Evidence-Based NursingEvidence-Based NursingAn OverviewAn Overview

What’s It All About?What’s It All About?

Betty Ackley, RN, MSN, EdSBetty Ackley, RN, MSN, EdS

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ObjectivesObjectives

Identify the advantages of Evidence-Based Identify the advantages of Evidence-Based NursingNursing

Explain the process of Evidence-Based Explain the process of Evidence-Based NursingNursing

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A portion of this presentation is A portion of this presentation is adapted from the following text:adapted from the following text: Ackley B, Ladwig G, Swan B, Tucker S. Ackley B, Ladwig G, Swan B, Tucker S. (2008). (2008). Evidence-Based Nursing Care Evidence-Based Nursing Care Guidelines: Medical-Surgical Guidelines: Medical-Surgical InterventionsInterventions. Philadelphia: Mosby.. Philadelphia: Mosby.

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Evidence-based nursing is a systematic Evidence-based nursing is a systematic process that utilizes current evidence in process that utilizes current evidence in making decisions about the care of patients, making decisions about the care of patients, including evaluation of quality and including evaluation of quality and applicability of existing research, patient applicability of existing research, patient preferences, costs, clinical expertise, and preferences, costs, clinical expertise, and clinical settings clinical settings (Fineout-Overholt, 2005). (Fineout-Overholt, 2005).

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How Do You GiveHow Do You Givethe Best Care Possible?the Best Care Possible?

What interventions help prevent falls in the What interventions help prevent falls in the elderly?elderly?

What interventions help prevent or treat What interventions help prevent or treat stomatitis for the chemotherapy patient?stomatitis for the chemotherapy patient?

How do you protect hospitalized patients from How do you protect hospitalized patients from developing developing Clostridium difficileClostridium difficile infection? infection?

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We answer these questions by We answer these questions by referring to texts or expert nurses, referring to texts or expert nurses,

and there is only beginning research.and there is only beginning research.

The nursing field is currently opinion or expert The nursing field is currently opinion or expert based. This does not allow nursing to meet based. This does not allow nursing to meet the criterion of being a profession. the criterion of being a profession.

Instead:Instead:

The nursing field The nursing field mustmust become research become research based, building our practice on research and based, building our practice on research and documenting better outcomes as a result. We documenting better outcomes as a result. We will then be a profession, not an occupation.will then be a profession, not an occupation.

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EBNCritical ThinkingCritical ThinkingEmpowermentEmpowerment

ExcellenceExcellenceGrowthGrowth

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EBN EBN Nursing’s Nursing’s

CoreCore

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The EBN Nurse is The EBN Nurse is EmpoweredEmpowered

The EBN nurse knows what needs to be The EBN nurse knows what needs to be done, how it should be done, and the done, how it should be done, and the evidence that supports her or his practiceevidence that supports her or his practice

““Armed” with EvidenceArmed” with Evidence

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EBN vs EBP EBN vs EBP

EBP

EBM

EBN EB Psych

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EBN:EBN:AllAll Levels of Nursing Levels of Nursing

EducationEducationAllAll Nursing Specialties Nursing Specialties

Licensed Practical NurseLicensed Practical Nurse Associate Degree NurseAssociate Degree Nurse Baccalaureate NurseBaccalaureate Nurse Master’s Degree NurseMaster’s Degree Nurse PhD (conduct research) PhD (conduct research)

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EBN vs Research UtilizationEBN vs Research UtilizationComplex processComplex processNewer conceptNewer concept——developed 10 yrs developed 10 yrs agoago

Includes patient preferenceIncludes patient preference

Includes a system to grade or level Includes a system to grade or level the quality of the researchthe quality of the research

Includes evaluation of the evidence Includes evaluation of the evidence based on the clinical setting in based on the clinical setting in which it will be appliedwhich it will be applied

Includes an evaluation of cost- Includes an evaluation of cost- effectivenesseffectiveness

Includes evaluation of staffing and Includes evaluation of staffing and expertise of staffexpertise of staff

Less complex processLess complex processOlder conceptOlder concept——used in the 1970s used in the 1970s to early 1990sto early 1990s

Patient preference not includedPatient preference not included

No defined system to evaluate No defined system to evaluate research; may change practice research; may change practice based on one studybased on one study

