resources to support EBP
EBP mentors
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7
Q

Evidence informed decision making

A

A continuous interactive process involving the explicit, conscientious and judicious consideration of the best available evidence to provide care

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8
Q

Decision making in nursing practice is influenced by…

A

Evidence and also by individual values, client choice, theories, clinical judgement, ethics, legislation, regulation, health-care resources and practice environments

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9
Q

History of evidence based practice

A

Cochrane
Guyett and sackett
British medical journal

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10
Q

Cochrane

A

Medical researcher
1972
Initiated the need for treatment decisions to be based on a systematic review of clinical evidence
Proposed = international collaboration of researches to systematically review all the best clinical trials specialty by specialty
Cochrane centre for systematic review opened in 1992 in the United Kingdom

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11
Q

Guyett and sackett

A

McMaster university
1980
Introduced term “evidence-based medicine”

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12
Q

British medical journal

A

Identified evidence-based practice as one of the 15 greatest breakthroughs since the journal’s launch in 1840

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13
Q

Evidence was originally directly related to

A

Quantitative research evidence

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14
Q

Elements of evidence based practice

A

Research evidence = quantitative, qualitative, mixed methods
Clinical expertise/judgement/expertise
Patient perspectives/values
Local context and environment

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15
Q

Research as evidence for practice

A

Needs to be interpreted within the context of the situation
Is not the only factor that informs decision making
Research alone will not change practice

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16
Q

Strengths of evidence based practice

A

Increased patient safety
Higher quality care, better health outcomes
Greater efficiency and reduced health care costs
Increased autonomous practice
Higher levels of job satisfaction

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17
Q

Criticisms of evidence based practice

A

Serves cost clutters and suppresses clinical freedom
Keeping up to date with literature is impossible
Insufficient time for evidence based practice with demanding case loads and staffing shortages
Lack of evidence that it improves health outcomes
Difficult to make happen
Emphasizing research over clinical judgement and family-cantered approaches = cookbook approach
Values randomized control trials and systematic reviews above all other research
Disconnect between evidence based practice and the theory guiding practice

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18
Q

Challenges of evidence based practice

A

Researchers expertise in doing research is not equal to their expertise in interpreting and knowing whether the findings make a meaningful difference in practice
Starting with a known or preferred intervention and then find research to support it
Evidence may not be meaningful in daily practice- disconnected
Using a general recipient without consideration for specific needs/preferences of the family and the context of care
Ensuring evidence is kept current
Appropriate evidence for one profession may be different than others- interprofessional conflict

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19
Q

Complexity of evidence based practice use

A

Need for rapid decisions
Multiple and diverse (sometimes conflicting) decisions
Conflicting evidence from different practitioners
Lack of complete information on which to base decisions
Availability of evidence-based guidelines
Need to explain decision-making processes

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20
Q

What would help nurses develop evidence based practice

A

A spirit of inquiry = consistently questioning practices
Strong belief in the value of EBP
Knowledge and skills in EBP
Commitment to deliver highest quality care to patients and families
An organizational culture that supports EBP

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21
Q

Evidence based practice seven steps

Study These Flashcards
A 
Zero = cultivate a spirit of inquiry 
One = formulate practice questions 
Two = search for best evidence 
Three = critically appraise evidence 
Four = integrate evidence with other knowledge 
Five = evaluate outcomes of change 
Six = disseminate EBP results
22
Q

Evidence is…

Study These Flashcards
A

That which tends to prove or disprove something; grounds for belief; proof
Something that makes plain or clear; an indication or sign
Data or information used to determine whether a claim or view should be trusted
Knowledge derived from research

23
Q

Evidence of…

Study These Flashcards
A 
Feasibility = economic and policy research 
Appropriateness = ethical and philosophical research 
Meaningfulness = interpretive research 
Effectiveness = randomized control trials and cohort research
24
Q

4 types of evidence

Study These Flashcards
A

Research evidence-based
Clinical experience practice
Service user/carer perspectives
Local context

