1. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Nursing Leadership & Management Patricia Kelly-Heidenthal 0-7668-2508-6

2. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 3 Evidence-Based Health Care

3. Chapter 3Copyright © 2003 Delmar Learning, a Thomson Learning company3 Objectives  Upon completion of this chapter, the reader should be able to: Know the historical context of evolution of evidence-based care (EBC) in nursing. Discuss the importance of EBC to nursing as a profession. Identify further potential contributions of nursing leadership in development and dissemination of an EBC model of care. Understand the ongoing stimulus for establishing an EBC model for health care delivery.

4. Chapter 3Copyright © 2003 Delmar Learning, a Thomson Learning company4 Objectives Recognize the barriers to efficient, effective, and quality health care delivery by nurses. Assess the types of evidence used and required for EBC processes. Understand the role of the Agency for Healthcare Research and Quality (AHRQ) in the development of EBC.

5. Chapter 3Copyright © 2003 Delmar Learning, a Thomson Learning company5 Evidence-based Care  Evidence-based care is the process of providing clinically competent care that is based on the best scientific evidence available.

6. Chapter 3Copyright © 2003 Delmar Learning, a Thomson Learning company6 Importance of EBC  There is a lack of agreed-upon standards or processes for identifying clinical interventions and outcomes based on evidence.  EBC attempts to remedy this situation by promoting a scientific process driven by uniform standards and practice guidelines, while also emphasizing quality improvement.  Because of the nurse’s close interaction with the patient, nursing can have a significant influence upon and involvement with the EBC process.

7. Chapter 3Copyright © 2003 Delmar Learning, a Thomson Learning company7 Historical Overview of EBC  The term evidence-based medicine (EBM) was developed at McMaster Medical School in Canada in the 1980s.  D. L. Sackett encouraged EBM as a way to integrate individual clinical medical experience with external clinical evidence, using a systematic research approach.  EBC evolved to include other clinical health care providers.

8. Chapter 3Copyright © 2003 Delmar Learning, a Thomson Learning company8 Trends Moving Nursing Toward EBC  Early initiatives for using EBC in nursing began in 1996.  Since then EBC in nursing has rapidly developed in the United States, Australia, Canada, and the United Kingdom.  In the United States, the Agency for Healthcare Research and Quality (AHRQ) has stimulated the adoption of EBC. AHRQ established 12 evidence- based practice centers in 1997.

9. Chapter 3Copyright © 2003 Delmar Learning, a Thomson Learning company9 Establishing the Culture for EBC  In order for innovative change to develop in an institution, a supportive culture must exist. Creating such a culture required three major actions: Establishing the culture Creating a capacity for change Using the organizational infrastructure to sustain and reinforce change

10. Chapter 3Copyright © 2003 Delmar Learning, a Thomson Learning company10 Evidence: How It Is Developed and Evaluated  Analyzing data to determine its credibility as evidence must be accompanied by the ability to judge its usefulness in guiding practice.  EBC involves integrating both clinically observed and research-directed evidence, then applying knowledge and evidence to a clinical area where outcomes of care can be evaluated and measured.

11. Chapter 3Copyright © 2003 Delmar Learning, a Thomson Learning company11 Level and Quality of Evidence  There are various EBC models, containing up to six levels of evidence. Level and Type of Evidence for Nursing Intervention (based on Stetler, Morsi, and Rucki) Hierarchy of Evidence (Pfizer Pharmaceuticals) Evidence-based Levels (Consensus recommendations of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines)

12. Chapter 3Copyright © 2003 Delmar Learning, a Thomson Learning company12 Conducting Evidence Reports in Nursing  Select topic or identified problem.  Report the evidence.  Identify methods for assigning levels of evidence.  Report findings, including statistical summary if appropriate.  Give summary of evidence review.  Make recommendations for level of evidence to be assigned and clinical application potential.

13. Chapter 3Copyright © 2003 Delmar Learning, a Thomson Learning company13 Barriers to Efficient, Effective, and Quality Health Care Delivery by Nurses  The U.S. health care system does not have uniform definitions of what constitutes efficient, effective, quality health care.  It is difficult to get all clinical health care providers to apply EBC processes at the unit level.  EBC processes must be uniform enough to be valid, but also adaptable to specific needs of institutions.  EBC requires involvement of and collaboration between clinical practitioners and health care researchers.