Ch. 6 4205Ch. 6 4205Evidence-Based Practice, Evidence-Based Practice, Advocacy, & Bill of RightsAdvocacy, & Bill of Rights

Presented byPresented by

Pamela Roberts, MSN RNPamela Roberts, MSN RN

EBP DefinedEBP Defined

• The process of providing clinically competent care, supported by the best scientific evidence available, such as outcomes research and expert advisers.

EBP CharacteristicsEBP Characteristics

• Framework for clinical practiceFramework for clinical practice• Considers internal and external Considers internal and external

influences on practiceinfluences on practice• Encourages critical thinking Encourages critical thinking • Judicious use of evidence for Judicious use of evidence for

broad-based thinkingbroad-based thinking• Numerous studiesNumerous studies cited cited

Critical Thinking and EBP Critical Thinking and EBP

• Translating theory to practiceTranslating theory to practice

• Posing answerable questionsPosing answerable questions

• Broad-based critical thinking Broad-based critical thinking

• Analysis, synthesis, interpreting, and Analysis, synthesis, interpreting, and drawing conclusionsdrawing conclusions

Using Evidence-Based PracticeUsing Evidence-Based Practice

• Asking the right questionsAsking the right questions– Why was the research done, what setting was Why was the research done, what setting was

used? used?

• Applying innovation to practiceApplying innovation to practice– Innovation is originality Innovation is originality

• Evaluating the effect of predetermined Evaluating the effect of predetermined outcomeoutcome

• Was success achieved?Was success achieved?• How were the results disseminated? How were the results disseminated?

– Disseminated – dispersed, distributedDisseminated – dispersed, distributed

Why are we using Why are we using Evidence-Based Practice?Evidence-Based Practice?

• Increased rate of information distributionIncreased rate of information distribution– You can google anything you want on the internetYou can google anything you want on the internet

• NontraditionalNontraditional– EBP moves away from tradition. “This is the way we’ve EBP moves away from tradition. “This is the way we’ve

always done it.” Well, maybe that way has been wrong always done it.” Well, maybe that way has been wrong all these yearsall these years

• Decision making based on comprehensive body of Decision making based on comprehensive body of knowledgeknowledge

• Patient care improvementPatient care improvement– Implementing the Fallen Star program has decreased the Implementing the Fallen Star program has decreased the

rate of falls rate of falls • Conscientious use of current best evidence in Conscientious use of current best evidence in

making decisions about nursing caremaking decisions about nursing care– By educating clients based on what’s currentBy educating clients based on what’s current

Why use EBP?Why use EBP?

• Efficacy Efficacy – The ability to reach the desired resultThe ability to reach the desired result

• Efficiency Efficiency – Desired result timely with minimal effortDesired result timely with minimal effort

• EffectivenessEffectiveness– The ability to produce the desired resultThe ability to produce the desired result

The Nurses Role in EBPThe Nurses Role in EBP

• Active in the evolution of EBP in the Active in the evolution of EBP in the organizationorganization

• Promote ways to systemize evidence Promote ways to systemize evidence at the bedsideat the bedside

• Remained enlightened about the use Remained enlightened about the use of EBPof EBP– We do CEU’s, take classes, read articles and We do CEU’s, take classes, read articles and

what notwhat not

How do we use EBP?How do we use EBP?

• Translating evidence into practiceTranslating evidence into practice• PET PET • P – Practice questionP – Practice question

– PICOPICO• E - EvidenceE - Evidence• T – TranslationT – Translation

– Are the changes in practice feasible? If so, Are the changes in practice feasible? If so, actions are taken to put the change into actions are taken to put the change into practice, this is when a plan is developedpractice, this is when a plan is developed

PICO for practice questionPICO for practice question

• Patient, population, or problemPatient, population, or problem

• InterventionIntervention

• Comparison with other treatmentsComparison with other treatments

• OutcomesOutcomes

Searching for EvidenceSearching for Evidence

• PubMed (MEDLINE)PubMed (MEDLINE)

• CINAHL (The Cumulative Index to CINAHL (The Cumulative Index to Nursing and Allied Health Literature)Nursing and Allied Health Literature)

• The Cochrane LibraryThe Cochrane Library

CINAHL CINAHL

• EBSCOEBSCO• 2700 nursing, allied health, 2700 nursing, allied health,

biomedical, and consumer health biomedical, and consumer health journalsjournals

• ANA and NLN journalsANA and NLN journals• Various depths of coverageVarious depths of coverage• References dissertations, books, References dissertations, books,

standards of practice, legal cases, standards of practice, legal cases, critical paths…etc.critical paths…etc.

