Evidenced Based Practice; Evidenced Based Practice; Systematic Reviews; Systematic Reviews; Critiquing ResearchCritiquing Research
CNL Exam ReviewCNL Exam Review
Evidence-Based PracticeEvidence-Based Practice
Conscientious integration of best Conscientious integration of best research evidence with clinical research evidence with clinical expertise and patient values and expertise and patient values and needs in the delivery of high-quality, needs in the delivery of high-quality, cost-effective health carecost-effective health care
Synthesis of knowledge for Synthesis of knowledge for development of guidelines, standards, development of guidelines, standards, protocols, or policies to direct nursing protocols, or policies to direct nursing interventions and practiceinterventions and practice
Evidence-Based PracticeEvidence-Based Practice
Hospital PrioritiesHospital Priorities– Pressure UlcersPressure Ulcers– FallsFalls– Hospital Acquired InfectionsHospital Acquired Infections– Reducing costsReducing costs– Improving patient and staff satisfactionImproving patient and staff satisfaction– Reducing errorsReducing errors
communicationcommunication
Evidenced-Based PracticeEvidenced-Based Practice Masters preparedMasters prepared
– InnovatorsInnovators– Early adoptersEarly adopters
ApplicationApplication– Evaluate MeritEvaluate Merit– Clinical RelevanceClinical Relevance– Sufficiency of research baseSufficiency of research base– Pilot changePilot change– Monitor OutcomesMonitor Outcomes
Creating an EBP CultureCreating an EBP Culture
Value ReflectionValue Reflection– Develop ritualsDevelop rituals
Ask whyAsk why– Is there evidence to support it?Is there evidence to support it?– Is it best for patients?Is it best for patients?– Are there better ways?Are there better ways?– Share concerns-multidisciplinaryShare concerns-multidisciplinary– Gather informationGather information
Intellectual Research Intellectual Research CritiqueCritique
A careful examination of all A careful examination of all aspects of a study to judge: aspects of a study to judge: – Merits Merits – LimitationsLimitations– MeaningMeaning– SignificanceSignificance– BiasBias
Critique SkillsCritique Skills
Critical thinkingCritical thinking Logical reasoningLogical reasoning Knowledge of research Knowledge of research
methodologymethodology Attention to detailsAttention to details Recognition of strengths and Recognition of strengths and
weaknessesweaknesses
Is the quality of the study good enough to use the results
What do the results mean to my patients
Are the findings applicable to my practice
Levels of EvidenceLevels of Evidence
Clinical Experience
Expert Committee
Case-control study
Cohort Study
Random Control Trial
Critically Appraised
Systematic Review
Rigor in Random Control Rigor in Random Control StudiesStudies
P < .05P < .05 Sample sizeSample size Reliability of measuresReliability of measures Control confounding variablesControl confounding variables ReplicationReplication
Types of Systematic Types of Systematic Reviews Reviews
Meta-Analysis-random control trialsMeta-Analysis-random control trials Systematic Review-other quantitative Systematic Review-other quantitative
studiesstudies– narrative findingsnarrative findings
Meta-SynthesisMeta-Synthesis PitfallsPitfalls
– Literature reviewsLiterature reviews
Common ThreadsCommon Threads Problem FormationProblem Formation
– Clearly identified problem and variablesClearly identified problem and variables– Identified prior to searching the literatureIdentified prior to searching the literature– Inclusion and exclusion criteriaInclusion and exclusion criteria
Comprehensive SearchComprehensive Search– Published and unpublished workPublished and unpublished work
NetworkingNetworking ConferencesConferences DissertationsDissertations
– Two independent selectorsTwo independent selectors
Common Threads (con’t)Common Threads (con’t) Data EvaluationData Evaluation
– Primary studies evaluated for rigor Primary studies evaluated for rigor – Reliability and validity coding Reliability and validity coding – Two independent evaluators to establish Two independent evaluators to establish
inter-rater reliabilityinter-rater reliability– Quality scoresQuality scores
Data Analysis/FindingsData Analysis/Findings– Thorough interpretation of studiesThorough interpretation of studies– Visual aides to describe studiesVisual aides to describe studies– Identification of potential threats and biasIdentification of potential threats and bias
Systematic ReviewSystematic Review
Summarize findings regarding a Summarize findings regarding a clinical problemclinical problem
Studies have related or identical Studies have related or identical hypotheseshypotheses
Quantitative designsQuantitative designs Narrative findingsNarrative findings
Meta-AnalysisMeta-Analysis Randomized control studiesRandomized control studies
– Testing interventionsTesting interventions Studies have related or identical Studies have related or identical
hypotheseshypotheses Statistical FindingsStatistical Findings
– Measure the magnitude of a common Measure the magnitude of a common effecteffect
– Test for homogeneityTest for homogeneity– Explain heterogeneityExplain heterogeneity
High level of evidenceHigh level of evidence
Meta-SynthesisMeta-Synthesis
Qualitative studiesQualitative studies Related phenomenaRelated phenomena Develop theoryDevelop theory RigorRigor
– Participants and/or primary authors Participants and/or primary authors agree with interpretationsagree with interpretations
Used for enhancing the experienceUsed for enhancing the experience Moderate level of evidenceModerate level of evidence
Levels of EvidenceLevels of Evidence
Clinical Experience
Expert Committee
Case-control study
Cohort Study
Random Control Trial
Critically Appraised
Systematic Review