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Chapter 27

Strategies for Promoting Evidence-BasedNursing Practice



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

Elsevier items and derived items © 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.



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.




Benefits of Evidence-Based Practicein Nursing

Improved outcomes for patients, providers,and health care agencies

Cost and quality

Magnet Status Program




Guidelines for SynthesizingResearch Evidence

Systematic review Meta-analysis Integrative reviews

Metasummary and metasynthesis(qualitative)




Stetler Model of Research Utilization toFacilitate Evidence-Based Practice




7

Phases of Stetler Model

• Phase I: Preparation• Phase II: Validation• Phase III: Comparative evaluation/decision

making• Phase IV: Translation/application• Phase V: Evaluation




8

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.




9

Phase II: Validation

• Synthesis of knowledge• If research knowledge base is strong, a

judgment is made about the applicability or

usefulness for your agency




10

• Includes four parts – Substantiating evidence – Fit of setting – Feasibility – Current practice

Phase III: ComparativeEvaluation/Decision Making




11

Decision Making

• Three types of decisions – Use the findings – Consider using the findings – Reject or not use the findings




12

Phase IV: Translation/Application

• Steps of change – Assess the situation to be changed – Develop a plan for change: protocol, algorithm – Implement the plan




13

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




14

Instrumental Application

• Develop a protocol, guideline, or algorithmbased on research to change practice.

• Create a poster to document steps for

changing practice.




15

Symbolic Utilization

• Research is used to: – Revise a policy – Develop a new role – Legitimize a position – Implement a new health delivery system




16

Phase V: Evaluation

• Formal evaluation – Case studies – Audits, surveys – Quality assurance projects

• Informal evaluation – Self-monitoring – Discussions with patients, families, peers, and

other professionals




17

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.




18

Grove Model for ImplementingEvidence-Based Guidelines in Practice

To facilitate the use of evidence-basedguidelines in practice




19

Implementing Evidence-Based Guidelinesin Practice

Development of Evidence-Based Guidelines Evidence-Based Practice Centers




20

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




21

Introduction

• Identify practice problem• Link practice problem with evidence-based

guideline

• Interest in guideline in practice




22

Evidence-Based Guideline

• Guideline development – Author of guideline – Significance of health care problem – Strength of research evidence – Link to national standards – Cost-effectiveness analysis




23

• 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




24

• 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




25

Implementation of EBP

How will the intervention be used by anindividual, group, or agency?




26

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




27

Implementation

• Protocol• Algorithm• Policy




28

Evaluation

The individual, nursing unit, clinic, or agencyevaluates the effectiveness of the EBP guidelineand decides whether to continue.




29

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




30

Evaluation (cont’d)

• Formal evaluation – Case studies – Audits, surveys – Quality assurance projects

• Informal evaluation – Self-monitoring – Discussions with patients, families, peers, and

other professionals




31

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




32

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




33


• 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




34


• 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

chapter 027

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