Evidenced Based Practice; Systematic Reviews; Critiquing Research CNL Exam Review

Evidence-Based Practice Conscientious integration of best research evidence with clinical expertise and patient values and needs in the delivery of high-quality, cost-effective health care Synthesis of knowledge for development of guidelines, standards, protocols, or policies to direct nursing interventions and practice

Evidence-Based Practice Hospital Priorities Pressure Ulcers Falls Hospital Acquired Infections Reducing costs Improving patient and staff satisfaction Reducing errors communication

Evidenced-Based Practice Masters prepared Innovators Early adopters Application Evaluate Merit Clinical Relevance Sufficiency of research base Pilot change Monitor Outcomes Innovators-bring new ideas Early adopters-embrace new ideas. Communication of new ideas through media and books, journal but most effective in 1:1 or face-to face to increase utilization Barriers/Facilitators-practitioners uncomfortable and lack knowledge to critique or understand researcher. 2) lack support from administration. 3) poor quality of research findings. To improve increase in dissemination of research, publish more literature reviews and meta-Analysis., Develop evidenced based guidelines for practitioners. Clinicians need to publish implementation and outcomes of implemented EBP. Magnet Status-must have EBP protocol Evaluate Merit-valid study pooled studies. Large sample size, rigor of methods, representative sample. Strength of findings. Clinical Relevance-need everyone on board Sufficiency of research base-Meta-Analysis and literature clustering or review. Meta-analysis is a methodology that scientifically pools results from previous studies into a single quantitative analysis Pilot change-need to be flexible. Watch resistors. Give extra time. Monitor Outcomes-have to consider nurse, system and client outcomes.

Creating an EBP Culture Value Reflection Develop rituals Ask why Is there evidence to support it? Is it best for patients? Are there better ways? Share concerns-multidisciplinary Gather information

Intellectual Research Critique A careful examination of all aspects of a study to judge: Merits Limitations Meaning Significance Bias Bias-any influence or action in a study that distorts the findings or slants them away from the true or expected

Critique Skills Critical thinking Logical reasoning Knowledge of research methodology Attention to details Recognition of strengths and weaknesses

Levels of Evidence

Rigor in Random Control Studies P < .05 Sample size Reliability of measures Control confounding variables Replication

Types of Systematic Reviews Meta-Analysis-random control trials Systematic Review-other quantitative studies narrative findings Meta-Synthesis Pitfalls Literature reviews

Common Threads Problem Formation Comprehensive Search Clearly identified problem and variables Identified prior to searching the literature Inclusion and exclusion criteria Comprehensive Search Published and unpublished work Networking Conferences Dissertations Two independent selectors How the literature was searched should be clearly identified in the article Bias in published work is that many times only studies with significant findings are accepted in refereed journals

Common Threads (con’t) Data Evaluation Primary studies evaluated for rigor Reliability and validity coding Two independent evaluators to establish inter-rater reliability Quality scores Data Analysis/Findings Thorough interpretation of studies Visual aides to describe studies Identification of potential threats and bias

Systematic Review Summarize findings regarding a clinical problem Studies have related or identical hypotheses Quantitative designs Narrative findings

Meta-Analysis Randomized control studies Testing interventions Studies have related or identical hypotheses Statistical Findings Measure the magnitude of a common effect Test for homogeneity Explain heterogeneity High level of evidence Homogeneity is the similarity between studies. If heterogeneous then need to explain. Look for differences in sample and quality of studies. If done correctly-high level of evidence

Meta-Synthesis Qualitative studies Related phenomena Develop theory Rigor Participants and/or primary authors agree with interpretations Used for enhancing the experience Moderate level of evidence Qualitative critique for having many studies in isolation. Can you combine phenomenology, grounded theory and ethnographic philosophies

Levels of Evidence