Ch. 6 4205
Evidence-Based Practice,
Advocacy, & Bill of Rights
Presented by
Pamela Roberts, MSN RN
EBP Defined
• The process of providing clinically
competent care, supported by the
best scientific evidence available,
such as outcomes research and
expert advisers.
EBP Characteristics
• Framework for clinical practice
• Considers internal and external
influences on practice
• Encourages critical thinking
• Judicious use of evidence for
broad-based thinking
• Numerous studies cited
Critical Thinking and EBP
•
•
•
•
Translating theory to practice
Posing answerable questions
Broad-based critical thinking
Analysis, synthesis, interpreting, and
drawing conclusions
Using Evidence-Based Practice
• Asking the right questions
– Why was the research done, what setting was
used?
• Applying innovation to practice
– Innovation is originality
• Evaluating the effect of predetermined
outcome
• Was success achieved?
• How were the results disseminated?
– Disseminated – dispersed, distributed
Why are we using
Evidence-Based Practice?
• Increased rate of information distribution
– You can google anything you want on the internet
• Nontraditional
– EBP moves away from tradition. “This is the way we’ve
always done it.” Well, maybe that way has been wrong
all these years
• Decision making based on comprehensive body of
knowledge
• Patient care improvement
– Implementing the Fallen Star program has decreased
the rate of falls
• Conscientious use of current best evidence in
making decisions about nursing care
– By educating clients based on what’s current
Why use EBP?
• Efficacy
– The ability to reach the desired result
• Efficiency
– Desired result timely with minimal effort
• Effectiveness
– The ability to produce the desired result
The Nurses Role in EBP
• Active in the evolution of EBP in the
organization
• Promote ways to systemize evidence
at the bedside
• Remained enlightened about the use
of EBP
– We do CEU’s, take classes, read articles and
what not
How do we use EBP?
• Translating evidence into practice
• PET
• P – Practice question
– PICO
• E - Evidence
• T – Translation
– Are the changes in practice feasible? If so,
actions are taken to put the change into
practice, this is when a plan is developed
PICO for practice question
•
•
•
•
Patient, population, or problem
Intervention
Comparison with other treatments
Outcomes
Searching for Evidence
• PubMed (MEDLINE)
• CINAHL (The Cumulative Index to
Nursing and Allied Health Literature)
• The Cochrane Library
CINAHL
• EBSCO
• 2700 nursing, allied health,
biomedical, and consumer health
journals
• ANA and NLN journals
• Various depths of coverage
• References dissertations, books,
standards of practice, legal cases,
critical paths…etc.
MEDLINE (PubMed)
• Produced by the National Library of
Medicine
• Premier source for biomedical
literature
• 5000 journal with 300 nursing specific
• Evidence-based filters in clinical
queries
The Cochrane Library
• A collection of seven databases
• Contains evidence summaries and
synthesizes reviews
• Reviews are based on the best
available information in health-care
interventions
• Structured to minimize bias
• Good evidence-based source
Search tips
• Use controlled vocabulary for
keywords and phrases
• Use AND, OR, and NOT
Ex: Clinical competence AND
Intravenous therapy
More search tips
• Think of alternative spellings such as
tumour, behaviour, gynaecology
American vs. British)
• Use limits such as age, date of
publication, and language
Reviewing the search
• Who wrote it?
• Who
sponsored the
research?
• When was it
published?
• Has it been
reviewed? If so
by whom?
• Why was it
published?
• Has it been
cited?
Advocacy
Advocacy
• Advocacy is the foundation and essence
of nursing and nurses have a
responsibility to promote human
advocacy
• Advocacy is helping people grow and self
actualize
• Nurses must advocate for themselves,
clients, family members, subordinates,
and their profession
Goals of the Advocate
1. Inform
2. Autonomy (enhance this)
3. Respect
1. To respect the decisions of others, even if
you don’t agree with it.
How Nurses Can Act as
Advocates
• Helping others make informed
decisions
• Cultural and ethnic diversity and
sensitivity
• Directly intervening on behalf of
others
• Continuing care of DNR client
Advocating for Clients
• Client’s needs and goals are paramount
• Advocate the distribution of resources
• Leadership must be willing to take risks
– Time out procedures (right pt, right site, right
surgery)
– DNRs
– Ethics Committee for Staff
• Must be willing to accept conflict
Bills of Rights
• Passed by the National League for
Nurses and American Hospital
Association in the 1960’s
• Privacy law primarily protects the
rights of the patient
• Guide professional practice
Subordinate Advocacy
What is it?
• The manager helps subordinates
resolve ethical problems and live with
the solutions at the unit level
• Like if you have a problem on E5, you
should try to solve the problem and
live with the consequences on E5
Promoting
Subordinate Advocacy
1.
2.
3.
4.
Staff needs, (listen to)
Empower staff
Promote autonomy (for the nurses)
Face challenges (and solve
problems together)
5. “Go to bat” for the staff (when
needed)
Workplace Advocacy
• Manager insures safe, growth
oriented environment
• Occupational health and safety must
be assured
Internal vs. External Whistle-Blowing
• Internal whistle-blowing
– Within the organization, reporting up the chain of
command
• External whistle-blowing
– Reporting outside the organization, such as the media
or an elected official
• Public awareness has increased
– People are more likely to complain when they feel
wronged
• Nurses must act individually or collectively
Professional Advocacy
• Leader-managers also must be
advocates for the nursing profession
• Professional duty is assumed by entering
the profession of nursing
• Speak out on consumer issues,
continuing and expanding attempts to
influence legislation, and increasing
membership on governmental health
policy-making boards and councils
• Speak out on staffing issues