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Strategies for Overcoming Barriers in Implementing ...

SUNY Downstate Medical CenterSUNY Downstate Medical CenterDepartment of NursingDepartment of NursingNursing Research and EvidenceNursing Research and Evidence--Based Practice ConferenceBased Practice ConferenceMay 26, 2010 May 26, 2010 Strategies for Overcoming Barriers in Strategies for Overcoming Barriers in Implementing EvidenceImplementing Evidence--Based PracticeBased PracticeVeronica D. Feeg, PhD, RN, FAANP rofessor, Molloy CollegeEditor, Pediatric NursingEvidenceEvidence--Based Nursing Care? Based Nursing Care? EvidenceEvidence--Based Practice?Based Practice?What is Evidence? Collection of facts that grounds one s belief that something is true. ( )What is Evidence Based Practice? The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

SUNY Downstate Medical Center Department of Nursing Nursing Research and Evidence - Based Practice Conference May 26, 2010 Strategies for Overcoming Barriers in

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1 SUNY Downstate Medical CenterSUNY Downstate Medical CenterDepartment of NursingDepartment of NursingNursing Research and EvidenceNursing Research and Evidence--Based Practice ConferenceBased Practice ConferenceMay 26, 2010 May 26, 2010 Strategies for Overcoming Barriers in Strategies for Overcoming Barriers in Implementing EvidenceImplementing Evidence--Based PracticeBased PracticeVeronica D. Feeg, PhD, RN, FAANP rofessor, Molloy CollegeEditor, Pediatric NursingEvidenceEvidence--Based Nursing Care? Based Nursing Care? EvidenceEvidence--Based Practice?Based Practice?What is Evidence? Collection of facts that grounds one s belief that something is true. ( )What is Evidence Based Practice? The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

2 (Sackett, 1996)What is All this Fuss About?Session OverviewSession Overview Summarize approaches to EBP in nursing practice Define, describe and explain the practical application of EBP Differentiate between research, research utilization, and EBP Explicate levels of evidence Operationalize the process Strategize for change Discuss implementation leadership and organizational Barriers Foster a spirit of inquiry among clinical nursesEBP EBP Not Research and Not Research Not Research and Not Research UtilizationUtilizationEvidence-based practice (EBP) is a problem solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician s expertise as well as patient preferences and values to make decisions about the type of care that is provided.

3 Resources must be considered in the decision making Practice DefinedBased Practice Defined External versus internal evidence External evidence: generated from rigorous research Internal evidence: generated from outcomes management; practice based evidence Application in the real world Research translation in real hospital settings Combined considerations Clinician s expertise Patient preferences and values Merging the science and art within a context of caringEBP = Change in PracticeEBP = Change in PracticeReadiness for Change?Readiness for Change?A survey of readiness for EBP (n=1,097) Although these nurses acknowledge that they frequently need information for practice, they feel much more confident asking colleagues or peers and searching the Internet and World Wide Web than they do using bibliographic databases such as PubMed or CINAHL to find specific information.

4 They don t understand or value research and have received little or no training in the use of tools that would help them find evidence on which to base their practice. (p. 40)Pravikoff, D., Tanner, A. & Pierce, S. (2005) Readiness of nurses for evidence-based practice. American Journal of Nursing, 105(9), Surprising Not Surprising Many HurdlesMany Hurdles EBP is perceived as the result of individual practitioners accessing, collating and interpreting overwhelming body of literature Postponing EBP until we can get through the stacks of articles and QI we ve set aside! Reluctance to challenge the system Limited time or support for non-patient centric activities Lack of resources, tools, or methods to organize with others to tackle large questionsNot Surprising Not Surprising Many HurdlesMany Hurdles VOLUME OF LITERATURE No unaided human being can read, recall, and act effectively on the volume of clinically relevant scientific literature.

5 (IOM, 2001, ) FORM OF KNOWLEDGE Are results from single primary research adequate for informing practice? What is the base of standards, protocols? (Stevens, 2006) SOLUTION Evidence summaries, systematic reviews and EBP resources Knowledge translation conversion to give meaning for clinicians in decision makingFinding the EvidenceFinding the Evidence Knowing where to look Knowing what to do with what you findActing on the EvidenceActing on the Evidence Strength of the Evidence + Quality of the Evidence = Confidence to ActCritical Components of an EBP CultureCritical Components of an EBP Culture Spirit of Inquiry: All providers are encouraged to question their current practices EBP Champions: Who have depth knowledge and skill in EBP, mentoring others, tackle Barriers to organizational change Infrastructure: Tools that facilitate EBP computers, databases, personnel Administrative Role Models.

