Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 2 Translating Research Evidence Into Nursing Practice: Evidence-Based Nursing

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Research Utilization (RU) Versus Evidence-Based Practice (EBP) Research utilization (RU) The use of study findings in a practical application unrelated to the original research Evidence-based practice (EBP) Basing clinical decisions on best possible evidence—especially high- quality research

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Resources for Evidence-Based Practice Systematic reviews Clinical practice guidelines Other preappraised evidence

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Research Integration and Synthesis Forms of integrative reviews: Narrative, qualitative integration (traditional review of quantitative or qualitative results) Meta-analysis (statistical integration of results) Metasynthesis (theoretical integration of qualitative findings)

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Barriers to Using Research in Nursing Practice Research-related barriers Nurse-related barriers Organizational barriers Barriers related to the nursing profession

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Two Models for Evidence-Based Nursing Practice The Stetler Model of research utilization to promote evidence-based practice The Iowa Model of evidence-based practice to promote quality care

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Five Sequential Phases of the Stetler Model Phase I: Preparation Phase II:Validation Phase III:Comparative Evaluation and Decision Making Phase IV:Translation/Application Phase V:Evaluation

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Iowa Model of Evidence-Based Practice to Promote Quality Care The Iowa Model outlines a series of activities with three critical decision points: Decide whether problem is a sufficient priority for the organization exploring possible changes Decide whether there is a sufficient research base Decide whether change is appropriate for adoption in practice

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Iowa Model of Evidence-Based Practice to Promote Quality Care

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of Individual EBP 1.Framing an answerable clinical question 2.Searching for relevant research-based evidence 3.Appraising and synthesizing the evidence 4.Integrating evidence with other factors 5.Assessing effectiveness

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Appraisal of Evidence Validity of study findings Clinical importance of findings Precision of estimates of effects Associated costs and risks Utility in a particular clinical situation

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins EBP in Organizational Context More formalized than individual EBP Must take organizational and interpersonal factors into account “Triggers” include both pressing clinical problems and existing knowledge

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Organizational (Team-Based) EBP Projects Involve the development or adaptation of clinical practice guidelines or clinical protocols Assessment of implementation potential of the innovation Transferability Feasibility Cost/benefit ratio

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Criteria for Evaluating the Implementation Potential of an Innovation Under Scrutiny

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementing and Evaluating the Innovation Pilot Test Develop an evaluation plan Collect information on outcomes Train staff in the use of the new guideline and, if necessary, “market” the innovation Try the guideline out on one or more units or with a group of clients Evaluate the pilot project

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Nurses’ Role in Using Research Evidence Read widely and critically Attend professional conferences Learn to expect evidence that a procedure is effective Become involved in a journal club Pursue and participate in RU/EBP projects