1. Thinking about EBP – Models for Action
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Thinking about EBP – Models for Action
Stepping up to Evidence Based Practice – Ideas into Action 1
Debra Ugboma
January 2010

2. Objectives Help define Evidence Based Practice (EBP)
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Objectives
Help define Evidence Based Practice (EBP)
Discuss some of the issues surrounding EBP
Identify some models which can help with the implementation of EBP
Consider how to “step up” to EBP
Identify resources to support EBP
What do I need for this session:
Worksheet 1

3. Thinking about Evidence Based Practice (EBP)
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Thinking about Evidence Based Practice (EBP)
“Doing right things right” (Muir Gray, 2009 p41)
“.. the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patient/clients (Sackett et al 1996 p 71-72)
“Practice supported by a clear, up-to-date rationale, taking into account the patient/clients preferences and using your own judgement. If we practice EBP then we are set to give the best possible care” (Aveyard and Sharp, 2009 p4)

4. Why does it sometimes seem so complicated?
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Why does it sometimes seem so complicated?
Plethora of definitions (and frameworks) for EBP
There is so much information available
The “information revolution”
Increased demand for more/better quality research
Information much more widely available (intranet).
Research can be hard to interpret
Evidence is always evolving
There isn’t always evidence/information relating to your practice/practice query
Making the move from anecdotal to research evidence

5. How can I get started? Keep it simple! Do one thing at a time
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How can I get started?
Keep it simple!
Do one thing at a time
Find a lead in your team (someone with drive, motivation, authority? – Buddy up!)
Enlist library support to obtain information
Let others critique the evidence for you…
Get involved in audit
Empower and support the team to make changes
Try using structured models (next slides)
also see next presentation – “Getting Ready and Getting Started”

6. Stepping up to EBP.. Active involvement in research
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Stepping up to EBP..
Active involvement
in research
Projects into publication!
Structured EBP projects
Implementing
EBP dissertations
Evidence from others/policy etc.
Getting involved in audit
Ideas into action
Questioning care, responding to feedback

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A PHT Model?

8. Models and Frameworks can help?
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Models and Frameworks can help?
The following slides outline some models and frameworks that can be utilised for taking ideas into action and developing EBP. Some are simple, others more complex and multi-faceted.
If you get chance to read the literature around EBP, you might find another one that better suits you and your team.
Don’t get too bogged down in them, use the essence of them to help you drive change and EBP forward.

9. Evidence Based Decision Making (Gray, 2009)
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Evidence Based Decision Making (Gray, 2009)

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Awareness, Agreement, Adoption, Adherence (Pathman,1996 cited in Friedman et al 2009)

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Awareness, Agreement, Adoption, Adherence (Pathman,1996 cited in Friedman et al 2009)
Awareness: How does the care issue come to your attention – what systems in place? Raise awareness and evidence for care in team meetings/handover etc. Who else may need to be aware?
Agreement: Agreement from team/participants in care that new procedure/practice required. Discuss and debate with team, identify how to overcome potential problems etc. Who else needs to be involved?
Adoption: Adopt the evidence. Plan how to implement any change in care/practice and implement the change. Who is to lead/drive it? Maybe have a “D day”, allow for discussion in the early stages, use novel reminders
Adherence: What happens over time? Are you still adhering to the evidence. How do you know? Undertake audit. Evaluate staff/patient response when possible. Are there further changes to make?

12. Staged approach to EBP (Thompson et al, 2005)
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Staged approach to EBP (Thompson et al, 2005)
Identify a clinical question in response to a recognised information need
Search for the most appropriate evidence
Critically appraise this evidence
Incorporate the evidence into a strategy for action
Evaluate the effects of any decisions and action taken
This is a fairly traditional and standard approach for implementing EBP and change. Consider how you will evaluate e.g. audit (do you also need to audit before implementing any change?)

13. A Framework for consideration (courtesy of Sarah Balchin)
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A Framework for consideration (courtesy of Sarah Balchin)
Implementing Evidence into Practice
Quality and availability of evidence
Context and culture
Facilitation

14. Evidence Quality and availability of evidence
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Evidence
Quality and availability of evidence
Ideally less than 5 years old
Generalisable?
From a range of sources?
Peer reviewed for research derived?
Are limitations acknowledged?
Any potential conflict of interest?

15. Facilitation Facilitation Who is responsible ?
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Facilitation
Facilitation
Who is responsible ?
What facilitation skills do they have?
Is responsibility explicit?
What time has been allocated?
Who can they go to for help?
How “up for it” is the team?

16. Context and culture Context and culture What else is going on?
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Context and culture
Context and culture
What else is going on?
How big a change is this?
What resources are going to be needed to maintain the change?
Who are your supporters?
Who may be your detractors?
How important will this be perceived?

17. Stepping up to EBP - Empower, Educate and Embrace
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Stepping up to EBP - Empower, Educate and Embrace
Foster a work environment that questions and challenges care.
Empower individuals to turn “ideas into action”
Target the involvement of specific individuals who can lead projects, and enthuse and motivate others.
Begin to up-skill, and develop knowledge as required (targeted individuals) e.g. library/evidence searching skills, Learning & Development Team, formal study e.g. EBP modules/degree pathways.
Developing skills is usually better than a focus on developing knowledge

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Making a start..
Answer the questions and undertake the activities on Worksheet 1
Complete the “do one thing” section and then try it out in your clinical area before the next session. How did it go?

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Resources
Nursing Times evidence based practice archive:
An international digest of the evidence for nursing practice
NHS Evidence (also direct via Library link):
CASP Appraisal tools:
Centre for Evidence Based Medicine:
Patient safety first 5 evidence based interventions:

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References
Aveyard H and Sharp P A beginners guide to evidence based practice in health and social care. Maidenhead: Open University Press
Craig JV and Pearson M 2007 Evidence-based practice in nursing In: Craig JV, Smyth RL (Eds) 2007 The Evidence-Based Practice Manual for Nurses, Edinburgh: Churchill Livingston Elsevier
Friedman L, Engleking C, Wichham R, Harvey C, Read M and Bardel Whitlock K 2009 The EDUCATE study: A continuing education exemplar for clinical practice guideline implementation, Clinical Journal of Oncology Vol 13 (2):
Gerrish K, Ashworth P, Lacey A, Bailey J 2008 Developing evidence-based practice: experiences of senior and junior clinical nurses, Journal of Advanced Nursing 62 (1): 62-73
Muir Gray JA 2009 Evidence-based health care and public health: how to make decisions about health services and public health, Edinburgh:Churchill Livingstone Elsevier
Tagney J, Haines C 2009 Using evidence-based practice to address gaps in nursing knowledge. British Journal of Nursing Vol 18 (8):
Thompson C, McCaughan D, Cullum N, Sheldon T and Raynor P 2005 Barriers to evidence based practice in primary nursing care, why viewing decision making as context is helpful, Journal of Advanced Nursing 52(4):