1. American Association of Colleges of Nursing. © 2009 - All Rights Reserved. This program generously funded by the Robert Wood Johnson Foundation Evidence-Based Practice

2. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. Evidence-Based Practice: As Used in this Module Integrating best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.

3. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. Key Message The key message of this module is: Safe, effective delivery of patient care requires the use of nursing practices consistent with the best available knowledge. This includes use of clinical expertise and patient preferences and values in addition to current best research evidence.

4. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. Learner Objectives By the end of this module, the learner will be able to: 1. Define Evidence-Based Practice and Translation Research. 2. Describe the process from research generation, dissemination, implementation and evaluation. 3. Analyze personal and patient preferences/values implementing research findings.

5. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. Introduction Evidence-based practice (EBP), integrating best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care, provides the direction for the way to think about clinical practice and lead practice change.

6. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. The Role of Evidence You need a appreciation and understanding of the role of evidence, which includes: how to select an evidence-based practice how clinical expertise and patient values and preferences should form the basis for nursing intervention Development of skills in: locating knowledge critical thinking clinical discernment How do you do this?

7. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. EBP in Nursing We have progressed from research utilization to EBP and translational research. Faculty and students need an understanding of the process of getting to EBP and the potential for positive impact on patient care.

8. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. Synonymous Terms with EBP Translational research is the testing of the effect of interventions aimed at promoting the rate and extent of adoption of EBP by healthcare providers.  T1—moving research findings from "bench to bedside"  T2—the translation of results from clinical studies into everyday clinical practice and health decision making The work in this competency is directed to T2. How do we do this?

9. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. Models and Steps to EBP 1.Identify problem and formulate a specific question 2.Identify need for change 3.Identify change agents 4.Identify target audience 5.Identify stakeholders 6.Locate the body of knowledge, synthesize and extract the clinical meaning 7.Adapt the knowledge/design the innovation to the local users 8.Assess the barriers to using the knowledge 9.Develop the dissemination plan 10.Develop evaluation plan 11.Pilot test the EB practice 12.Evaluate the process 13.Implement the practice change 14.Evaluate the outcome 15.Maintain the change 16.Disseminate the results of the practice change

10. Knowledge Explosion

11. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. Knowledge Explosion Lifelong learning is an important value in EBP. Keeping up with the latest evidence is an increasingly difficult task.  It is estimated that more than 6,000 pages are published daily and with internet resources expanding the numbers only increase. How do you plan to maintain "lifelong learning" in your own professional career?

12. Clinical Expertise and Patient Values in the Equation

13. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. Clinical Expertise and Patient Values in the Equation Generally EBP has focused on the translation of research into practice. One of the complaints of EBP is that it is cookbook health care. Do you see "cookbook" health care in your practicum? Research evidence alone is not sufficient to ensure sound clinical decisions necessary for effective health care.

14. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. Clinical Expertise There are times when evidence is not available to guide practice or it is equivocal and no clear direction is obvious. Clinical decision making is a complex process and requires more than research to guide practice. Clinical expertise is the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in numerous ways, but especially in more effective and efficient assessments and diagnoses and thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. Experienced clinicians use both individual clinical expertise and the best available external evidence. Can you give an example of when you might use clinical expertise ?

15. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. Incorporating Patient / Family Preferences One of IOM’s 10 rules for health care calls for the patient to be at the center of decision making. As such, incorporating patient/family preferences and values includes asking patients about their preferred role in decision making, clarifying their values, and asking about support or undue pressure.

16. American Association of Colleges of Nursing. © 2009 - All Rights Reserved.. Incorporating Patient / Family Preferences Some make the case that patient-centered care may at times conflict with evidence-driven care and that patient preferences have priority over evidence-based recommendations. Can you give an example of such a conflict? How would you resolve this?