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Chapter 27
Strategies for Promoting Evidence-BasedNursing Practice
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Evidence-Based Practice
• Definition: conscientious integration of bestresearch evidence with clinical expertise andpatient values and needs in the delivery of
quality, cost-effective health care
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Criticisms of Evidence-BasedPractice
in Nursing
Nursing lacks the research evidence. Evidence generated based on populations is
applied to individual patients.
Contributions of qualitative research are stillevolving.
Guidelines can lead to “cookbook” nursing. Administrators do not provide resources
needed.
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Benefits of Evidence-Based Practicein Nursing
Improved outcomes for patients, providers,and health care agencies
Cost and quality
Magnet Status Program
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Guidelines for SynthesizingResearch Evidence
Systematic review Meta-analysis Integrative reviews
Metasummary and metasynthesis(qualitative)
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Stetler Model of Research Utilization toFacilitate Evidence-Based Practice
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Phases of Stetler Model
• Phase I: Preparation• Phase II: Validation• Phase III: Comparative evaluation/decision
making• Phase IV: Translation/application• Phase V: Evaluation
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Phase I: Preparation
• Identify a need for knowledge related to aspecific nursing practice situation.
• Conduct a review of published research
related to the topic of concern.
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Phase II: Validation
• Synthesis of knowledge• If research knowledge base is strong, a
judgment is made about the applicability or
usefulness for your agency
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• Includes four parts – Substantiating evidence – Fit of setting – Feasibility – Current practice
Phase III: ComparativeEvaluation/Decision Making
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Decision Making
• Three types of decisions – Use the findings – Consider using the findings – Reject or not use the findings
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Phase IV: Translation/Application
• Steps of change – Assess the situation to be changed – Develop a plan for change: protocol, algorithm – Implement the plan
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Cognitive Application
• Research modifies your way of thinking orperception by: – Improving understanding of a situation
– Allowing analysis of practice dynamics – Expanding problem-solving skills for clinicalproblems
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Instrumental Application
• Develop a protocol, guideline, or algorithmbased on research to change practice.
• Create a poster to document steps for
changing practice.
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Symbolic Utilization
• Research is used to: – Revise a policy – Develop a new role – Legitimize a position – Implement a new health delivery system
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Phase V: Evaluation
• Formal evaluation – Case studies – Audits, surveys – Quality assurance projects
• Informal evaluation – Self-monitoring – Discussions with patients, families, peers, and
other professionals
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Iowa Model of Evidence-BasedPractice
• Assemble, critically analyze, and synthesizeresearch for use in practice.
• Evaluate the sufficiency of the research base.
• Pilot change in practice.• Institute the change in practice.• Monitor outcomes.
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Grove Model for ImplementingEvidence-Based Guidelines in Practice
To facilitate the use of evidence-basedguidelines in practice
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Implementing Evidence-Based Guidelinesin Practice
Development of Evidence-Based Guidelines Evidence-Based Practice Centers
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Grove Model
• Search for best evidence for practice problem• Use existing evidence-based guideline• Assess quality and cost-benefit ratio of
guideline• Use guideline in practice• Monitor outcomes from use of guideline• Extend use of guideline to other practice
settings
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Introduction
• Identify practice problem• Link practice problem with evidence-based
guideline
• Interest in guideline in practice
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Evidence-Based Guideline
• Guideline development – Author of guideline – Significance of health care problem – Strength of research evidence – Link to national standards – Cost-effectiveness analysis
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• Discuss setting for using guideline• Fit within this setting and/or change required• Benefits of using evidence-based guideline
• Cost or risks associated with guideline• Support to use guideline
Cost-Benefit Ratio
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• Who is involved in decision?• What steps have been taken to implement
guideline and results?
• Probable decision regarding implementation?
Decision to Use Evidence-BasedPractice (EBP) Guideline
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Implementation of EBP
How will the intervention be used by anindividual, group, or agency?
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Use of Evidence-Based Guidelines inPractice
• Who will implement guideline?• Final form of guideline• Communication process related to guideline
• Support of health care professionals forguideline
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Implementation
• Protocol• Algorithm• Policy
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Evaluation
The individual, nursing unit, clinic, or agencyevaluates the effectiveness of the EBP guidelineand decides whether to continue.
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Evaluation (cont’d)
• Anticipated outcomes for agency, provider,and/or patient
• Specific outcomes to be examined
• Process for evaluating these outcomes• Action related to evaluation
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Evaluation (cont’d)
• Formal evaluation – Case studies – Audits, surveys – Quality assurance projects
• Informal evaluation – Self-monitoring – Discussions with patients, families, peers, and
other professionals
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Project Outcomes
• Patient outcomes – Clinical end points (symptoms and signs, status of
disease) – Functional status – Psychological status – Satisfaction with care: access, convenience,
financial coverage, quality
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Project Outcomes (cont’d)
• Provider outcomes – Number of patients cared for – Revenue generated – Status of patient: repeat hospitalizations,
emergency department visits – Patient satisfaction with care
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Project Outcomes (cont’d)
• Agency outcomes – Length of stay of patients – Revenue generated – Health status of patient – Quality assurance, such as infection rate – Patient and provider satisfaction – Access to care
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Project Outcomes (cont’d)
• What is to be measured?• How will it be measured?• Analysis of results
• Use of the results to maintain or change practice
El i it d d i d it © 2009 2005 2001 1997 b S d i i t f El i I