NURSING RESEARCH: CHAPTER 2

Translating research into Nursing Practice: EVIDENCE-BASED NURSING

DEFINITION OF EBP:
EBP- conscientious use of current best evidence in making clinical decisions about patient care. NURSES & OTHER HCP must be:

1. Lifelong learners- who have the skills to search for, understand & evaluate new information about patient care. 2. Capacity to be flexible 3. Adapt to change

Basic feature of EBP (clinical problem solving strategy)

De-emphasizes decisions based on:

1. 2. 3. 4. Cutom Authority Opinion Ritual

Emphasis on:
1. Identifying the best available research evidence 2. Integrating it with other factors

Evidence based decision making should integrate best research evidence with:
1.

Clinical expertise 2. Patient preferences & circumstances 3. Awareness of the clinical setting & resource constraints Key ingredient- effort to personalize the evidence to fit a specific patients needs & a particular clinical situation.

RESEARCH UTILIZATION & EBP

RESEARCH UTILIZATION- narrower

Use of findings from a disciplined study or set of studies in a practical application that is unrelated to the original research.

Emphasis- translating empirically derived knowledge into real world applications. Genesis of the process- research based innovation/ new knowledge.

EBP (evidence-based practice)

broader.; incorporates research findings with other factors RU- begins with how can i put this innovation to good use in clinical setting. EBP- clinical question ( what does the evidence say is the best approach to solving this problem)

RU CONTINUUM
Start point- emergence of new knowledge & new ideas One end- discrete clearly identifiable attempts to base specific actions on research findings. 3 distinct types of RU:

1. INDIRECT RU- changes in nurses thinking. 2. DIRECT RU- direct use of findings in giving patient care. 3. PERSUASIVE RU- use of findings to persuade others to make changes in policies or practices relevant to nursing care.

HISTORY OF RU IN NSG. PRACTICE

1980s- several changes in nursing education & research prompted by the desire to develop a knowledge base for nursing practice. Nursing education- courses on research methods. Nursing research- shift focus toward clinical nursing problems

CONCERNS ABOUT THE LIMITED USE OF RESEARCH FINDINGS:

Nurses are often unaware of research findings 2. Nurses did not incorporate results into their practice CURN PROJECT (Conduct and Utilization of Research in Nursing)
1.

A 5 year development project awarded to Michigan Nurses Association by the Division of Nursing in 1970.

MAJOR OBJECTIVE OF CURN:

Use of research findings in Nurses daily practice by:

1. Disseminating current research findings 2. Facilitating organizational changes needed to implement innovations 3. Encouraging collaborative clinical research.

RU- organizational process Nurses- essential to OP

CONCLUSION:

RU was feasible only if:

1. research is relevant to practice 2. Results are broadly disseminated

1990s- call for RU began to be superseded by the push for EBP.

EBP IN NURSING
ADVOCATES 1. Offers a solution to improving health care quality in our current cost-constrained environment. RATIONAL APPROACH- best possible care with most costeffective use of resources. CRITICS 1. Worries that advantages f EBP are exaggerated & that : 1. Individual clinical judgments 2. Patient inputs Are devalued.

2. Provides an important framework for self-directed lifelong learning essential in era of rapid clinical advances & information explosion.

2. Insufficient attention is being paid to the role of qualitative research.

OVERVIEW OF THE EBP MOVEMENT

COCHRANE COLLABORATION- one of the cornerstones of EBP;

Founded in UK based on the work of Archie Cochrane--- british epidemiologist

Early 1970s
Drew attention to the dearth of solid evidence about the effects of health care. Called efforts to make research summaries of clinical trials available to physicians & other HCP.

1993- development of Cochrane center in oxford COCHRANE COLLABORATIONinternational collaboration

AIM OF CC

Help providers make good decisions about health care by:

Preparing; Maintaining; And disseminating Systemic reviews of the effects of health care interventions.

EVIDENCE BASED MEDICINE- developed from a group from Mcmaster Medical School in Canada Clinical learning strategy David Sackett- pioneer of EBM; means integrating individual clinical expertise with the best available external evidence from systemic research.

EBP
Major paradigm shift EBP ENVIRONMENT:

Skillful clinician can no longer rely on a repository of memorized information Must be adept in accessing, evaluating, synthesizing & using new research evidence.

TYPES OF EVIDENCE & EVIDENCE HIERARCHIES

General agreement- findings from rigorous research are paramount. RANDOMIZED CLINICAL TRIAL (RCT)- well suited for drawing conclusions about the effects of health care intervention.

Resistance to EBP by nurses due to:

1.

2.

3.

Bias in ranking sources of evidence primarily in terms of questions about effective treatments. Thought that evidence from qualitative & non-RCT studies would be ignored. Accdg. To Closs & Cheater- derived from viewing it as an unwelcome extension of the positivist tradition.

7 level hierarchy

Comes from the systematic reviews that integrate findings from multiple RCT studies using rigorous & methodical procedures. The worth of the evidence can vary considerably. Evidence hierarchy is not universally appropriate. Appropriate with regard to questions about the effects of clinical interventions or treatments. Best evidence- refers generally to findings that are methodologically appropriate, rigorous and clinically relevant for answering

Questions about:
1. The efficacy , safety, & cost effectiveness of nursing intervention. 2. About the reliability of nursing assessment measures 3. Determinants of health and well being 4. Meaning of health or illness 5. Nature of patients experience

Confidence in evidence enhanced when:

Research methods are compelling Multiple confirmatory replication studies Evidence has been systematically evaluated and synthesized.

Other sources:
Benchmarking data 2. Chart review 3. Quality improvement and risk data 4. Clinical expertise One benefit of EBP movement is that when clinical questions arise for which there is no satisfactory evidence, a new research agenda can result.
1.

BY: PETIT NACARIO, SN

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