Promoting Research and Evidencebased Practice at the Bedside

Promoting Research and Evidencebased Practice at the Bedside

Promoting Research and Evidencebased Practice at the Bedside Jacque Carpenter PhD, RN October 28, 2016 Objectives Distinguish research, quality improvement, and evidence-based practice in nursing Discuss strategies to translate evidence into nursing practice

Historical Context Florence Nightingale: Founder of modern nursing and statistician Use of Evidence in Practice Patient care based on tradition

2 Translating Evidence to Practice It can take 17 years before research is translated into routine clinical practice (Morris, Wooding, & Grant, 2011) Making Clinical Decisions How do you make clinical decisions?

How you were taught Tradition Gut feelings Policies & Procedures Research texts Journals Be curious

Ask critical questions about your practice Why do we do it this way? Whats the current best evidence? Is there a more efficient way? Knowledge Development Discovery Evaluation

Nursing Research Quality Improvement Evidence-based Practice

Application Quality Improvement Systematic, data-guided activities designed to bring about immediate improvements in healthcare delivery in particular settings (Hastings Center). Quality Improvement

Goal is to improve the local system of care, rather than to develop new knowledge Quality Improvement Extension of clinical practice Nurses do quality improvement every day QI examples

Nursing Sensitive indicators Performance Measures Compliance checks Audits

Nursing Research A systematic search for knowledge using disciplined methods to solve issues (Polit & Beck, 2008) Nursing Research The ultimate goal of nursing research is to develop, refine, and expand a body of knowledge (Polit & Beck, 2008).

Nursing Research Subjects are exposed to risks in order to benefit others, not the subjects themselves OHRP- Regulations designed to ensure that risks for subjects are minimized, PHI is protected, and potential subjects are informed about risk and voluntarily agree to participate

Research Examples Dysphagia Screen Validation study A randomized controlled trial to examine the effect of incentive spirometry on dyspnea and vital capacity in hospitalized pneumonia patients Examining the effects of three splinting interventions on inspiratory volume in sternal fracture patients

QI or Research Research Process QI Rapid Cycle Process QI vs Research Research Principal Investigator seeks to gain knowledge not

immediate benefit of subjects Informed consent required unless explicitly waived by IRB QI Clinicians are directly responsible for patients well-being Data used in changing environment to manage care processes

IRB!! QI/Research Dilemma Following research rules when not applicable increases cost and complexity and may discourage important work. Not following regulations that do apply risks

endangering subjects and result in sanctions form federal office for human research protections (OHRP) QI & Research Dilemma Johns Hopkins University Hospital successfully implemented checklist to reduce CLBSIs in ICUs Five proven procedures including washing hands &

disinfecting skin before insertion Checklist intervention undertaken at MHA Evidence-based Practice Conscious integration of the best research evidence with clinical expertise and patient preferences in nursing practice (Sackett D et al.,

2000) Evidence-based Practice Evidence-based Practice Use of evidence-based standards from professional organization Use of research to guide

protocols Institute for Healthcare Improvement (IHI) bundles Specifics:

Safe patient handling Falls prevention Pressure ulcer prevention Restraint free environments 2 Falls QI Example Falls is a nursing sensitive indicator. Quarterly data are collected at the hospital

and compared to benchmarks. Fall prevention process is evidence-based. Process audited periodically. Not all units follow process. Process tweaked on certain units to improve fall rate. Falls Research Example Falls is a nursing sensitive indicator

A nurse proposes an innovation to be tested on patients, which may impact patient falls in general (including areas outside the facility) 2 Falls EBP Example Falls is a nursing sensitive indicator Unit struggles with unacceptable fall rate

Evidence that fall intervention bundle reduced falls Nurse implements bundle on the unit Evaluates fall rate next quarter Translating Evidence into Practice Clinical Question Share

results Gather evidence Evaluate outcome Appraise

Patient Consider expertis e ACE Star Model of Knowledge Transformation

Original Research QA, PI data collection Literature Synthesis Practice Change

Guidelines Develop PICO Question Refine PICO Question as Necessary Evaluate Strength of the Evidence Evaluate Quality of Research Report

Write the Literature Review Write the Research Proposal Complete IRB Paperwork Submit Research Proposal Collecting Data Writing up Results

Internally Externally AACN Hierarchy of Evidence Met aanal ysis or Met

asyn thesi RCTs s Descriptive, correlational studies, integrative reviews, systematic reviews Organizational standards with supporting evidence

Multiple case reports, theory-based evidence from expert opinions Manufacturers recommendations only Appraise the Evidence Critique guide Are the study results valid? Do the conclusions drawn by the authors

logically follow? Will the outcomes improve patient care? Change for Change Sake? Nursing Research Quality Evidence-based

Improvement Practice Questions?

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