Two professional registered nurses are interested in evidence-based practice and have developed research questions to study. The nurses discuss what evidence-based practice is all about and are trying to determine if the organizational culture supports nurses who seek out and use research to change long-standing practices that are rooted in tradition rather than science.
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1. What is the best explanation of the difference between evidence-based practice and best practices?
2. The two registered nurses review a variety of research studies to answer their proposed research questions. What is the difference in the efficacy of randomized controlled trials, integrative reviews, or meta-analysis with practice-based evidence for continuous process improvement?
3. The registered professional nurses must consider alternative support mechanisms when searching for the best evidence to support their clinical practice. What are possible mechanisms of support for evidence-based practice?
4. Describe the challenges that exist today for nurses in implementing evidence-based practice?
APA STYLE 7 EDITION
3 PARAGRAPHS
2 REFERENCES
Chapter 5
Evidence-Based Practice
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Definitions #1
Variety of definitions, interpretations
Definition according to David Sackett
Definition by Sigma Theta Tau International
Use of the term best practice by industries
Association with “benchmarking”
Now, one of the less scientific forms of evidence used
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Definitions #2
Goal: provide optimal patient care
Enhancement of nursing practice
Improvement of patient or system outcomes
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Use of Evidence-Based Practice #1
Why?
Control of health care costs: early stimulus
Provision of highest quality patient care: selection of optimal interventions for patients
Patient satisfaction
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Use of Evidence-Based Practice #2
When and Where?
Priority across nursing specialties (see Table 5.1)
Valued across nursing roles and responsibilities
Preparation of nurse leaders and administrators
Refinement of nursing curricula
Expectation of staff nurses to participate in or lead initiatives
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Use of Evidence-Based Practice #3
Around the World
Worldwide commitment
Australia (the Joanna Briggs Institute)
Canada (Registered Nurses’ Association of Ontario)
United Kingdom
Nursing Knowledge International (NKI): international clearinghouse, facilitator
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Question #1
Is the following statement true or false?
The term evidence-based practice was first defined during the time of Florence Nightingale.
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Answer to Question #1
False
Evidence-based practice emerged as a term in response to the ongoing expansion and demanding changes in health care.
It evolved when discussions of evidence-based medicine were expanded to include an interdisciplinary audience.
David Sackett, one of the leaders of the movement, defined evidence-based medicine.
Sigma Theta Tau expanded the definition to address nursing.
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Determination of Evidence-Based Practice
Questions arising in practice settings
Nurses empowered to ask critical questions (see Box 5.1)
Questions leading to decision making to affect outcomes
Best answers, decisions from informed, evidence-based analysis of each situation
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Sources of Evidence #1
Tradition based
Consultation with more experienced, educated, higher-authority-level nurse
Institutional standards, procedure manuals
Coworkers, other health care providers
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Sources of Evidence #2
Evidence based
Research
Randomized controlled trial (RCT): considered the gold standard of clinical evidence
Integrative review
Meta-analysis
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Additional Sources of Evidence
Benchmarking data
Clinical expertise
Cost-effectiveness analyses
Infection control data
Medical record review data
National standards of care
Pathophysiologic data
Quality improvement data
Patient and family preferences
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Question #2
Is the following statement true or false?
Institutional standards are considered evidence based.
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Answer to Question #2
False
Institutional standards and procedure manuals are typically considered sources for tradition-based evidence rather than evidence-based information.
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Support Mechanisms for Best Evidence
Garner administrative support
Collaborate with research mentor (see Box 5.3)
Seek assistance from professional librarians
Search already reviewed or summarized research (journals, Cochrane Collaboration, AHRQ)
Access resources from professional organizations (AACN, AWHONN, AORN, ONS)
Benchmark with high-performing teams, units, institutions
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Mechanisms for Incorporation Into Practice
Development, refinement of research-based policies, procedures
Protocols, algorithms, decision trees, standards of care, critical pathways, care maps, institutional clinical practice guidelines
Consensus of interdisciplinary team
Patient, family support
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Challenges to Implementation #1
Accessibility of research findings
Anticipated outcomes of using research
Support from others
Lack of organizational support (Funk et al., 1991)
Spiva and colleagues (2017) used this instrument in the implementation of a mentoring program to promote evidence-based practice
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Challenges to Implementation #2
Practicing nurses often feel overwhelmed by the volume of research on their topics of interest
Practicing nurses often lack the time and experience to be able to efficiently read and synthesize the literature
Practicing nurses struggle with the political challenges of attempting to change long-standing policies and procedures in their clinical settings
See Box 5.4
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Question #3
Which of the following would a nurse most likely need to address as the greatest obstacle when planning to implement evidence-based practice?
A. Accessibility of research findings
B. Support from others
C. Setting
D. Organizational support
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Answer to Question #3
D
On the basis of research about barriers to implementing evidence-based practice, lack of organizational support was perceived to be the most significant limitation.
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End of Presentation
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