Transcript
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NURSING RESEARCH:
CHAPTER 2Translating research into Nursing Practice:
EVIDENCE-BASED NURSING
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DEFINITION OF EBP:
EBP- conscientious use of currentbest evidence in making clinical
decisions about patient care.
NURSES & OTHER HCP must be:1. Lifelong learners- who have the skills to
search for, understand & evaluate new
information about patient care.2. Capacity to be flexible
3. Adapt to change
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Evidence based decision making
should integrate best research
evidence with:1. Clinical expertise
2. Patient preferences & circumstances
3. Awareness of the clinical setting &
resource constraints
Key ingredient- effort to personalize
the evidence to fit a specific patients
needs & a particular clinical situation.
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RESEARCH UTILIZATION &
EBP RESEARCH UTILIZATION- narrower
Use of findings from a disciplined study or
set of studies in a practical application
that is unrelated to the original research. Emphasis- translating empirically
derived knowledge into real world
applications. Genesis of the process- research
based innovation/ new knowledge.
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EBP (evidence-based
practice) broader.; incorporates research
findings with other factors
RU- begins with how can i put this
innovation to good use in clinicalsetting.
EBP- clinical question ( what does the
evidence say is the best approach tosolving this problem)
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RU CONTINUUM
Start point- emergence of newknowledge & new ideas
One end- discrete clearly identifiableattempts to base specific actions on
research findings. 3 distinct types of RU:
1. INDIRECT RU- changes in nurses thinking.
2. DIRECT RU- direct use of findings in giving
patient care.3. PERSUASIVE RU- use of findings to
persuade others to make changes inpolicies or practices relevant to nursingcare.
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HISTORY OF RU IN NSG.
PRACTICE 1980s- several changes in nursing
education & research prompted by the
desire to develop a knowledge base
for nursing practice. Nursing education- courses on
research methods.
Nursing research- shift focus towardclinical nursing problems
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CONCERNS ABOUT THE LIMITED
USE OF RESEARCH FINDINGS:
1. Nurses are often unaware ofresearch findings
2. Nurses did not incorporate results
into their practice CURN PROJECT (Conduct and
Utilization of Research in Nursing)
A 5 year development project awarded toMichigan Nurses Association by the
Division of Nursing in 1970.
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MAJOR OBJECTIVE OF
CURN: Use of research findings in Nurses
daily practice by:
1. Disseminating current research findings
2. Facilitating organizational changesneeded to implement innovations
3. Encouraging collaborative clinical
research.
RU- organizational process
Nurses- essential to OP
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CONCLUSION:
RU was feasible only if:
1. research is relevant to practice
2. Results are broadly disseminated
1990s- call for RU began to besuperseded by the push for EBP.
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EBP IN NURSING
ADVOCATES CRITICS
1. Offers a solution to improving
health care quality in our
current cost-constrained
environment.RATIONAL APPROACH- best
possible care with most cost-
effective use of resources.
1. Worries that advantages f EBP
are exaggerated & that :
1. Individual clinical
judgments2. Patient inputs
Are devalued.
2. Provides an importantframework for self-directed lifelong
learning essential in era of rapid
clinical advances & information
explosion.
2. Insufficient attention is beingpaid to the role of qualitative
research.
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OVERVIEW OF THE EBP
MOVEMENT COCHRANE COLLABORATION- one of the
cornerstones of EBP; Founded in UK based on the work of Archie
Cochrane--- british epidemiologist
Early 1970s Drew attention to the dearth of solid evidence
about the effects of health care.
Called efforts to make research summaries ofclinical trials available to physicians & other HCP.
1993- development of Cochrane center inoxford
COCHRANE COLLABORATION-international collaboration
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AIM OF CC
Help providers make good decisions about healthcare by: Preparing;
Maintaining;
And disseminating
Systemic reviews of the effects of health careinterventions.
EVIDENCE BASED MEDICINE- developedfrom a group from Mcmaster Medical School inCanada
Clinical learning strategy David Sackett- pioneer of EBM; means
integrating individual clinical expertise with thebest available external evidence from systemicresearch.
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TYPES OF EVIDENCE &
EVIDENCE HIERARCHIES General agreement- findings from
rigorous research are paramount.
RANDOMIZED CLINICAL TRIAL
(RCT)- well suited for drawingconclusions about the effects of health
care intervention.
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Resistance to EBP by nurses
due to:1. Bias in ranking sources of evidence
primarily in terms of questions about
effective treatments.
2. Thought that evidence fromqualitative & non-RCT studies would
be ignored.
3. Accdg. To Closs & Cheater- derivedfrom viewing it as an unwelcome
extension of the positivist tradition.
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7 level hierarchy
Comes from the systematic reviews thatintegrate findings from multiple RCT studiesusing rigorous & methodical procedures.
The worth of the evidence can vary
considerably. Evidence hierarchy is not universally
appropriate.
Appropriate with regard to questions about
the effects of clinical interventions ortreatments.
Best evidence- refers generally to findingsthat are methodologically appropriate,
rigorous and clinically relevant for answering
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Other sources:
1. Benchmarking data
2. Chart review
3. Quality improvement and risk data
4. Clinical expertise
One benefit of EBP movement is that
when clinical questions arise for which
there is no satisfactory evidence, anew research agenda can result.
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BY: PETIT
NACARIO, SN
THANK YOU!
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