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Evidence Based Practice Models

Oct 24, 2014

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EVIDENCE BASED PRACTICE MODELSBY Click to edit Master subtitle style LIDIYA

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definition: EBP

EBP is a conscientious use of current best evidence in making clinical decisions about patient care. It is a problem solving approach to clinical practice that integrates a systematic search for and critical appraisal of the most relevant evidence to answer a burning clinical question; ones own clinical expertise; and patient preferences 5/27/12

Knowledge sources of EBP

BEST RESEARCH EVIDENCE ONES OWN CLINICAL EXPERTICE PATIENTS VALUES , PREFERENCES CLINICAL SETTING ASSESSMENT & HISTORY

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BACK GROUND OF EBP

[3] The EBP movement was founded by Professor Archibald Leman Cochrane, CBE, FRCP, FFCM (19091988) in 1972. Dr. Cochran, a British epidemiologist, identified a gap between current practices and evidence-based guidelines One of the cornerstones of the EBP movement is the Cochrane collaboration. Cochrane published an 5/27/12

BACK GROUND OF EBP CONTD..

The aim of the collaboration is to help providers make good decisions about health care by preparing, maintaining, and disseminating systematic reviews of the effect of health care interventions

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EVIDENCE-BASED MEDICINE:

Evidence-based medicine is the conscientious, explicit and judicious used of current best evidence in making decisions about the care of individual patients

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DEFINITION:EBPN

The society defines EBN as an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities who are served. This assumes that optimal nursing care is provided when nurses and health care decision-makers have access to a synthesis of the latest research, a consensus of expert opinion, and are thus able to exercise their judgment as they 5/27/12 plan and provide care that takes into

RESEARCH UTILISATION AND EBP:

it is the use of findings from a disciplined study or set of studies in a practical application that is unrelated to the original research.

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EBP Vs RU

Complex process Less complex NURSING EVIDENCE

process RESEARCH BASED NURSING Newer conceptsUTILISATION developed Older conceptsapproximately 10 used in the years ago.

1970s toearly . 1990s

Includes patients PATIENTS preferences PREFERENCES Includes a system NOT INCLUDED to grade or level

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No defined

EVIDENCE HIERARCHIES

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STEPS IN EBP:

ASK: identify the research question. ACQUIRE: search the literature for preappraised evidence or research. Secure the best that is available APPRAISE: conduct the critical appraisal of the literature and studies.evaluate the validity and determine the applicability in practice.5/27/12

STEPS IN EBP:CONTD

APPLY: institute recommendations and findings and apply them to nursing practice. ASSESS: evaluate the application of the findings, outcomes and relevance to nursing practice

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TYPES OF EBP LITERATURE:

The key component of EBP is a systematic review. A systematic review is a summary of evidence typically conducted by an expert or a panel of experts in a particular topic, that uses rigorous process (to minimise bias) for identifying, appraising and synthesizing studies to answer a specific clinical question and draw conclusions about the data 5/27/12 generated. (Melnyk & fineout

TYPES OF EBP LITERATURE:

SYSTEMATIC REVIEW; DEFINITION: it is the consolidation of research evidence that incorporate a critical assessment and evaluation of the research(not simply a summary) and addresses a focused clinical question using methods designed to reduce the likelihood of bias.5/27/12

Types of S.R

The 3 types of S.R is important in EBPN. Integrative research review Meta- analysis Meta synthesis

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SYSTEMATIC REVIEW: TYPES1. INTEGRATIVE RESEARCH REVIEW:

Panels or group of experts conduct integrative reviews and begin by identifying the topic or question. The result is a narrative summary of past research in which the reviewers extract findings from original studies and use analytical reasoning to produce conclusions about the findings of a body of 5/27/12

SYSTEMATIC REVIEW: TYPES CONTD

META-ANALYSIS: This is a research technique in which entire studies on a particular topic or question (PICO) are appraised to determine the state of knowledge on that topic. a statistical technique for quantitatively combining the results of multiple studies that measure the 5/27/12 same outcome, into a single pooled

SYSTEMATIC REVIEW: TYPES CONTD..