Clinical setting is not consideredClinical setting is not considered

Cost is not addressedCost is not addressed

Staffing and expertise are not Staffing and expertise are not addressedaddressed

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Levels of Evidence Levels of Evidence (Adapted from Melnyk & Fineout-Overholt, 2005)(Adapted from Melnyk & Fineout-Overholt, 2005)

Level ILevel I Systematic review or meta-analysis, or evidence-based Systematic review or meta-analysis, or evidence-based clinical practice guidelines based on systematic reviews of clinical practice guidelines based on systematic reviews of randomized controlled trials (RCTs) randomized controlled trials (RCTs) or or three or more RCTs three or more RCTs of good quality that have similar resultsof good quality that have similar results

Level IILevel II Evidence obtained from at least one well-designed RCT Evidence obtained from at least one well-designed RCT

Level IIILevel III Evidence obtained from well-designed controlled trials Evidence obtained from well-designed controlled trials without randomizationwithout randomization

Level IVLevel IV Evidence from well-designed case control or cohort studiesEvidence from well-designed case control or cohort studies

Level VLevel V Evidence from systematic reviews of descriptive and Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis) qualitative studies (meta-synthesis)

Level VILevel VI Evidence from a single descriptive or qualitative study Evidence from a single descriptive or qualitative study

Level VIILevel VII Evidence from the opinion of authorities and/or reports of Evidence from the opinion of authorities and/or reports of expert committeesexpert committees

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Steps of Evidence-Based Steps of Evidence-Based NursingNursing

1.1. Ask the burning clinical question.Ask the burning clinical question.2.2. Collect the best evidence available.Collect the best evidence available.3.3. Critically appraise the evidence.Critically appraise the evidence.4.4. Integrate the available evidence with clinical Integrate the available evidence with clinical

expertise, client preference, and values in expertise, client preference, and values in developing a practice decision or change.developing a practice decision or change.

5.5. Measure the “before and after” of outcomes.Measure the “before and after” of outcomes.6.6. Evaluate the EBN decision or change.Evaluate the EBN decision or change.

(Adapted from Melnyk & Fineout-Overholt, 2005)(Adapted from Melnyk & Fineout-Overholt, 2005)

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ASKMME!ASKMME!

©Copyright, The Betty Ackley LLC©Copyright, The Betty Ackley LLC

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AAsk the sk the burningburning question question

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SSearch and collect the earch and collect the most relevant and best most relevant and best

evidenceevidenceavailable.available.

  

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thinthinkk

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MMeasure the outcomes easure the outcomes before instituting the before instituting the

change.change.

Measure the outcomes Measure the outcomes after the change.after the change.

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MMake it Happen!ake it Happen!

Rewrite a policy and procedure;Rewrite a policy and procedure;write a clinical protocol;write a clinical protocol;change a nursing supply.change a nursing supply.

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EEvaluatevaluate the practice the practice decision or change.decision or change.

Were there improved Were there improved outcomes? outcomes?

Did it save money? Time? Did it save money? Time? Is it realistic in the clinical Is it realistic in the clinical

setting?setting?

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Why Do You Do It That Way?Why Do You Do It That Way?

The answer used to be:The answer used to be:

That’s how I was taught in school.That’s how I was taught in school. That’s what it says in the textbook.That’s what it says in the textbook. That’s the way we’ve always done it here.That’s the way we’ve always done it here.

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Now The Now The CorrectCorrect Answer Is: Answer Is:

Evidence-based nursing shows that . . .Evidence-based nursing shows that . . .

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We will show the worldWe will show the world that that nursing carenursing care

makes a difference!makes a difference!

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ReferencesReferences

Ackley B, Ladwig G, Swan B, Tucker S. (2008). Ackley B, Ladwig G, Swan B, Tucker S. (2008). Evidence-Based Nursing Care Guidelines: Evidence-Based Nursing Care Guidelines: Medical-Surgical InterventionsMedical-Surgical Interventions. Philadelphia: . Philadelphia: Mosby.Mosby.

Fineout-Overholt, E & Melnyk, B. (2005). Fineout-Overholt, E & Melnyk, B. (2005). Building a culture of best practice. Building a culture of best practice. Nurse LeaderNurse Leader 3(6):26-30.3(6):26-30.

Melnyk, B & Fineout-Overholt, E. (2005). Melnyk, B & Fineout-Overholt, E. (2005). Evidence-based Practice in Nursing and Health Evidence-based Practice in Nursing and Health CareCare. Philadelphia: Lippincott Williams & Wilkins.. Philadelphia: Lippincott Williams & Wilkins.