EVIDENCE-BASED PRACTICE 14 C H A P T E R EVIDENCE-BASED PRACTICE

Critical Thinking Core of evidence-based practice (EBP) Analytical, reflective thinking Requires accurately defined problem Based on reliable data

Importance of Critical Thinking Necessary for analysis of patient data Required to achieve improved outcomes

Evidence-Based Practice Evolved to include nursing and allied health Clinical practice guidelines National Database of Nursing Quality Indicators

Reframing Education Create an environment of inquiry/self-reflection Purpose of learning—to improve patient care Teach knowledge, skills, and attitudes (Figure 14-3)

Stetler Model of Research Utilization Used to direct clinical decision-making Tool to create or change policy Five-step process (Figure 14-4)

Iowa Model of Research-Based Practice Triggers indicate issues or concerns (Figure 14-5) Committee is formed to research the trigger

The Path to Evidence Ask the right questions Look at a variety of sources Do not rely on traditional practices

Appraising the Evidence Evidence Hierarchy (Figure 14-6) Integrative reviews Systematic reviews Meta-analysis vs. Meta-synthesis Internet Exercise 14-1 guides the students through the Agency for Healthcare Research and Quality’s website to locate the Rating System of the Strength of Scientific Evidence.

Approaches to Generating Evidence Quantitative Qualitative Intervention Outcomes

Generating the Evidence Formulate the question (PICO or PS) (Figure 14-8) Find the evidence (Figure 14-9) Case Scenario 14-1 has the students practice writing a question in PICO format, and conduct a literature search for clinical recommendations.

Obstacles to EBP Lack of time/access to information Insufficient staffing