MEDLINE (PubMed)MEDLINE (PubMed)

• Produced by the National Library of Produced by the National Library of MedicineMedicine

• Premier source for biomedical Premier source for biomedical literatureliterature

• 5000 journal with 300 nursing specific5000 journal with 300 nursing specific

• Evidence-based filters in clinical Evidence-based filters in clinical queriesqueries

The Cochrane LibraryThe Cochrane Library

• A collection of seven databasesA collection of seven databases• Contains evidence summaries and Contains evidence summaries and

synthesizes reviewssynthesizes reviews• Reviews are based on the best Reviews are based on the best

available information in health-care available information in health-care interventionsinterventions

• Structured to minimize biasStructured to minimize bias• Good evidence-based sourceGood evidence-based source

Search tipsSearch tips

• Use controlled vocabulary for Use controlled vocabulary for keywords and phraseskeywords and phrases

• Use AND, OR, and NOTUse AND, OR, and NOT

Ex: Clinical competence AND Ex: Clinical competence AND

Intravenous therapyIntravenous therapy

More search tipsMore search tips

• Think of alternative spellings such as Think of alternative spellings such as tumour, behaviour, gynaecology tumour, behaviour, gynaecology American vs. British)American vs. British)

• Use limits such as age, date of Use limits such as age, date of publication, and languagepublication, and language

Reviewing the searchReviewing the search

• Who wrote it?Who wrote it?• Who Who

sponsored the sponsored the research?research?

• When was it When was it published?published?

• Has it been Has it been reviewed? If so reviewed? If so by whom?by whom?

• Why was it Why was it published?published?

• Has it been Has it been cited?cited?

AdvocacyAdvocacy

AdvocacyAdvocacy

• Advocacy is the foundation and essence Advocacy is the foundation and essence of nursing and nurses have a of nursing and nurses have a responsibility to promote human responsibility to promote human advocacyadvocacy

• Advocacy is helping people grow and Advocacy is helping people grow and self actualizeself actualize

• Nurses must advocate for themselves, Nurses must advocate for themselves, clients, family members, subordinates, clients, family members, subordinates, and their professionand their profession

Goals of the AdvocateGoals of the Advocate

1.1. InformInform

2.2. Autonomy (enhance this)Autonomy (enhance this)

3.3. RespectRespect1.1. To respect the decisions of others, even if To respect the decisions of others, even if

you don’t agree with it. you don’t agree with it.

How Nurses Can Act as How Nurses Can Act as AdvocatesAdvocates

• Helping others make informed Helping others make informed decisions decisions

• Cultural and ethnic diversity and Cultural and ethnic diversity and sensitivitysensitivity

• Directly intervening on behalf of Directly intervening on behalf of others others

• Continuing care of DNR clientContinuing care of DNR client

Advocating for ClientsAdvocating for Clients

• Client’s needs and goals are paramountClient’s needs and goals are paramount• Advocate the distribution of resourcesAdvocate the distribution of resources• Leadership must be willing to take risksLeadership must be willing to take risks

– Time out procedures (right pt, right site, right Time out procedures (right pt, right site, right surgery)surgery)

– DNRsDNRs– Ethics Committee for StaffEthics Committee for Staff

• Must be willing to accept conflictMust be willing to accept conflict

Bills of RightsBills of Rights

• Passed by the National League for Passed by the National League for Nurses and American Hospital Nurses and American Hospital Association in the 1960’sAssociation in the 1960’s

• Privacy law primarily protects the Privacy law primarily protects the rights of the patrights of the patientient

• Guide professional practiceGuide professional practice

Subordinate AdvocacySubordinate Advocacy

What is it? What is it? • The manager helps subordinates The manager helps subordinates

resolve ethical problems and live with resolve ethical problems and live with the solutions at the unit levelthe solutions at the unit level

• Like if you have a problem on E5, you Like if you have a problem on E5, you should try to solve the problem and should try to solve the problem and live with the consequences on E5live with the consequences on E5

PromotingPromotingSubordinate AdvocacySubordinate Advocacy

1.1. Staff needs, (listen to)Staff needs, (listen to)

2.2. Empower staffEmpower staff

3.3. Promote autonomy (for the nurses)Promote autonomy (for the nurses)

4.4. Face challenges (and solve Face challenges (and solve problems problems together)together)

5.5. ““Go to bat” for the staff (when Go to bat” for the staff (when needed)needed)

Workplace AdvocacyWorkplace Advocacy

• Manager insures safe, growth Manager insures safe, growth oriented environmentoriented environment

• Occupational health and safety must Occupational health and safety must be assuredbe assured

Internal vs. External Whistle-BlowingInternal vs. External Whistle-Blowing

• Internal whistle-blowing Internal whistle-blowing – Within the organization, reporting up the chain of Within the organization, reporting up the chain of

commandcommand

• External whistle-blowing External whistle-blowing – Reporting outside the organization, such as the media Reporting outside the organization, such as the media

or an elected official or an elected official

• Public awareness has increased Public awareness has increased – People are more likely to complain when they feel People are more likely to complain when they feel

wrongedwronged

• Nurses must act individually or collectivelyNurses must act individually or collectively

Professional AdvocacyProfessional Advocacy

• Leader-managers also must be Leader-managers also must be advocates for the nursing professionadvocates for the nursing profession

• Professional duty is assumed by entering Professional duty is assumed by entering the profession of nursingthe profession of nursing

• Speak out on consumer issues, Speak out on consumer issues, continuing and expanding attempts to continuing and expanding attempts to influence legislation, and increasing influence legislation, and increasing membership on governmental health membership on governmental health policy-making boards and councilspolicy-making boards and councils

• Speak out on staffing issuesSpeak out on staffing issues