1. Excellence in Nursing Practice Through Research, EBP & Application to Bedside Patient Care Chesapeake Bay Society of PeriAnesthesia Nurses Saturday, February 8 th, 2014 Kim A. Noble, PhD., RN, CPAN © Copyright Kim A. Noble; use prohibited without permission

2. Part II The Beginning: The PICO Question; An EBP Start Kim A. Noble, PhD., RN, CPAN knoble@aspan.org ©

3. Objectives Following participation in this lecture, the learner will: Discuss the steps in the EBP process; Discuss the steps in the EBP process; Describe examples of EBP changes in perianesthesia nursing; Describe examples of EBP changes in perianesthesia nursing; Develop, compare and refine a PICOT question. Develop, compare and refine a PICOT question. ©

4. A Little History… A paradigm shift… Moved from an age of experts, wisdom and experience… To evidence… ©

5. A Little More History… Nursing education Diploma entry  ADN BSN entry ©

6. Final History… Medical research history… Archie Cochrane (1909-1988) Effectiveness and Efficiency: Random Reflections on Health Sciences (1972) Evidence Based Medicine (1992) ©

7. A History of Nursing Research 1900: AJN first published; 1923: First doctoral program in nursing at Teachers College: Columbia; 1929: First masters program in nursing: Yale; 1950: ANA conducted study of nursing that led to 1959 first standards; 1952: Journal of Nursing Research established; 1960-1970’s: Nursing models researched; 1970: ANA Commission on Nursing Research; 1970’s: Research added to BSN curriculum; 1972: Cochrane EBP established; qualitative research begins; 1980: First nursing research received federal funding. 1986: Nursing research included in NIH; 1993: NINR ©

8. Evidence Based Practice ©

9. What is Evidence Based Practice (EBP)? The Same as research…. Based in research… But also Different from research… http://guides.mclibrary.duke.edu/content.php?pid=431451&sid=3529499 ©

10. Look Closer at EBP Critical Thinking A foundation in Critical Thinking Explosion of journals http://sundayresources.net/neil/2013/01/03/evidence-based-practice-in-the-church-2/ ©

11. Why Evidence? http://www.nsttac.org/content/evidence-based-practices ©

12. Why EBP Now? Why is nursing evidence so important: High visibility of quality and safety movement; Tremendous growth of new knowledge; Identification of delay in application of new evidence; Decline in best-care knowledge for pt care; Tremendous consumer pressure. White & Dudley-Brown, 2012, p. 4-5.

13. EBP Process Begins with Ideas Come from your experience: Sacred cows? Questions? Ideas? Guide practice change. Base nursing practice on research findings; As the name implies… © What is YOUR question?

14. Your Idea Leads to a Question: PICO(T) The Question guides the process. Define your question: P P:Population. I I: Intervention. C C:Comparison. O O:Outcome. T T:Timing. ©

15. So…Where Do We Start? Begin with a question… Your assignment… ©

16. Let’s Look at the Question: PICOT: Population P P:Population Gender Ethnicity Disease Think about… Think about… ©

17. PICOT: Intervention I I: Intervention (Indicator): Disease exposure Risk behavior Prognostic factor Think about… Think about… ©

18. PICOT: Comparison C C:Comparison (Control) Placebo “Normal” Treatment No disease No risk Think about… Think about… ©

19. PICOT: Outcome O O:Outcome: Risk of disease Accuracy of Diagnosis Rate of occurrence Think about… Think about… ©

20. PICOT: Timing T T:Timing: Time for outcome Length of study __# of sample Think about… Think about… ©

21. Types of Questions Therapy/Intervention: In __, what is the effect of __ on __ compared with__ within __? Etiology Diagnosis Prevention Prognosis/Prediction Meaning P T I O C ©

22. The Question Forms the Literature Review Keywords. Exclusion & inclusion criteria. Search: CINHAL, Medline, Cochrane, JBI. Records. © YOUR new best friend!

23. Research Review Challenging! Strategies: terror. Spread the terror. Consistency (tools). Practice improves ease. Mentoring process. ©

24. Review Consensus “Many hands makes light work.” This case many eyes. Discuss the research. Consensus for ranking of research evidence. ©

25. Practice Recommendations Translation of research  practice. EBP recommendations answer your question. Process can be used to guide policy. ©

26. © Boswell, C. & Cannon, S. (2007). Introduction to Nursing Research: Incorporating Evidence-Based Practice, Sudbury, MA: Jones & Bartlett. Malloch, K. & Porter-O’Grady, T. (2006). Introduction to Evidence-Based Practice in Nursing and Health Care, Sudbury, MA: Jones & Bartlett. White, K. M. & Dudley-Brown, S. (2012). Translation of Evidence Into Nursing and Health Care Practice, New York: Springer. References