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Developing Best Practices for the
Nursing Profession through Research
(Evidence-Based Practice in Nursing and
Health Care)
22ndnd Collegiate Nursing Research CongressCollegiate Nursing Research Congress
Erlinda Castro-Palaganas, PhD, RN
Benguet State University
November 27, 2010
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ObjectivesObjectives
At the end of the presentation, theAt the end of the presentation, the
participants will be able to:participants will be able to:
Explain the role of developing bestExplain the role of developing bestpractices vispractices vis----vis evidencevis evidence--based practicebased practice
in patient care outcomes in the context ofin patient care outcomes in the context of
research;research;
Appreciate role ofEBP in individual,Appreciate role ofEBP in individual,
organizational and community dynamics.organizational and community dynamics.
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Research Teaching
Community-
Engaged
Service
Practice-based
research
Community/community-oriented service
Academic community
practice
Community-
based learning
Practice-based
learning
Service-learning
Community-Engaged Teaching, Research and Service
Scholarship in discovery, integration, application and teaching.
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What is Nursing ResearchWhat is Nursing Research
Systematic inquiry designed to develop knowledgeSystematic inquiry designed to develop knowledge
about issues of importance to the nursingabout issues of importance to the nursing
professionprofession It is a diligent, systematic inquiry or study thatIt is a diligent, systematic inquiry or study that
validates and refines existing knowledge andvalidates and refines existing knowledge and
develops new knowledge; indicates planning,develops new knowledge; indicates planning,
organization and persistence.organization and persistence. The ultimate goal of research is the developmentThe ultimate goal of research is the development
of a research body of knowledge for a discipline orof a research body of knowledge for a discipline or
profession, such as nursing.profession, such as nursing.
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Why Nursing Research?Why Nursing Research?
Nursing is a practice profession, thus research isNursing is a practice profession, thus research isessential to develop and refine knowledge thatessential to develop and refine knowledge that
can be used to improve clinical practice.can be used to improve clinical practice.
Professional Nurses need to be able to:Professional Nurses need to be able to:
-- read research reports,read research reports,
-- identify effective interventions for practice, andidentify effective interventions for practice, and
-- implement these interventions to promoteimplement these interventions to promotepositive outcomes for patients and familiespositive outcomes for patients and families
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What is your role in nursingWhat is your role in nursing
research?research?
BSN: Critique research findings for use inBSN: Critique research findings for use in
practice; use research findings in practicepractice; use research findings in practice
MSN/MAN: Collaborate in research projects;MSN/MAN: Collaborate in research projects;
provide clinical expertise for researchprovide clinical expertise for research
PhD: Develop nursing knowledge throughPhD: Develop nursing knowledge through
research and theory development; conductresearch and theory development; conductfunded independent research projectsfunded independent research projects
PostDocPostDoc: Develop and coordinate funded: Develop and coordinate funded
research programsresearch programs
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How do we acquire knowledge inHow do we acquire knowledge in
Nursing?Nursing?
Knowledge is essential informationKnowledge is essential information
acquired in a variety of ways, expected toacquired in a variety of ways, expected to
be accurate reflection of reality, andbe accurate reflection of reality, and
incorporated and used to direct a personsincorporated and used to direct a persons
actions.actions.
The quality of nursing practice depends onThe quality of nursing practice depends on
the quality of the knowledge that youthe quality of the knowledge that you
acquired.acquired.
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How do we acquire knowledge inHow do we acquire knowledge in
Nursing?Nursing?
TraditionsTraditions
AuthorityAuthority
BorrowingBorrowing
Trial and ErrorTrial and Error
Personal Experience (Novice, advancedPersonal Experience (Novice, advanced
beginner, competent, proficient, expert)beginner, competent, proficient, expert) Role Modeling (mentorship)Role Modeling (mentorship)
IntuitionIntuition
Reasoning (Inductive vs. Deductive)Reasoning (Inductive vs. Deductive)
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For nursing as a discipline to beFor nursing as a discipline to beeffective in research, the focuseffective in research, the focus
of researchof research--directed activitydirected activity
should beshould be creating a culturecreating a culturewithin nursing that values,within nursing that values,
uses, and supportsuses, and supportsresearch.research.
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As practitioners of aAs practitioners of a
discipline, nurses mustdiscipline, nurses must
perceive that research isperceive that research isimportant in developingimportant in developing
evidenceevidence--based nursingbased nursing
practice in all settings andpractice in all settings andspecialties.specialties.
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Developing Best Practices
for the Nursing Profession
through Research: Buildingan Evidence-Based Practice
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From best evidence to bestFrom best evidence to best
practice: effectivepractice: effective
implementation of change inimplementation of change inpatients carepatients care
RichardRichard GrolGrol, Jeremy, Jeremy GrimshawGrimshaw
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What is Best Practice?What is Best Practice?
