Evidence Based Nursing

Process to Practice
Bracken Health Sciences Library
(adapted from a presentation of Dr. Norma MacIntyre, School of Rehabilitation Therapy, Queens University)

The importance of evidence

The importance of evidence

What is Evidence-Based Practice?

An approach to clinical practice A way to keep current with new developments

N. MacIntyre, 2005

What is Evidence-Based Practice?

a methodological approach to clinical practice where evidence is used to inform decision-making about making a diagnosis (or interpreting a diagnostic test), selecting an intervention, or evaluating prognostic indicators

Centre for Evidence-Based Medicine

What is Evidence-Based Practice?

an approach to health care practice in which the clinician is aware of the evidence that bears on her clinical practice, and the strength of that evidence

Health Information Research Unit, McMaster, 2002

What is Evidence-Based Practice?

an approach to decision making in which the clinician uses the best evidence available, in consultation with patient, to decide upon the option which suits that patient best

J. A. Muir Gray, 1997

What is Evidence-Based Practice?

Evidence based health care is the integration of individual clinical expertise with the best available external clinical evidence and the values and expectations of the patient

D. Sackett et al, 1996

Evidence-Based Practice

Involves life-long, self-directed, problem-based learning Involves exploring the relationship between clinical reasoning and research evidence
Involves practice

N. MacIntyre, 2005

Keeping Up?

Do nothing and get out of date Depend solely on courses/conferences Choose the main professional journal(s) and read them cover to cover every month
Learn how to find and appraise the evidence to answer questions that come from clinical practice

N. MacIntyre, 2005

Evidence Based Nursing Practice

Knowledge Standard

Each nurse possesses, through basic education and continuing learning, knowledge relevant to her/his professional practice

Ontario College of Nurses, 2002

Evidence Based Nursing Practice

Knowledge Standard Indicators

Providing a theoretical and/or evidence-based rationale for all decisions Understanding the knowledge required to meet the needs of complex clients Knowing where/how to access learning resources when necessary

Ontario College of Nurses, 2002

Evidence Based Nursing Practice

Knowledge Standard Indicators

Seeking and reviewing research in nursing, health sciences and related disciplines Using research to inform practice/professional service

Ontario College of Nurses, 2002

Evidence Based Nursing Practice

Knowledge Application Standard

Each nurse continually improves the application of professional knowledge

Ontario College of Nurses, 2002

Evidence Based Nursing Practice

Knowledge Application Standard Indicators

Ensuring practice is based in theory and evidence and meets all relevant standards/guidelines Assessing/describing the client situation using a theory, framework or evidence-based tool Managing multiple nursing interventions simultaneously

Ontario College of Nurses, 2002

Evidence Based Nursing Practice

Knowledge Application Standard Indicators

Evaluating/describing the outcome of specific interventions and modifying the plan/approach Integrating research findings into professional service and practice

Ontario College of Nurses, 2002

The cognitive continuum.

Thompson, C. et al. Evid Based Nurs 2004;7:68-72

Copyright 2004 BMJ Publishing Group Ltd.

Five Steps of Evidence-Based Practice

Define the Question

Identify Question ~ Search and Screen Literature ~ Refine Question

Collect the Evidence Critically Appraise the Evidence for Validity and Relevance

N. McKibbon, 1999

Five Steps of Evidence-Based Practice

Integrate the Evidence and Patient Factors

Make & Carry Out the Decision

Evaluate the Process

Results ~ Self-reflection

N. McKibbon, 1999

PICO

A clinical question should incorporate at least three elements

Patient

Age, sex, ethnicity, etc. Condition, diseases, general health status

Intervention

Education, diagnostics, treatment plan, self-care, etc.

PICO

Comparison Intervention

Placebo, etc.

Outcome

Expected and actual effects on patient

PICO

Do nurse led tobacco cessation interventions result in decreased smoking rates after hospital admission for coronary heart disease?

PICO

PATIENT

(Adult) coronary heart patients Smokers Discharged from hospital

INTERVENTION

Nurse led tobacco cessation programmes

PICO

COMPARISON

(Non-nurse led tobacco cessation programmes

Self-administered, non-nurse administered, etc.)

No comparison

OUTCOME

Lower rates of tobacco use among Patient group

PICO

Not all questions are of a clinical nature

Intervention can be interpreted very broadly

Evidence Pyramid

SUNY Downstate Medical Center, 2003

Evidence Pyramid

Important medical questions are typically studied more than

once, often by different research teams in different locations. A meta-analysis combines results from different studies, hopefully averaging out any differences caused by random change or local variation and getting at something close to the real truth. In general a meta-analysis, if you can find one, will be a better guide to practice than an individual article.

SUNY Downstate Medical Center, 2003

Evidence Based Resources Models

Usefulness = Relevance x Validity Work

Claude Moore Health Sciences Library, 2003

Evidence Based Resources Models

Claude Moore Health Sciences Library, 2003

Evidence Based Resources Models

Claude Moore Health Sciences Library, 2003

See you at the Search Sessions!

Mon. Sept. 24 OR Wed. Sept. 26 8:30 9:30 Bracken Library eLab