This is a MAN_MSN requirement of Roxanne Ebo. for the subject MSNG503 (Prof. Faye Felicilda.

1. Process to Practice
Roxanne L. Ebo

4.  An approach to clinical practice
 A way to keep current with new
developments
 An integration of the best evidence
available, nursing expertise, and the values
and preferences of the individuals, families,
and communities who are served.

5.  … a methodological approach to clinical
practice where evidence is used to inform
decision-making about making a diagnosis (or
interpreting a diagnostic test), selecting an
intervention, or evaluating prognostic
indicators

6.  … an approach to health care practice in
which the clinician is aware of the evidence
that bears on her clinical practice, and the
strength of that evidence

7.  … an approach to decision making in which the
clinician uses the best evidence available, in
consultation with patient, to decide upon the
option which suits that patient best

8. Evidence based health care
is
the integration of individual
clinical expertise
with
the best available external
clinical evidence and
the values and expectations of
the patient

9.  Involves life-long, self-
directed, problem-based
learning
 Involves exploring the
relationship between clinical
reasoning and research
evidence
 Involves practice

10.  Do nothing … and get out of date
 Depend solely on courses/conferences
 Choose the main professional journal(s) and
read them cover to cover every month
 Learn how to find and appraise the evidence
to answer questions that come from clinical
practice

11. Knowledge Standard
 Each nurse possesses, through basic education and
continuing learning, knowledge relevant to her/his
professional practice

12. Knowledge Standard Indicators
 Providing a theoretical and/or evidence-based
rationale for all decisions
 Understanding the knowledge required to meet the
needs of complex clients
 Knowing where/how to access learning resources
when necessary

13. Knowledge Standard Indicators
 Seeking and reviewing research in nursing, health
sciences and related disciplines
 Using research to inform practice/professional service

14. Knowledge Application Standard
 Each nurse continually improves the application of
professional knowledge

15. Knowledge Application
Standard Indicators
 Ensuring practice is based in
theory and evidence and meets
all relevant standards/guidelines
 Assessing/describing the client
situation using a theory,
framework or evidence-based
tool
 Managing multiple nursing
interventions simultaneously

16. Knowledge Application
Standard Indicators
 Evaluating/describing the outcome
of specific interventions and
modifying the plan/approach
Integrating research findings
into professional service and
practice

17. Thompson, C. et al. Evid Based Nurs 2004;7:68-72
The cognitive continuum.

18.  Define the Question
 Identify Question ~ Search and Screen Literature ~
Refine Question
 Collect the Evidence
 Critically Appraise the Evidence for Validity
and Relevance

19.  Integrate the Evidence and Patient Factors
 Make & Carry Out the Decision
 Evaluate the Process
 Results ~ Self-reflection

20.  A clinical question should incorporate at least
three elements
 Patient
 Age, sex, ethnicity, etc.
 Condition, diseases, general health status
 Intervention
 Education, diagnostics, treatment plan, self-care,
etc.

21.  Comparison Intervention
 Placebo, etc.
 Outcome
 Expected and actual effects on patient

22.  Do nurse led tobacco cessation interventions
result in decreased smoking rates after
hospital admission for coronary heart disease?

23.  PATIENT
 (Adult) coronary heart patients
 Smokers
 Discharged from hospital
 INTERVENTION
 Nurse led tobacco cessation programmes

24.  COMPARISON
 (Non-nurse led tobacco cessation programmes
 Self-administered, non-nurse administered, etc.)
 No comparison
 OUTCOME
 Lower rates of tobacco use among Patient group

25.  Not all questions are of a clinical nature
 Intervention can be interpreted very broadly

27.  “Important medical questions are typically studied
more than once, often by different research teams in
different locations. A meta-analysis combines results
from different studies, hopefully averaging out any
differences caused by random change or local variation
and getting at something close to the real truth. In
general a meta-analysis, if you can find one, will be a
better guide to practice than an individual article.”
SUNY Downstate Medical Center, 2003

28.  Usefulness = Relevance x Validity
Work