Taylor, ch 5

 A step-by-step dynamic process used to solve clinical problems  EBP solves problems by applying best research data, best clinical judgment and expertise, and objective and subjective information from pts  Finding this research involves looking at previous research studies to see what the best practice is for a particular condition or procedure

 The client is the focus of EBP  It is our duty as nurses to make sure the patient is receiving the best care possible  Nurses need to contribute to the body of knowledge that makes up best practices by conducting research of their own

 Directs nurses toward a common goal  Leads to improved patient care  Provides rational and knowledgeable reasons for nursing actions  Gives nurses knowledge base necessary for appropriate actions  Helps resolve current nursing issues  Prepares nurses to question assumptions and values  Serves research, education, and practice

 Traditionally by: ◦ Tradition ◦ Authority ◦ Borrowing ◦ Trial and error ◦ Personal experience ◦ Intuition ◦ Reasoning

 Nursing research which is: ◦ “A diligent and systematic inquiry to validate and refine existing knowledge, and generate new knowledge that influences nursing practice.”  (Burns & Grove, 2007)

 Improve care of people in clinical settings  Study people and the nursing process  Develop greater autonomy and strength as a profession  Provide evidence-based nursing practice

 Quantitative—involves concepts of basic and applied research  Qualitative—gain insight by discovering meanings. Based on belief that reality is based on perceptions that differ for each person and change over time

 State the problem  Define the purpose of the study  Review related literature  Formulate hypothesis and variables  Select research design  Select population and sample  Collect data  Analyze data  Communicate findings and conclusions

 Steps are same until the data collection process  Data collection involves gathering information from the same population sample over a specific time period  It analyzes the effects of a variable on that group at different phases of the members’ lives

Must know and accept responsibility for: Asking questions Reading literature Understanding Critical thinking Synthesizing info Applying science

 An orderly series of steps that allows a researcher to find the answer to a question ◦ Identify the problem ◦ Gather data ◦ Analyze data ◦ Use the findings ◦ Evaluate outcomes

 What do you want to do? ◦ Improve practice? ◦ Update knowledge? ◦ Validate a policy or procedure? ◦ Plan a new program or intervention?

 P = Patient, population, or problem  I = Intervention being considered  C = Comparison of interest (old or new)  O = Outcome wanted

 “In a 55-year-old man with a 35-year-old history of chronic smoking, would the administration of bupropion as compared to a nicotine replacement therapy (NRT) be a better therapy in causing long-term abstinence from smoking?”  Can you identify each PICO component?

 Run a subject search thru Medline or CINAHL  Consider hospital policies and procedures  Clinical expertise  Cost  Chart reviews  Patient preference

 Which research applies best?  How strong or weak is the research?  Is this research relevant to the clinical situation?

 Apply what you learned from the evidence  Include clinical experience  Include patient preferences

 Did the application of your evidence improve the patient outcomes?  If not, go back to one of the earlier parts of the process and start over, if necessary

Data: 9 randomized controlled clinical trial study used to address the problem of surgical site infections, CAUTIs  PARTICIPANTS: Adults receiving topical antisepsis prior to surgery, blood cultures, and vascular catheter insertion  INTERVENTIONS: Chlorhexidine gluconate  COMPARISONS: Povidone-iodine  OUTCOMEzation, catheter-related sepsis  RESULT: The use of chlorhexidine for skin antisepsis, instead of povidone-iodine, would result in significant reductions in hospital-acquired infections

 The positive outcomes from EBR can improve the overall performance of an institution  The Quality Improvement department of the institution focuses on the continuing process of creating positive patient outcomes  Part of the department includes Risk Management whose efforts are directed toward preventing errors in patient care

 These reports contain information about circumstances involving errors in patient care that either led to or could lead to injury  The report is not to be placed in the patient’s chart, but does become part of Risk Management and is used to track and prevent errors

 Complete name of person and names of witnesses  Factual account of incident  Date, time, and place of incident  Pertinent characteristics of person involved  Any equipment or resources being used  Any other important variables  Documentation by physician of medical examination of person involved

 This accrediting agency promotes quality in institutions by requiring them to meet Accountability Measures or standards of care for various patient conditions  Meeting these measures and standards helps maintain quality of patient care  These measures are based on evidence that the interventions are effective

 Unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof  Serious injury specifically includes loss of limb or function  The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.  JCAHO tracks these events in an effort to maintain quality patient care

 NPSGs have come about based on the types of sentinel events that have occurred.  The NPSGs are also part of Risk Management and Quality Improvement

 A process that looks at the reasons that any error or “near miss” situation occurred  There is usually more than one reason thus avoiding the “blame game”  Root cause analysis transforms an old culture that reacts to problems to a new culture that solves problems before they escalate; thereby improving institutional and personal performances.