Evidence-Based Practice
Back to the Basics
Anne Burnett, RN-BC, MSN, CRRN
Veterans Healthcare System of the
Ozarks
April 4, 2011
Learning Objectives
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Evidence-Based Practice History
EBP Process
An Example of Using EBP
ABC Mnemonic
Florence Nightingale
“The most important practical lesson that can
be given to nurses is to teach them what to
observe – how to observe – what symptoms
indicate improvement – what the reverse –
which are of importance – which are of
none”.
(Nightingale, 1860)
Translation
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Teach nurses what is important to monitor
How to monitor it
What trends show improvement
What trends show negative change
Which indications are important
Which indications don’t matter
Professional Nursing
• Information
– Collecting
– Interpreting
– Evaluating
EBP Defined
• Combines
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Research
Data Collection
Nurse experience
Patient wishes and needs
DATA
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Nursing Assessment
Observations
Collecting
Care improvement
Evaluating
Sharing
Academic & Publishing
Landmarks
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1860 •
1873 •
1900 •
1907 •
1912 •
1923 •
1923 •
1929 •
1952 •
Nightingale
Hospital RN Programs in US
American Journal of Nursing
Teacher’s college of Columbia
National League of Nursing Education
1st Doctoral Program in Nursing Education
Goldmark Report
1st Master of Nursing
Nursing Research Journal
Key Drivers for the 20th
Century
• Nursing Research Conferences – 1960’s
– American Nurse’s Association
• Building Foundations
– Developing Academic Programs
• Frameworks and understanding research
– The Practice of Nursing Research
– Burns & Grove, 1980’s
Key Drivers for the 21st
Century
• Formalizing five steps of EBP
– Melnyk & Fineout-Overholt; Evidence-Based Practice
in Nursing & Healthcare
• Nursing developing a researched body of
knowledge
– Boswell & Cannon; Introduction to Nursing Research
Incorporating Evidence-Based Practice
• EBP Conferences
– Locally, Regionally, Nationally
Veterans Healthcare System of
the Ozarks
• EBP Council
• Made up of nurses from diverse care
delivery areas:
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Acute care
Surgery
Outpatient areas
Psychiatric care
(Boswell & Cannon, Ch.1; Hockenberry, et al; Mantzoukas; Titler; Turkel, et al)
Challenges & Solutions
• Challenges
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Culture Changes
Introducing EBP
Implementing EBP
Educational Gaps
Prior Experience
• Solutions
– Education for staff
& the council
– Poster Presentations
– Developing
Nursing Projects
– Research Critiques
EBP Council
• Serves as resource
– Developing Change Strategies
• Share information
– How to access research
• Guiding staff to other change venues
– Appropriate change process
– Example the Watson Theory Project
Integrating EBP
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Studies on how to integrate EBP
Culture of change
Recent research developments
Nurse Empowerment
Skills
• Developing skills
• Overcoming resistance to change
• Engaging staff
Mnemonic Development
• Mnemonics have been used by nurses for
years
• Tool to integrate multiple step processes
• ADPIE
Mnemonic
• Reduce volumes of information
• Helps sequence
– Complex information
• Building Blocks for EBP
The ABCs of EBP
= Ask
= Books
= Consider
= Develop
= Evaluate
= Facilitate
A = Ask the Question
• A is the essence of EBP
• Melnyk & Fineout-Overholt
– “BURNING QUESTION”
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Right Question
Right way
Key to using EBP
A has a secondary mnemonic:
– PICOT
PICOT Format
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P = Population.
I = Intervention.
C = Comparison.
O = Outcome.
T = Time.
Secondary Mnemonic
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PICOT
Filtering
Project Goals
Focus the research
Goals for PICOT
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Application of the collected evidence
Narrow focus
End product
Application
PRACTICE PICOT
• So this sample question reads:
• Does this diabetic teaching tool help my
diabetic patients reduce their A1c in six
months compared to the current process we
use?
Example of the PICOT
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Population: Diabetic patients
Intervention: Diabetic teaching tools
Comparison: A1c prior to the education
Outcomes: A1c after the education
Time: 3 months, 6 months, Ongoing
ABCs of EBP
= Ask
= Books
= Consider
= Develop
= Evaluate
= Facilitate
B = Books
• B stands for books; meaning research
• Use the question to narrow the search to
manageable amounts
• Internet search engines & research sites
• http://www.ahrq.gov
• http://www.cdc.gov
(Boswell & Cannon, Ch.7; Burns & Grove, Ch.2; Melnyk & Fineout-Overholt,
Ch.3)
B = Books
• Using Search engines & sites
• Nursing Organizations
• On-line libraries at work or school
Caution!!!!
