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