5. Evidence Based Practice What is EBP? Most commonly cited definition is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Sackett, et al.
6. Evidence Based Practice The EBP Cycle Identify/define the problem Formulate a focused clinical question Identify the appropriate resources Search for valid and relevant information Critically appraise/review this information Implement in practice Clinical audit
7. Formulate a Question Ask a focused, answerable question: NOT Are febrile seizures in babies dangerous? INSTEAD Does a febrile seizure in a 6-month old infant increase the likelihood that s/he will develop epilepsy?
8. Formulate a Question What is the effect of [the Intervention or predictor variable] On [the Outcome or given characteristic] For [the group or patient characteristics]
9. Formulate a Question Use the PICO framework: P – patient/problem I – intervention C – comparison O – outcome
10. P Population Disease or condition Stage of disease Gender Age group Socioeconomic group Healthcare setting
11. I Intervention What is being done? Drug therapy, surgery, radiotherapy Level of intervention: frequency, dosage Stage of intervention: prevention, secondary prevention; advanced Delivery of intervention: self-medication, etc.
13. O Outcome What happened to P as a result of I? Patient oriented: quality of life; reduction in severity of symptoms; adverse effects Provider oriented: cost-effectiveness
14. Medical vs. Nursing Concerns Medical Abnormalities of joint ( Xrays, tests) Medication Surgical intervention Nursing Prevention ADLs Pain Sleep problems
17. What is Evidence? Hierarchy of research evidence: Systematic reviews Randomized controlled trials Non-randomized controlled trials e.g. cohort studies, case-control studies Consensus statements from respected authorities Individual/expert knowledge Anecdotal evidence
18. Where is the Evidence? Traditional bibliographic databases MEDLINE, CINAHL Point of care/clinical resources DynaMed, Essential Evidence Plus
19. Finding the Evidence Use functions of the database to narrow searches: Subject Headings Limiters Filters
20. Subject Headings Specific words or phrases selected from a controlled vocabulary that describe a work MEDLINE = MeSH CINAHL = CINAHL Headings
21. Limiters Parameters for your search MEDLINE limiters include: Age group Publication type Language Dates
22. Research Filters Research filters are pre-designed search strategies Clinical Queries PubMed page: http://www.ncbi.nlm.nih.gov/pubmed/clinical Limiter in MEDLINE (EBSCOhost) ((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical trials[MeSH Terms] OR clinical trial[Publication Type] OR random*[Title/Abstract] OR random allocation[MeSH Terms] OR therapeutic use[MeSH Subheading])
23. Searching for the Evidence Search Example: What should the NP do to prevent pressure ulcers in the elderly?
24. Searching for the Evidence Forming a Question What is the effect of Nursing Care/Intervention –Intervention is the predictor variable On – Preventing pressure ulcers – this is the given characteristic or outcome For – the elderly – the specific group of patients or population characteristic
26. Searching for the Evidence Qualitative Research MEDLINE – Qualitative filter under Clinical Queries CINAHL – Heading for “Qualitative Studies”
27. Searching for the Evidence Search Example Mary is a nurse midwife practicing in an large city in the Midwest. She has noticed an increase in the number of pregnant teens who are addicted to heroin. The drug treatment facilities near by will not take pregnant teens. Mary wants to know what she should include in her prenatal plan for these teens?
28. Searching for the Evidence Search Example Mark is a nurse practitioner in a pain management clinic. He is looking for alternative ways to treat chronic pain in adjunct with medication and injection. He wants to know what alternative therapies are available for patients with chronic back pain?
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