• CINAHL Full Search under EBSCO Host
• First run: Diabetes
– 57,163 results
• Second run: narrow dates
– 35,672
• Third run: add ‘education’
– 1,623
• Fourth run: add ‘tool’
– 1 study
ABCs of EBP
= Ask
= Books
= Consider
= Develop
= Evaluate
= Facilitate
C = Consider
• Evaluate the research
• Tool developed
• Using the tool
(Boswell & Cannon, Ch.5, Burns & Grove, Ch.2 4; Mantzoukas; Melnyck &
Fineout-Overholt, 2005, Ch. 5)
Research Evaluation Tool
Article
Title
Target
Population/is
it applicable
here?
What was
tested/ is it
applicable
Dates
Strengths
of Study
Weaknesses of
study
Other
comments/
citation if
indicated
Dick &
Jane
look for
Spot.
2 children
looking for
dog.
N/A we don’t
have pediatrics
here.
Ф
Tested
methods to
look for
dogs.
N/A we
don’t have
dogs here.
Ф
This
study is
not dated.
I would
guess
1940’s.
Ф
In-depth
case
study.
Only 2
subjects. Needs
larger sample
size.
Citation if the
study is going to
be used to build
a paper, or
develop further
research.
Comments if the
study might be
used for
something in the
future.
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Any other brief
memory joggers
you want to add.
You might get
ideas for other
search
parameters
Boswell & Cannon, p.108; Mantzoukas)
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Use them as a
pilot study
ABCs of EBP
= Ask
= Books
= Consider
= Develop
= Evaluate
= Facilitate
D = Develop & Apply
• Develop and apply the intervention being
considered
• Use specific steps, specific details in order
to make the project manageable
• Specific to your patient population
(Melnyk & Fineout-Overholt, Ch.10)
Develop the EBP Project
• Does this tool help my diabetic patients
reduce their A1c in six months compared to
the current process we use?
– Tool adjusted for your patient population
– Instructions for staff
– Instructions for patients
ABCs of EBP
= Ask
= Books
= Consider
= Develop
= Evaluate
= Facilitate
E = Evaluate
• Evaluating care delivery should be second
nature for nurses
• Familiar from the nursing process
• Collecting data to drive the evaluation
• Statistical analysis may be necessary
• Decide what is going to be measured
(Boswell & Cannon, Ch.9; Melnyk & Fineout-Overholt, Ch.10 & 11)
Chocolate
Evaluate Results of the Project
• Does this tool help my diabetic patients
reduce their A1c in six months compared to
the current process?
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Run A1c
Count
Pre/Post Test
Questionnaires
Note
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Research
Ethics
Privacy
Institutional Review Board
ABCs of EBP
= Ask
= Books
= Consider
= Develop
= Evaluate
= Facilitate
F = Facilitate
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Facilitate EBP
Academic Growth
Professional Growth
Skills Development
Share Project Findings
(Melnyk & Fineout-Overholt, Ch.14)
Evidence at Work in Practice
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Fact sheets for nurses
Publish research article reviews
Share findings
Attend conferences
Support other staff development
Culture changes
Getting EBP to the Staff
• Power Point Presentation
• New employee orientation
• Introduces new staff to our cultural
environment
• EBP not in original curricula
Thank You
• “Let whoever is in charge keep this simple
question in her head:
– Not how can I always do this right thing
myself, but how can I provide for this right
thing to be always done?”
– Florence Nightingale, 1860
The Answer is EBP!
Questions?
References
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Boswell, C. & Cannon, S. (Eds.) (2007). Introduction to nursing research:
Incorporating evidence-based practice, p.108. Sudbury, MA: Jones & Bartlett.
Burns, N., & Grove, S. (2005) The practice of nursing research ch.2, (5th ed.),
Elsevier.
Bradshaw, W. (2010). Importance of nursing leadership in advancing
evidence-based practice. Neonatal Network, 29(2), 117-122.
Dontje, K. (2008). Evidence-based practice: Understanding the process.
Topics in Advanced Practice Nursing eJournal, 7(4). Retrieved May 13, 2010
from http:www.medscape.com/viewarticle/567786.
Hockenberry, M., Walaen, M., Brown, T., Barrera, P. (2008). Creating an
evidence-based practice environment: One hospital’s journey. Journal of
trauma nursing, 15(3) p.136-142.
Ireland, M. (2008) Assisting students to use evidence as a part of reflection on
practice. Nursing Education Perspectives, 29(2) p.90-93.
References
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Melnyk, B, & Fineout-Overholt, E. (Eds.). (2005). Evidence-based practice in
nursing & healthcare: A guide to best practice. (Ch1) Philadelphia:Lippincott
Williams & Wilkins
Nightingale, F. (1860). Notes on nursing: What it is and what it is not. Dover
edition, NY, 1969 (original work published by D. Appleton and company,
1860).
Seben, S., March, K., Pugh, L. (2010). Evidence-based practice: The forum
approach. American Nurse Today, 5(11) p.32-34.
Titler, M. (2010). Chapter 7, The evidence for evidence-based practice
implementation.
Retrieved Sep. 29, 2010 from
http://wwwahrq.gov/qual/nurseshdbk/docs/TitlerM_EEBPI.pdf