Evidence Based Nursing Process to Practice Bracken Health Sciences Library (adapted from a presentation of Dr. Norma MacIntyre, School of Rehabilitation Therapy, Queen’s University)

The importance of evidence

N. MacIntyre, 2005 What is Evidence-Based Practice?  An approach to clinical practice  A way to keep current with new developments

Centre for Evidence-Based Medicine What is Evidence-Based Practice?  … a methodological approach to clinical practice where evidence is used to inform decision-making about making a diagnosis (or interpreting a diagnostic test), selecting an intervention, or evaluating prognostic indicators

Health Information Research Unit, McMaster, 2002 What is Evidence-Based Practice?  … an approach to health care practice in which the clinician is aware of the evidence that bears on her clinical practice, and the strength of that evidence

J. A. Muir Gray, 1997 What is Evidence-Based Practice?  … an approach to decision making in which the clinician uses the best evidence available, in consultation with patient, to decide upon the option which suits that patient best

D. Sackett et al, 1996 What is Evidence-Based Practice? Evidence based health care is the integration of individual clinical expertise with the best available external clinical evidence and the values and expectations of the patient

N. MacIntyre, 2005 Evidence-Based Practice  Involves life-long, self-directed, problem-based learning  Involves exploring the relationship between clinical reasoning and research evidence  Involves practice

N. MacIntyre, 2005 Keeping Up?  Do nothing … and get out of date  Depend solely on courses/conferences  Choose the main professional journal(s) and read them cover to cover every month  Learn how to find and appraise the evidence to answer questions that come from clinical practice

Ontario College of Nurses, 2002 Evidence Based Nursing Practice Knowledge Standard  Each nurse possesses, through basic education and continuing learning, knowledge relevant to her/his professional practice

Ontario College of Nurses, 2002 Evidence Based Nursing Practice Knowledge Standard Indicators  Providing a theoretical and/or evidence-based rationale for all decisions  Understanding the knowledge required to meet the needs of complex clients  Knowing where/how to access learning resources when necessary

Ontario College of Nurses, 2002 Evidence Based Nursing Practice Knowledge Standard Indicators  Seeking and reviewing research in nursing, health sciences and related disciplines  Using research to inform practice/professional service

Ontario College of Nurses, 2002 Evidence Based Nursing Practice Knowledge Application Standard  Each nurse continually improves the application of professional knowledge

Ontario College of Nurses, 2002 Evidence Based Nursing Practice Knowledge Application Standard Indicators  Ensuring practice is based in theory and evidence and meets all relevant standards/guidelines  Assessing/describing the client situation using a theory, framework or evidence-based tool  Managing multiple nursing interventions simultaneously

Ontario College of Nurses, 2002 Evidence Based Nursing Practice Knowledge Application Standard Indicators  Evaluating/describing the outcome of specific interventions and modifying the plan/approach  Integrating research findings into professional service and practice

Copyright ©2004 BMJ Publishing Group Ltd. Thompson, C. et al. Evid Based Nurs 2004;7:68-72 The cognitive continuum.

N. McKibbon, 1999 Five Steps of Evidence-Based Practice  Define the Question Identify Question ~ Search and Screen Literature ~ Refine Question  Collect the Evidence  Critically Appraise the Evidence for Validity and Relevance

N. McKibbon, 1999 Five Steps of Evidence-Based Practice  Integrate the Evidence and Patient Factors Make & Carry Out the Decision  Evaluate the Process Results ~ Self-reflection

PICO  A clinical question should incorporate at least three elements  Patient Age, sex, ethnicity, etc. Condition, diseases, general health status  Intervention Education, diagnostics, treatment plan, self-care, etc.

PICO  Comparison Intervention Placebo, etc.  Outcome Expected and actual effects on patient

PICO  Do nurse led tobacco cessation interventions result in decreased smoking rates after hospital admission for coronary heart disease?

PICO  PATIENT (Adult) coronary heart patients Smokers Discharged from hospital  INTERVENTION Nurse led tobacco cessation programmes

PICO  COMPARISON (Non-nurse led tobacco cessation programmes  Self-administered, non-nurse administered, etc.) No comparison  OUTCOME Lower rates of tobacco use among Patient group

PICO  Not all questions are of a clinical nature  Intervention can be interpreted very broadly

SUNY Downstate Medical Center, 2003 Evidence Pyramid

SUNY Downstate Medical Center, 2003 Evidence Pyramid  “ Important medical questions are typically studied more than once, often by different research teams in different locations. A meta-analysis combines results from different studies, hopefully averaging out any differences caused by random change or local variation and getting at something close to the real truth. In general a meta-analysis, if you can find one, will be a better guide to practice than an individual article. ”

Claude Moore Health Sciences Library, 2003 Evidence Based Resources Models  Usefulness = Relevance x Validity Work

Claude Moore Health Sciences Library, 2003 Evidence Based Resources Models

Claude Moore Health Sciences Library, 2003 Evidence Based Resources Models

See you at the Search Sessions! Mon. Sept. 24 OR Wed. Sept. 26 8:30 – 9:30 Bracken Library eLab