Distinguishing Tradition-Based and Evidence-Based Care Eleanor S. McConnell, PhD, RN, GCNS-BC Duke University School of Nursing Durham Veterans Affairs Medical Center Geriatric Research, Education and Clinical Center November 2013 tp://coegne.nursing.duke.edu
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Distinguishing Tradition-Based and Evidence-Based Care Eleanor S. McConnell, PhD, RN, GCNS-BC Duke University School of Nursing Durham Veterans Affairs.
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Distinguishing Tradition-Based and Evidence-Based Care
Eleanor S. McConnell, PhD, RN, GCNS-BCDuke University School of NursingDurham Veterans Affairs Medical CenterGeriatric Research, Education and Clinical CenterNovember 2013
http://coegne.nursing.duke.edu
Think of a situation when….
You were afraid you were going to do more harm than good…..Examples…•Should I give a 45 year old woman with abdominal pain morphine in the ED?•Should I give Herpes Zoster vaccine to someone who has already had shingles?•Should I use a falls alarm to prevent falls….•What is your example?
Evidence-based Practice Defined“..the integration of clinical expertise, patient values,
and the best evidence into the decision making process for patient care. “• Clinical expertise: the clinician's accumulated experience,
education and clinical skills. • The patient brings to the encounter his or her own
personal and unique concerns, expectations, and values. • Best evidence is usually found in clinically relevant
research that has been conducted using sound methodology. (Sackett, 2002)
EBP – Begins and Ends with a Patient
Case 1
Mrs. A is a 45 y.o. woman recently admitted to your Emergency Department with acute abdominal pain.
• One member of the treatment team wishes to give her morphine to relieve her pain
• A second member of the treatment team believes that morphine is contraindicated, because it will mask the signs needed to make an accurate diagnosis
• What would you do?
Cycle of Evidence-based Practice
To learn more, go to these 2 sites: • http://www.hsl.unc.edu/services/tutorials/ebm/welcome.htm
OR
• http://www.cebm.utoronto.ca/practise/
Ask Pertinent question in area of uncertainty @ practice
Acquire Best available scientific evidenceComputers make this possible in “real time”
Appraise
Not all evidence is created equal
Apply Based on clinical experience, patient preference
Cycle of Evidence-based Practice
Ask In a 45 y.o. woman with acute abdominal pain will MS04 compared to no Rx result in inaccurate dx ?
Acquire Medline Search:Abdominal pain OR Acute abdomen AND adult AND diagnosis AND RCT search filter
Appraise
9 RCTs – latest, 20061 review paper (2003)
Apply VAS improved 31 mm MSO4 v. placebo
Difference in clinically important diagnostic outcome was 1%
(95% confidence interval [CI] -11% to 12%).
Search comes up with good answer because of “well-built” question &
EBM search filters
Notice that most articles have abstracts that are available for free – in real time
Case 2
Mrs. J is an 82 y.o. woman who comes to your clinic for her annual evaluation.
• She tells you she has seen recent advertisements on TV for medicines that can prevent dementia.
• Her mother died with dementia 20 years ago, and she does not want to be a burden on her family.
• What would you recommend?
Cycle of Evidence- based Practice
Ask Among healthy 80 year old women what preventive approaches to dementia are effective?