A best practice is aA best practice is a techniquetechnique,,
method, process, activity,method, process, activity,
incentive, or reward whichincentive, or reward whichconventional wisdomconventional wisdom regards asregards as
more effective at delivering amore effective at delivering a
particular outcome than any otherparticular outcome than any othertechnique, method, process, etc.technique, method, process, etc.
when applied to a particularwhen applied to a particular
condition or circumstance.condition or circumstance.
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Best Practices and EvidenceBest Practices and Evidence--
Based PracticeBased Practice
An approach to clinical practiceAn approach to clinical practice
A way to keep current with newA way to keep current with newdevelopmentsdevelopments
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What is EvidenceWhat is Evidence--BasedBased
Practice?Practice?
an approach to health carean approach to health carepractice in which the clinician ispractice in which the clinician is
aware of the evidence that bearsaware of the evidence that bears
on her/his clinical practice, andon her/his clinical practice, and
the strength of that evidencethe strength of that evidence
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What is EvidenceWhat is Evidence--BasedBased
Practice?Practice?
an approach to decision an approach to decision
making in which the clinician usesmaking in which the clinician uses
the best evidence available, inthe best evidence available, in
consultation with patient, toconsultation with patient, todecide upon the option whichdecide upon the option which
suits that patient bestsuits that patient best
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Therefore:
Evidence-Based Practice
is the use of the
best research, theory
or expert opinion, plusthe patients unique
circumstances and
personal values,combined with clinical
judgment to achieve
the best outcomes.
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Best Practice and EvidenceBest Practice and Evidence
Based Nursing PracticeBased Nursing Practice
Knowledge StandardKnowledge Standard
Each nurse possesses, through basicEach nurse possesses, through basic
education and continuing learning,education and continuing learning,
knowledge relevant to her/hisknowledge relevant to her/hisprofessional practiceprofessional practice
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Best Practice and EvidenceBest Practice and Evidence
Based Nursing PracticeBased Nursing PracticeKnowledge Standard IndicatorsKnowledge Standard Indicators
Providing a theoretical and/or evidenceProviding a theoretical and/or evidence--
based rationale for all decisionsbased rationale for all decisions
Understanding the knowledge requiredUnderstanding the knowledge requiredto meet the needs of complex clientsto meet the needs of complex clients
Knowing where/how to access learningKnowing where/how to access learning
resources when necessaryresources when necessary
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Best Practice and EvidenceBest Practice and Evidence
Based Nursing PracticeBased Nursing Practice
Knowledge Standard IndicatorsKnowledge Standard Indicators
Seeking and reviewing research inSeeking and reviewing research in
nursing, health sciences and relatednursing, health sciences and related
disciplinesdisciplines
Using research to informUsing research to inform
practice/professional servicepractice/professional service
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Best Practice and EvidenceBest Practice and Evidence
Based Nursing PracticeBased Nursing Practice
Knowledge ApplicationKnowledge Application
StandardStandard
Each nurse continually improvesEach nurse continually improves
the application of professionalthe application of professional
knowledgeknowledge
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Best Practice and EvidenceBest Practice and Evidence
Based Nursing PracticeBased Nursing PracticeKnowledge Application Standard IndicatorsKnowledge Application Standard Indicators
Ensuring practice is based in theory andEnsuring practice is based in theory and
evidence and meets all relevantevidence and meets all relevant
standards/guidelinesstandards/guidelines
Assessing/describing the client situation using aAssessing/describing the client situation using atheory, framework or evidencetheory, framework or evidence--based toolbased tool
Managing multiple nursing interventionsManaging multiple nursing interventions
simultaneouslysimultaneously
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Best Practice and EvidenceBest Practice and Evidence
Based Nursing PracticeBased Nursing PracticeKnowledge Application StandardKnowledge Application Standard
IndicatorsIndicators
Evaluating/describing the outcome ofEvaluating/describing the outcome of
specific interventions and modifying thespecific interventions and modifying the
plan/approachplan/approach
Integrating research findings intoIntegrating research findings into
professional service and practiceprofessional service and practice
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Thompson, C. et al. Evid Based Nurs 2004;7:68-72
The cognitive continuum.