25
Two types of questions
Background = broad and asks the question: who, what, where, when, how, why. About a situation or a medical condition Foreground questions = more specific
26
PICO(T) question
``` P = population/patient/problem, disease/condition, population and setting I = intervention, treatment, activity, procedure, action C = comparison (implicit/explicit), alternative intervention for comparison, usual intervention/control O = outcome, results T = time frame, over a period of time ```
27
Considerations prior to developing a question
Re-examine aspects of the practice issue | What is the context and basis for the question
28
Research is a systematic process of...
Collecting, analyzing, and interpreting information in order to increase our understanding of the phenomenon about which we are interested or concerned Informally = as we assess, acquire, and interpret information in daily practice Formally = as we participate in research, and as we assess, critique, and acquire information from research studies
29
History of nursing research: Florence nightingale
1859 | Focused on improving physical and emotional well being
30
History of nursing research: 1900-1940
Research focused on nursing education
31
History of nursing research: 1950s
Research focused on nurses- supply, demand, and time involved in nursing activities; and the identity of the professional nurse Research advanced with increased academic preparation, development of greater research skills and founding of the nursing research journal
32
History of nursing research: 1960s
Research focused on nursing practice - clinical nursing problems, practice-orientated concerns
33
Florence nightingale and evidence based nursing
Statistician Epidemiologist Made decisions based on best available evidence/best possible research Made efforts to collect data for evidence to influence public policy and healthcare Made attempt to demonstrate the value of having trained nurses caring for patients The start of nursing sensitive outcomes
34
History of nursing research: worldwide publications
``` 1963 = the international journal of nursing studies 1968 = the Canadian journal of nursing research 1970s = advances in nursing science; the western journal of nursing research; the journal of advanced nursing 1983 = first volume of the annual review of nursing research 1980s = applied nursing research 1993 = national institute of nursing research initiated 1990s = qualitative health research; clinical nursing research; clinical effectiveness in nursing ```
35
Future of nursing research
Increased focus on outcomes research Advancement of evidence-based practice Improving multidisciplinary/interprofessional collaboration Increasing dissemination of research findings Making nursing research more visible
36
Increased focus on outcomes research
Research assessing and monitoring the quality and cost-effectiveness of health care delivery and safety in patient care
37
Advancement of evidence-based practice
Using research and nursing knowledge to provide quality, appropriate, effective, safe patient care capturing the uniqueness of the individual
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Improving multidisciplinary/interprofessional collaboration
To improve research and quality and safety in patient care
39
Increasing dissemination of research findings
Through internet access, open access journals
40
Making nursing research more visible
Recognizing and supporting research opportunities; advancing and promoting use of research findings; facilitating development of nursing researchers
41
Quantitative research
Used to answer questions about relationships among measurable variables with the purpose of explaining, predicting, and controlling phenomena Randomized control trials - to evaluate the effectiveness of an intervention Case-control studies - to investigate the cause of a disease or the adverse effects of treatment Cohort studies - to study a group of people over a period of time Cross-sectional studies - to study a phenomena at one point in time Longitudinal studies - to study a phenomena over an extended length of time Descriptive studies - to observe, describe, and document a situation
42
Qualitative research
Used to answer questions about the complex nature of phenomena with the purpose of describing and understanding phenomena from the participants point of view Case study - to understand one person or situation Ethnography - to understand how behaviours reflect the culture of a group Phenomenological study - to understand an experience from the participants point of view Grounded theory study - to derive a theory from data collected in a natural setting Content analysis - to identify the specific characteristics of a body of material
43
Mixed research
An integration of both quantitative and qualitative research The qualitative approach emphasizes the capacity of the human to know, understand and reflect, encompassing context, interaction, and connection The quantitative approach strives for precision by focusing on things that can be counted
44
Peer review
Systematic distribution, evaluation, and reaching of consensus on the merits of a submitted manuscript or abstract Editors direct the process - select reviewers, make final decisions on publication Reviewers selected based on expertise and availability Look for technical and stylistic flaws, novelty of study, make recommendations for acceptance, rejection, or revision
45
Pre-appraised evidence (secondary research)
Systems, summaries, synopses of syntheses, syntheses, and synopses of studies Data has undergone a filtering process to include only research of higher quality These resources are regularly updated so that the evidence is current
46
Systems
Computer decision support systems which would match information from individual patients with the best evidence from research that applies to the clinical situation Ideal system would summarize all relevant research evidence about a clinical problem and link to the individual patient’s situation through an electronic health record
47
Summaries
Provide a critical appraisal synthesis of research evidence eon a specific topic, so that practitioners can easily determine validity and reliability Integrate best available evidence from the lower levels of the pyramid Gather from systematic reviews to provide a comprehensive rename of evidence concerning management options for a given health problem
48
Synopses of syntheses
Edited, short, structured descriptions and critical commentaries of systematic reviews Usually accompanied by a commentary on quality of the synthesis and clinical applicability of findings Comprehensive summary of research evidence to focused clinical question
49
Syntheses
Systematic reviews that summarize scientific studies | Comprehensive literature searches with critical appraisal
50
Synopses of single studies
Brief summary of high quality study with commentary Summary is brief and detailed to inform practice Has screened study for quality

Nursing 385 (9 decks)

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