META-SYNTHESIS: Meta synthesis is a systematic review in which findings from several or many qualitative studies examining the issue are merged to produce generalization and theories. This review does not use statistical methods to combine the findings.5/27/12

EBP MODELS:

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A number of models are used to describe EBP in nursing. A model provides a description of a process and includes the impact of EBP on practice. These models offer framework for understanding the EBP process and for designing and implementing an EBP project in a practice setting.

THE IOWA MODEL OF EVIDENCE BASED PRACTICE (TO PROMOTE QUALITY OF CARE):

This model was created by the university of IOWA medical centre nursing administration as a method to support EBP to improve quality of care.

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THE IOWA MODEL OF EVIDENCE BASED PRACTICE (TO PROMOTE QUALITY OF CARE):CONTD

The model includes these questions.

What are the triggers for EBP? What will make an organisation include patient focused care? How does the work force get educated on EBP to implement it? Critical thinking, staff empowerment and 5/27/12 professional development are

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The ARCC model was originally conceptualized by Bernadette Melnyk in 1999 as a part of a research strategic planning initiative in an effort to more fully integrate research and clinical practice as well as to advance EBP within an academic medical centre and progressive health care community. 5/27/12

Advancing research and clinical practice through close collaboration (ARCC) model

ARCC MODEL CONTD

A central concept in an ARCC model is that of an EBP mentor, an advanced practice nurse with in depth EBP and clinical knowledge and skills who provides mentorship in EBP and facilitates improvement in clinical care and patient outcomes through EBP implementation and and outcomes management projects.5/27/12

3.Integrating EvaluationInformed and EvidenceBased Practice: The PRAISES Model a framework forintegrating evaluation-informed and evidence-based practice (Fischer, 1986). We understand that at fi rst glance this framework can be somewhat intimidating, as it may look more like a General Motors wiring diagram than a fl owchart for 5/27/12 use by

the PRAISES Model is an attempt to integrate, structure, and systematize the process of evidencebased practice, while highlighting the interrelationships among interventive practices and evaluation in the overall process

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Characteristics of PRAISES model

1. Empirically-based. To the extent possible, this framework attempts to enhance development of the empirical base for evidence-based practice. the empirical base of evidence-based practice has two meanings. The first is the use of the results of classical evaluation research to guide selection of interventions that have 5/27/12

Characteristics of PRAISES model

2. Integrative. The PRAISES Model fl owchart attempts to integrate all practice and evaluation activities. This is the basis for our earlier assertions that good practice incorporates good evaluation. There are no distinctions made between evaluation and practice in the flowchart. Only the different activities required at each step are described.5/27/12

Characteristics of PRAISES model

Eclecticism

refers to the use of clear, precise, systematic criteria to select knowledge

this framework is intended to apply whatever the theoretical orientation, methods, or approach of the user are.

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Characteristics of PRAISES model

4. Systematic. This framework is an attempt to systematize practice. This means clearly identifying the various phases of practice and organizing them in a step-by-step sequence 5. Accountable. This framework is an attempt to add to our professional accountability as practitioners. It brings the entire process of practice out into the open for scrutiny by 5/27/12

Characteristics of PRAISES model

6. Way of Thinking. The PRAISES Model is intended, perhaps more than anything else, to illustrate and enhance a way of thinking about practice: systematic,data- based, outcomeoriented, structured, fl exible depending on the needs of the client, evidence-based, informed by ongoing evaluation, and up- to-date 5/27/12

Phases of PRAISES model

PHASE I. PRe-Intervention 1. Evaluate the context 2. Process the referral 3. Initiate contact 4. Structure

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Phases of PRAISES model

PHASE II. Assessment 5. Select problem 6. Conduct assessment 7. Collect baseline information 8. Establish goals

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Phases of PRAISES model

PHASE III. Intervention 9. Develop intervention plan 10. Develop evaluation plan 11. Negotiate contract 12. Prepare for intervention 13. Implement intervention5/27/12

Phases of PRAISES model

PHASE IV. Systematic Evaluation 14. Monitor and evaluate results 15. Assess and overcome barriers 16. Evaluate goal achievement

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Phases of PRAISE