Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence...
Transcript of Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence...
![Page 1: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/1.jpg)
Evidence-Based Practice
Spiritual Care
Chaplaincy Residency Research Seminary Series
![Page 2: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/2.jpg)
Objectives
• Recognize the differences between quality improvement, evidence based practice, and research
• Describe the importance of evidence-based practice
2
![Page 3: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/3.jpg)
Attitudes of Chaplains towards Evidence Based Care
• Barriers to developing Evidence-based Chaplaincy Care
3
• Lack of existing evidence/research on chaplaincy practice
• Resistance to outcomes oriented chaplaincy
• Lack of research literacy/research training in CPE curriculum
• Time limitations
![Page 4: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/4.jpg)
Opportunities for Increasing EBC with Chaplains: • Availability of
measurement tool
• Spiritual Injury Scale
• Spiritual Well-being Scale
• Brief RCOPE
• Support of
Leadership/Administration in EBC
• Interdisciplinary training and collaboration
4
![Page 5: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/5.jpg)
Where does evidence come from?
Expert Opinion, Case
Studies
Quality Improvement
Quasi-Experimental
Designs Research
Randomized Controlled
Trials
![Page 6: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/6.jpg)
Why is the Evidence So Important?
Evidence-Based Practice is the use of the best available information to answer clinical questions in
order to improve practice.
![Page 7: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/7.jpg)
Quality Care Demands Evidence
• Professional, social and ethical necessity to ensure safe patient care.
• Doing things the way that they’ve always been done is no longer acceptable
![Page 8: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/8.jpg)
When Evidence Drives Clinical Practice…
…It results in:
• Improved patient outcomes
• Avoidance of unnecessary procedures
• Reduction of complications
We should feel empowered to change
practice using proven methods
![Page 9: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/9.jpg)
QI, EBP, and Research: What’s the difference?
QI, EBP and Research can be directly related - but are not one in the same
QI
• Small scale cycles of interventions
• Improves processes, outcomes, efficiencies
EBP
• Translation of scientific investigations and other knowledge into clinical practice
Research
• Scientific investigation of phenomena
![Page 10: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/10.jpg)
QI, EBP, Research: What’s the difference?
• QI asks “ How are we doing?”
• EBP asks “What is the evidence for best practice?”
• Research asks “What…”
![Page 11: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/11.jpg)
Steps of Quality Improvement
• Plan
• Do
• Check
• Act
11
It’s a rapid cycle to improve care
![Page 12: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/12.jpg)
Examples of Quality Improvement
• Patient Satisfaction
• Monitoring Purposeful Rounding
• Falls
• Use of bed alarms when patient at high risk
• Heart Failure Readmission
• Daily Weight Audits
12
![Page 13: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/13.jpg)
Examples of Quality Improvement
• Patient Satisfaction
• Daily Chaplain rounding on ER Waiting room
• Readmission Reduction Project
• Increased Chaplain visits with high risk patients
• Renal Patient Anxiety
• Use of integrative interventions by chaplains with ESRD patients
13
![Page 14: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/14.jpg)
Significance of Quality Improvement
• Ongoing process
• Allows us to make changes
• Focuses on making things better for our patients
• Provides data on how things are working
• Generates questions about how to improve care
14
![Page 15: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/15.jpg)
Research Process
• Problem Statement
• Research Question or Hypothesis
• Review of the Literature
• Conceptual or Theoretical Framework
• Design and Method
• Sample, Measurement Tool
• Data Analysis and Interpretation
• Research Dissemination and Utilization
15
![Page 16: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/16.jpg)
Research Requires…
• Protection of Human Subjects
• Approval by Nursing Scientific Advisory Council
• Review and Approval by the Institutional Review Board (IRB)
• Formal Application, Approval and Renewal
• Informed Consent or Waiver
![Page 17: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/17.jpg)
Examples of Research
• Heart Failure Readmissions
• Predictors of Heart Failure Readmissions
• Surgery Room Temperatures
• Effect of Surgery Room Temperature on Core Temperature and Surgical Site Infection Rates
• Ventilator Associated Pneumonia
• Predictors in Trauma Patients
• Falls
• Sensors for Seniors
![Page 18: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/18.jpg)
Examples of Research
• Relationship between Chaplain Visits and Patient Satisfaction
• The Impact of Daily Visits from Chaplains on Patients with COPD
• Support of Cancer Patient’s Spiritual Needs and Medical Costs at the End of Life
18
![Page 19: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/19.jpg)
Where does evidence come from?
