Ch02 (7)

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Arizona Western College *

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LPN

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Medicine

Date

Dec 6, 2023

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39

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Copyright ©2023 F.A. Davis Company Book cover for Understanding Medical-Surgical Nursing, Seventh Edition. Chapter 2 Evidence-Based Practice
Copyright ©2023 F.A. Davis Company Learning Outcomes Define evidence-based practice and evidence- informed practice. Discuss why evidence-based practice should be used. Explain how to identify nursing evidence that should be put into practice. Describe the evidence-based practice process.
Copyright ©2023 F.A. Davis Company Learning Outcomes (continued) List the six steps of evidence-based practice. Identify who should give evidence-based nursing care, including when and where care should be given. Describe how the Quality and Safety Education for Nurses (QSEN) project can promote safe patient care.
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Copyright ©2023 F.A. Davis Company Chapter Concepts Caring Evidence-Based Practice Health-Care Technology Quality Improvement Safety
Copyright ©2023 F.A. Davis Company Evidence-Based Practice Systematic process Current evidence Patient care decision making Explicit and judicious Quality care Optimal patient outcomes • Gold Standard
Copyright ©2023 F.A. Davis Company Evidence-Based Practice Decision Making Evaluation of quality Applicability of existing research Patient preferences Costs Clinical expertise Clinical setting
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Copyright ©2023 F.A. Davis Company Why Use Evidence-Based Practice? Gold standard of health care Nurses can give best care possible. This Photo by Unknown Author is licensed under CC BY
Copyright ©2023 F.A. Davis Company Outcome Measurement Built into the process Shows value of the practice change
Copyright ©2023 F.A. Davis Company Multiple Evidence Sources Dental Dietetics Gerontology Medical Nursing Psychology Social work Other professions
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Copyright ©2023 F.A. Davis Company Levels of Evidence Quality I II III IV V VI VII
Copyright ©2023 F.A. Davis Company Level I Strongest evidence Systematic reviews of randomized controlled trials • True experimental studies • Factors that could falsely change results controlled as possible ‒ Example: Joanna Briggs Institute’s Evidence-Based Resources Cochrane Reviews
Copyright ©2023 F.A. Davis Company Level II Randomized Controlled Trials At least one well-designed randomized controlled trial
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Copyright ©2023 F.A. Davis Company Level III Evidence obtained from quasi-experimental research studies • Factors that could falsely change the results are not controlled • Less predictive of effectiveness
Copyright ©2023 F.A. Davis Company Level IV Evidence from well-designed case-control or cohort studies
Copyright ©2023 F.A. Davis Company Level V Systematic review of qualitative or descriptive studies
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Copyright ©2023 F.A. Davis Company Level VI Qualitative or a single descriptive study
Copyright ©2023 F.A. Davis Company Level VII Expert opinion Weakest level of evidence Expert opinions and published clinical articles that are not based in research
Copyright ©2023 F.A. Davis Company Process for Evidence-Based Practice Dependent nursing interventions • Delegated by health-care provider Independent nursing interventions • Does not require health-care provider order • Under supervision of registered nurse
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Copyright ©2023 F.A. Davis Company Six Steps of EBP: “ASKMME!”
Copyright ©2023 F.A. Davis Company Six Steps of EBP: “ASKMME!” Step 1: Ask the burning question. • “Why do we do it that way?” • “How could we do that better?” PICOT Method to form the question • Organizing framework for database searches • It narrows the focus for the search and produces more relevant findings
Copyright ©2023 F.A. Davis Company PICOT Framework that identifies relevant searchable question keywords on databases Time saver Stands for • P opulation/ P atient Problem: Who is your patient? • I ntervention: What do you plan to do for the patient? • C omparison: What is the alternative to your plan? • O utcome: What outcome do you seek? • T ime: What is the time frame? (This element is not always included.)
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Copyright ©2023 F.A. Davis Company Six Steps of EBP: “ASKMME!” Step 2: Search and collect the most relevant and best evidence available. • Computer databases • Cumulative Index to Nursing and Allied Health Literature (CINAHL)
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Copyright ©2023 F.A. Davis Company Six Steps of EBP: “ASKMME!” Step 3: Think critically. • Evaluate the quality of the evidence you find • Appraise evidence for ‒ Validity ‒ Relevance to situation ‒ Applicability
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Copyright ©2023 F.A. Davis Company Six Steps of EBP: “ASKMME!” Step 4: Measure outcomes before and after change. Determine patient outcomes that are likely to occur as a result of a change in nursing care
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Copyright ©2023 F.A. Davis Company Six Steps of EBP: “ASKMME!” Step 5: Make it happen. Institute the desired change in nursing practice based on evidence through education
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Copyright ©2023 F.A. Davis Company Six Steps of EBP: “ASKMME!” Step 6: Evaluate the practice change. Evaluation is the process used to determine whether the change made a significant difference
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Copyright ©2023 F.A. Davis Company EBP, Quality, and Safety: They Belong Together! Quality and Safety Education for Nurses (QSEN) Project • www.qsen.org ‒ Competencies ‒ Domains ‒ Concepts This Photo by Unknown Author is licensed under CC BY
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Copyright ©2023 F.A. Davis Company QSEN Areas of Focus Evidence-based practice Safety Teamwork and collaboration Patient-centered care • Nursing interventions should meet the patient’s needs Quality improvement Informatics
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Copyright ©2023 F.A. Davis Company Practice Analysis Tip: Linking NCLEX-PN® to Practice (continued_2) The LPN/LVN will participate in quality improvement (QI) activities (e.g., collecting data, serving on QI committee).
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Copyright ©2023 F.A. Davis Company Review Question #1 The nursing practice committee reviews a literature search. Which factors are considered when deciding which evidence to use? Select all that apply. 1. Quality 2. Applicability 3. Nurse convenience 4. Cost 5. Clinical expertise 6. Clinical setting
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Copyright ©2023 F.A. Davis Company Review Question #1 Answer Correct Answer: 1, 2, 4, 5, 6
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Copyright ©2023 F.A. Davis Company Review Question #2 The nurse evaluates research studies. What should the nurse consider the strongest level of evidence? 1. Level I 2. Level II 3. Level III 4. Level IV 5. Level V 6. Level VI 7. Level VII
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Copyright ©2023 F.A. Davis Company Review Question #2 Answer Correct Answer: 1
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Copyright ©2023 F.A. Davis Company Review Question #3 The nurse is evaluating research studies. Which of these does the nurse identify as level I evidence? 1. Case study 2. One randomized controlled trial 3. Quasi-experimental research studies 4. Systematic review of randomized controlled trials
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Copyright ©2023 F.A. Davis Company Review Question #3 Answer Correct Answer: 4
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Copyright ©2023 F.A. Davis Company Review Question #4 The nurse searches for level I evidence. Which sources can the nurse use? Select all that apply. 1. American Journal of Nursing 2. Cochrane Reviews 3. Google 4. Joanna Briggs Institute’s Evidence-Based Resources 5. WebMD.com
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Copyright ©2023 F.A. Davis Company Review Question #4 Answer Correct Answer: 2, 4
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Copyright ©2023 F.A. Davis Company Review Question #5 The student nurse is to apply the six QSEN competencies to patient care. Which of these is a QSEN competency? Select all that apply. 1. Evidence-based practice 2. Family-centered care 3. Health insurance coverage 4. Safety 5. Quality improvement 6. Teamwork and collaboration
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Copyright ©2023 F.A. Davis Company Review Question #5 Answer Correct Answer: 1, 4, 5, 6
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