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How to we derive evidence
best practice and EBP?Systematic reviews often involve
statistical integration of findings through
meta-analysis, a procedure whose
advantages include objectivity,
enhanced power, however, for broad
questions or when there is substantial
inconsistency of findings.Polit and Beck, 2008
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A Model for Evidence-based Practice
by Rosswurm & Larrabee (1999)
1.AssessNeed for
change
Includestakeholders
Collect internaldata aboutcurrent practice
Compare internaldata with externaldata
Identify problem
2.2. LinkProblem,interventions,outcomes
3.3.SynthesizeBest evidence
4.4. DesignPracticechange
5.Implement& evaluatechange in practice
Usestandardizedclassificationsystems andlanguage
Identifypotentialinterventionsand activities
Selectoutcomesindicators
Searchresearchliteraturerelated to majorvariables
Critique andweigh evidence
Synthesize
best evidenceAssessfeasibility,benefits andrisks
Defineproposedchange
Identifyneededresources
Planimplementation
processDefineoutcomes
Pilot studydemonstration
Evaluateprocess andoutcome
Decide toadapt, adopt,or reject
practicechange
Rosswurm, M. A. & Larrabee, J. H. (1999). A model for change to evidence-based practice. Image: Journal of Nursing Scholarship, 31(4), 317-322.doi: 10.1111/j.1547-5069.1999.tb00510.x
6.Integrate &Maintain change inpractice
Communicaterecommendedchange tostakeholders
Present staff inserviceeducation onchange inpractice
Integrate intostandards ofpractice
Monitorprocess andoutcomes
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SUNYDownstate Medical Center, 2003
Evidence PyramidEvidence Pyramid
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Evidence Based Resources ModelsEvidence Based Resources Models
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Evidence Based Resources ModelsEvidence Based Resources Models
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Best Practice and DecisionsBest Practice and Decisions
Towards ChangeTowards Change Make decisions about patient careMake decisions about patient care
Implement proven and accepted bestImplement proven and accepted best
practicepractice
Utilize to its maximum availableUtilize to its maximum available
resourcesresources
Advance profession, enhance quality ofAdvance profession, enhance quality of
life and learning, keep practice uplife and learning, keep practice up--toto--
date and currentdate and current
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Things that make us say,Things that make us say,
hmmmhmmm The use of evidence is critical toThe use of evidence is critical to
the novice and experienced nursethe novice and experienced nurse
Nursing practices are rooted inNursing practices are rooted intradition=outdatedtradition=outdated
Tradition and the oldTradition and the old--way do notway do not
lead to best practicelead to best practice
Research findings are notResearch findings are not
integrated into practiceintegrated into practice
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Reasons why Best Practices andReasons why Best Practices and
EBP is taking too long to take rootEBP is taking too long to take root
Attitudes: lack of value for researchAttitudes: lack of value for research
Presence of other goals with higherPresence of other goals with higher
priorities: money, leadership gradientpriorities: money, leadership gradient
Huge gap between information literacyHuge gap between information literacy
and computer skillsand computer skills
Limited access to high qualityLimited access to high qualityinformation resources (whats going oninformation resources (whats going on
with the rest of the world?)with the rest of the world?)
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The TasksThe Tasks--at Hand for theat Hand for the
developing best practice and EBPdeveloping best practice and EBP
Obtain knowledge and skillsObtain knowledge and skills
Disseminating that EBP improves careDisseminating that EBP improves careand outcomesand outcomes
Believing in the ability to foment changeBelieving in the ability to foment change
in the front line among healthcarein the front line among healthcare
practitionerspractitioners
Developing mentorship and practiceDeveloping mentorship and practice
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Gain administrative andGain administrative and
organizational buyorganizational buy--in in orderin in orderto be able to change policyto be able to change policy
where it is identified andwhere it is identified and
neededneeded
Develop common terms andDevelop common terms andprocesses to make EBP one ofprocesses to make EBP one of
the global languages of nursingthe global languages of nursing
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A Global LanguageA Global Language
Nursing researchNursing research
Nursing educationNursing education
EvidenceEvidence--based practicebased practice
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Congratulations !Congratulations !
You are doing your shareYou are doing your sharetowards developing besttowards developing best
practices and evidencepractices and evidencebasedbased--practice.practice.
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Thank You for Your Attention!
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ReferencesReferences
1. Ackley B,1. Ackley B, LadwickLadwick G, Swan B, TuckerS. EvidenceG, Swan B, TuckerS. Evidence--BasedBased
Nursing Care guidelines, MedicalNursing Care guidelines, Medical-- Surgical Interventions.Surgical Interventions.
Mosby ElsevierSt Louis Missouri, 2008.Mosby ElsevierSt Louis Missouri, 2008.
2.2. FineoutFineout--OverholtOverholt E,E, MelnykMelnyk B. Building a culture of bestB. Building a culture of bestpractice. Nurse Leader. 3:6, Dec 2005, pp 26practice. Nurse Leader. 3:6, Dec 2005, pp 26--3030
3.3. PolitPolit, D.F and Beck, C.T. Nursing Research: Generating, D.F and Beck, C.T. Nursing Research: Generating
and Assessing Evidence forNursing Practice. Lippincottand Assessing Evidence forNursing Practice. Lippincott
Williams and Wilkins, USA. 2008Williams and Wilkins, USA. 2008