![Page 20: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/20.jpg)
The Journey Is Made Up of Many Steps
1. Ask the burning clinical question.
2. Collect the most relevant and best evidence.
3. Critically appraise the evidence.
4. Integrate all evidence with one’s clinical expertise, patient preferences and values in making a practice decision or change.
5. Evaluate the practice decision or change.
![Page 21: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/21.jpg)
Writing Your Burning Question: Using PICO Format
P = Patient Population ASK Who?
I = Intervention What is the therapy or intervention?
C = Comparison Do you want to compare a current practice vs. a new practice?
O = Outcome What is the outcome you are questioning? What do you think might happen?
![Page 22: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/22.jpg)
PICO
Let’s look at a few questions and see if we can figure out the PICO format…
![Page 23: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/23.jpg)
PICO
What are best practice strategies for spiritual support and intervention
impacting LOS and readmission in Chronic Obstructive Pulmonary Disease
(COPD) inpatients?
![Page 24: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/24.jpg)
PICO
What chaplaincy interventions will lead to improved patient’s satisfaction during their acute hospital visit?
![Page 25: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/25.jpg)
Activity Time Write a PICO Question
![Page 26: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/26.jpg)
PICO Format
P = Patient Population ASK Who?
I = Intervention What is the therapy or intervention?
C = Comparison Do you want to compare a current practice vs. a new practice?
O = Outcome What is the outcome you are questioning? What do you think might happen?
![Page 27: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/27.jpg)
Step by Step Through the Process
Step 1: Identify Triggers
QI data, clinician observations trigger a “Burning Question”
Step 2: Form a Team
Step 3: Review the Evidence
Find the evidence in research studies or Clinical Practice Guidelines
http://en.wikipedia.org/wiki/File:RumbaBasicBoxStep.JPG
![Page 28: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/28.jpg)
Step by Step Through the Process
Step 4: Is there Sufficient Evidence to Change Practice?
If Yes:
• Select Outcomes
• Collect baseline data
• Implement
http://en.wikipedia.org/wiki/File:RumbaBasicBoxStep.JPG
![Page 29: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/29.jpg)
Step by Step Through the Process
• Step 5: Evaluate the Practice Change
• Is it working?
• What are the outcomes?
• Step 6: Share the Information
• Let others know of your findings and expand the scope
http://en.wikipedia.org/wiki/File:RumbaBasicBoxStep.JPG
![Page 30: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/30.jpg)
Step by Step Through the Process
Step 4: Is there Sufficient Evidence to Change Practice?
• What if the answer was NO?
Ask “Should We Conduct a Research Study?”
![Page 31: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/31.jpg)
Activity Time Is it QI, EBP or Research?
![Page 32: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/32.jpg)
Is it QI, EBP or Research?
Spiritual Care response to critical situations in the Emergency Department
32
![Page 33: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/33.jpg)
Quality Improvement
Spiritual Care response to critical situations in the Emergency Department
Usually will see a rate reported which can be trended
over time for making improvements
33
![Page 34: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/34.jpg)
Is it QI, EBP or Research?
What variables impact the renal patient’s quality of life?
34
![Page 35: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/35.jpg)
Research
What variables impact the renal patient’s quality of life?
Investigative in nature
Attempting to answer an unknown question
35
![Page 36: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/36.jpg)
Is it QI, EBP or Research?
How does chaplaincy visitation impact the cancer patient’s feelings of support when
making end-of-life decisions?
36
![Page 37: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/37.jpg)
EBP
How does chaplaincy visitation impact the cancer patient’s feelings of support when
making end-of-life decisions?
Have knowledge that intervention is effective
Implementation of intervention with monitoring of effectiveness
37
![Page 38: Evidence-Based Practice Spiritual Care · 2017-11-03 · Attitudes of Chaplains towards Evidence Based Care •Barriers to developing Evidence-based Chaplaincy Care 3 •Lack of existing](https://reader033.fdocuments.us/reader033/viewer/2022041819/5e5cd604b2822b576c138103/html5/thumbnails/38.jpg)
In Review: The Steps of EBP…
1. Ask the burning clinical question.
2. Collect the most relevant and best evidence.
3. Critically appraise the evidence.
4. Integrate all evidence with one’s clinical expertise, patient preferences and values in making a practice decision or change.
5. Evaluate the practice decision or change.