6 Leaders who value and model EBP and provide resources to maintain it Recognition: Rewards to individuals and unitsThe Steps of EBP The Steps of EBP Several VersionsSeveral VersionsSimpson(2004) considers evidence-based practice (EBP) to be a four step process :(a) the identification of the issue or problem,(b) the search of the literature for research,(c) the evaluation of research,(d) the action based on the Steps of EBP The Steps of EBP Several VersionsSeveral VersionsParahoo(2006) views EBP as a five step process involving:(a) the formulation of a clear question related to policy or practice,(b) the search of relevant research studies,(c) the appraisal of selected studies,(d) the analysis and the synthesis of the findings,(e) the dissemination of results and implementation of Steps of EBP The Steps of EBP Several VersionsSeveral VersionsThomsonet al.

7 (2004) suggests that integrating evidence within clinical reality involves a five step process involving:(a) forming clinical question in response to a recognized information need,(b) searching for the most appropriate evidence,(c) critically appraising the retrieved evidence,(d) incorporating the evidence into a strategy for action,(e) evaluating the effects of any decisions and actions Steps of EBP The Steps of EBP Several VersionsSeveral VersionsHolleman et al. (2006) advocate that the introduction of EBP into daily practice may involve a six step process: (a) assessment of the need for practice changes,(b) linking problem interventions and outcomes,(c) synthesis of best evidence,(d) design of practice change,(e) implementation and evaluation of practice change,(f) integration and maintenance of EBP Steps of EBP The Steps of EBP Melnyk & FineoutMelnyk & Fineout--Overholt (2005)Overholt (2005) Step 1: Ask the PICO Question Step 2: Search for the Best Evidence Step 3: Critically Appraise the Evidence Step 4: Integrate the Evidence with Your Clinical Expertise and Patient Preferences to Make the Best Clinical Decision Step 5: Evaluate the Outcome(s) of the EBP Practice Change Step 6.

8 Disseminate the Outcome(s)The Steps of EBP The Steps of EBP Melnyk & FineoutMelnyk & Fineout--Overholt (2005)Overholt (2005) Step 0 : Cultivate the Spirit of Inquiry & EBP Culture Step 1: Ask the PICO Question Step 2: Search for the Best Evidence Step 3: Critically Appraise the Evidence Step 4: Integrate the Evidence with Your Clinical Expertise and Patient Preferences to Make the Best Clinical Decision Step 5: Evaluate the Outcome(s) of the EBP Practice Change Step 6: Disseminate the Outcome(s)The EBP Process The EBP Process Melnyk & FineoutMelnyk & Fineout--Overholt (2005)Overholt (2005)Ignite the Spirit of InquiryFormulate a Searchable, Answerable PICO QuestionStreamlined, Focused SearchRapid Critical Appraisal & Synthesis of EvidenceApply Valid, Relevant EvidenceGenerate EvidenceInternal: OM, QIExternal: ResearchEvaluate the Outcome(s) and Disseminate the FindingsAsk the burning question in PICO format.

9 Patient population Intervention or interest Comparison intervention group OutcomeThe PICO Question The PICO Question Melnyk & FineoutMelnyk & Fineout--Overholt (2005)Overholt (2005)Levels of Evidence Levels of Evidence Melnyk & FineoutMelnyk & Fineout--Overholt (2005)Overholt (2005)Grading the Evidence and Strength of Grading the Evidence and Strength of RecommendationsRecommendationsGRADE Working Group, BMJ, June 2004 Agency for Healthcare Research and Quality (AHRQ) ( ) Canadian Centre for Health Evidence ( ) Clinical Evidence ( ) Cochrane Collaboration* ( ) CPM Resource Center ( ) Evidence-Based Nursing ( ) Joanna Briggs Institute for Evidence-Based Nursing and Midwifery ( ) National Guidelines Clearinghouse ( ) National Institute for Clinical Evidence (NICE) ( ) National Library of Medicine ( ) NHS Centre for Evidence-Based Medicine ( ) Sarah Cole Hirsh Institute for Best Nursing Practices Based on Evidence ( )Top EBP Website ResourcesTop EBP Website ResourcesAsk yourself: EMPHASIS ON PRACTICE OF RESEARCHOR EMPHASIS ON RESEARCH FOR PRACTICEDIFFERENCES B/T RESEARCH AND EBPDIFFERENCES B/T RESEARCH AND EBPS tevens, (2007).

10 Essential Elements of Evidence-Based Practice An Introduction to EBP and the ACE Star Model. Available: Star Model ACE Star Model Knowledge TransformationKnowledge TransformationStevens, (2007). Essential Elements of Evidence-Based Practice An Introduction to EBP and the ACE Star Model. Available: Star Model ACE Star Model Knowledge TransformationKnowledge TransformationThe conversion of research findings from primary research results, through a series of stages and forms, to impact on health outcomes by way of EB , (2007). Essential Elements of Evidence-Based Practice An Introduction to EBP and the ACE Star Model. Available: Performance Competencies:EBP Performance Competencies:Examples for Staff NursesExamples for Staff Nurses Discovery: Recognize ratings of strength of evidence when reading the literature Summary: List advantages of SRs as strong evidential foundation for clinical decision making Translation: Using specified databases, access CPGs on various clinical topics Integration: Assist in integrating practice change based on EB CPGs Evaluation.


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