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![Page 1: Created by Terran Mathers, PhD, RN There is no conflict of interest in the creation of this education program.](https://reader036.fdocuments.us/reader036/viewer/2022062408/56649e905503460f94b94b25/html5/thumbnails/1.jpg)
Created by Terran Mathers, PhD, RN
There is no conflict of interest in the creation of this education program.
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Objectives Explain the importance of Evidence Based
Practice (EBP) in nephrology nursing. List the steps of EBP. Identify four internet resources/databases
where previous research or guidelines may be located.
Recognize potential barriers to EBP within an organization so that strategies may be planned to overcome them.
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Introduction
Historical Background of EBP 1837: Pierre Louis 1970’s: Cochran Collaboration 1972: Briggs Report (DHSS) 2004: ANNA Nursing Research
Committee Survey
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What isEvidence-Based Research?
EBR defined: Clinically relevant research based on medical science; this research is patient-centered.
Research Utilization: Use of the knowledge found from research, usually based on a single study.
Cochrane Center (meta-analysis reviews)
(Melnyk & Fineout-Overholt, 2005; Sackett et al, 2000)
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What IsEvidence-Based Practice?
Patient Preferences& Values
Clinical Experience And Expertise
Assessment
Search and Appraisal Of Evidence
Evidence Based Practice**
Clinical Decision Making
Sackett et al, 2000; Melnyk & Fineout-Overholt, 2005
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Why Evidence-Based Practice?
Quality Care
Positive Patient
Outcomes
EnhanceProfessionalEnvironment
Cost Containment
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Centers forEvidence-Based Practice
Blue Cross and Blue Shield Association Duke University ECRI John Hopkins University McMaster University Oregon Health & Science University RTI International – University of North Carolina Southern California Stanford University – University of California, San
Francisco Tufts University – New England Medical Center University of Alberta, Edmonton, Alberta, Canada University of Minnesota, Minneapolis, MN University of Ottawa, Ottawa, Canada
www.ahrq.gov/clinic/epc/epcenters.htm
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Steps ofEvidence-Based Practice
Step 1:Step 1: Step 1:Step 1:
Melnyk & Fineout-Overholt, 2005
What is theclinical question?
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P = Patient Population / Disorder
I = Intervention or Interest Area
C= Comparison
O= Outcome
Ask the clinical questionin the “PICO” format
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PICO
P = Elderly nephrology patients
I = Psychosocial issues
C = Effect on compliance
O = Patient will be able to adapt tochanges related to diagnosisand treatment
Example:
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Steps ofEvidenced-Based Practice
Step 2: Step 2: Step 2: Step 2: Find the best evidence toanswer the question
Systematic review of the literature Meta-analysis or clinical practice
guidelines Rigorous process Preset criteria Overcomes bias Valid / credible results
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Guideline Databases
National Guideline Clearinghouse (NGC)http://www.guideline.gov
National Institute for Clinical Excellence (NICE)http://www.nice.org.uk/catcg2.asp?c=20034
National Kidney Foundation K/DOQI Guidelines:http://www.kidney.org/professionals/doqi/guidelineindex.cfm
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Steps ofEvidence-Based Practice
Step 3:Step 3:Step 3:Step 3: Appraise the evidence
1. What were the results of the study?2. Are the results valid?3. Will the results facilitate patient care?
Critical Questions to Ask:
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Step 4: Step 4: Step 4: Step 4:
Steps ofEvidence-Based Practice
Integrate the evidence, patient assessment information, clinical expertise, patient preferences and values.
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Steps ofEvidence-Based Practice
Evaluate the change in the clinical area.
Step 5: Step 5: Step 5: Step 5:
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Implementing EBP:The Barriers
Translating the meaning and relevance of EBP
Knowledge deficit Being overwhelmed by the
evidence The need for dedicated time Negative views about research Organizational constraints
VanBuskirk, 2005; Melnyk & Fineout-Overholt, 2005
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Facilitation of EBPPromote Acceptance
Access with surveys; focus groups
Identify baseline knowledge Identify real case scenarios Analyze the culture of the
environment
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Facilitation of EBPCorrect Misperceptions
Have key leaders attend nursing centers
Teach the basics of EBP (Online Tutorials)
Expose to useful databases
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EBP Online Tutorials Evidence-Based Clinical Practice Tutorial
http://www.urmc.rochester.edu/hslt/miner/digital_library/evidence_based_resources.cfm
Texas Health Science Center: Academic Center for Evidence-Based Nursinghttp://www.acestar.uthscsa.edu/
Evidence-Based Nursinghttp://www.hsl.unc.edu/Services/Tutorials/EBN/index.htm
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Facilitation of EBPQuestion Clinical Practices
Prioritize problems Utilize clinical practice
guidelines and research Promote a culture of
organizational acceptance for EBP
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References Honor Society of Nursing, Sigma Theta Tau
International (2005). Honor Society of Nursing, Sigma Theta Tau International: Position statement on evidence-based nursing. Indianapolis: Sigma Theta Tau International.
Cowan, P. (2004). Advancing evidence-based practice through meta-analysis. Nephrology Nursing Journal, 31(3), 343-345.
Gagan, M., & Hewitt-Taylor, J. (2004). The issues for nurses involved in implementing evidence in practice. British Journal of Nursing, 13(20), 1216-1220.
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References Gillis, A., & Jackson, W. (2002). Research for nurses:
Methods and interpretation. Philadelphia: F.A. Davis.
Larrabee, J. (2004). Advancing quality improvement through using the best evidence to change practice. Journal of Nursing Care Quality, 19(1). 10-14.
Malloch, K., & Porter-O’Grady, T. (2006). Introduction to evidence-based practice in nursing and health care. Boston: Jones and Bartlett.
Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott, Williams, & Wilkins.
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References Pape, T. (2003). Evidence-based nursing practice:
To infinity and beyond. The Journal of Continuing Education in Nursing, 34(4), 154-164.
Paramonczyk, A. (2005). Barriers to implementing research in clinical practice. The Canadian Nurse, 101(3), 12-18.
Portney, L. (2004). Evidence-based practice and clinical decision making: It’s not just the research course anymore. Journal of Physical Therapy Education, 18(3), 46-51.
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References Tod, A., Palfreyman, S., & Burke, L. (2004). Evidence-
based practice is a time of opportunity for nursing. British Journal of Nursing, 13(4), 211-216.
VanBuskirk, S. (2005). The value of evidence-based practice in nephrology nursing. Nephrology Nursing Journal, 32(2), 134-135.
Sackett, D. L., Straus, S. E., Richardson, W. S. et al. (2000). Evidence-based medicine: how to practice and teach EBM. London: Churchill, Livingstone.