This presentation aims to summarise and simplify the EBP process and features suggestions and tips to create an EBP project. It also shows several completed EBP projects.
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Evidence based practice in application
1. Evidence Based Practice in application
By:
Ahmad Amirdash
MS, APRN, AG-ACNP-BC, CCRN,
BBA
You are Welcome to use slides but please reference my post
when you do so to maintain the integrity of authorship
2. Objectives
To provide tips for completing an EBP project
To highlight obstacles that you may face
To offer solutions for anticipated problems
To suggest methods to save time and keep you on
track
To present examples of completed EBPs
3. Why the EBP approach?
• highest quality of care
• Decreased cost, enhanced safety, reduced
mistakes, proven results
• Maintain consistency in practice
• professional development and the utilization of
critical thinking
• Precursor to future projects
4. Understanding EBP and choosing your
topic of Interest
• critical approach for evaluating the latest
literature to support or discontinue a certain
practice
• EBP is not research
• Gathering resources, and critically reviewing and
appraising literature to collect evidence
• questioning a practice or to answer a burning
question
• Choose an issue related directly to your practice
and is promising
5. Picot or Pico question
• Before formulating a picot perform a quick
literature search
• Start with a broader or more General search
• Not enough articles?
• Low evidence level?
• Established guidelines
• A tip for a fast search, focus on titles and abstracts
6. Literature search
• In-depth search, note the results, and pick the
articles that are most relevant
• Know your available resources like the databases
available to you, peer reviewed journals, and
internet searches
• Develop a habit of searching literature and using
the several databases
• If you are conducting your project as a group, it
may help that each of you perform their own
search
• literature within the last 5 years
7. Evaluating and Appraising
• Statistical terms
• Types of studies
• Study design
• Inclusion and exclusion criteria
• Strengths &weaknesses
• Hierarchy of Evidence
• Your own conclusion
8. The evidence table
• Summarize your findings
• Be very brief when forming your evidence table
• Use a standard or common format
9. Citation Conceptual Framework Design/Method Sample/setting Major Variables Studied and Their
Definitions
Measurement Data Analysis Findings Appraisal: Worth to Practice
10. Creating an effective poster presentation
• stick to a standard format. Example: title,
introduction, objectives, PICOT question,
evidence table, outcome, Future plans,
References
• Phrase your PICOT and you may elaborate on
each
• Describe your search methods, databases used,
number of articles found, number of Articles
utilized depending on your inclusion criteria
• Strong level of evidence and written in very
concise manner
11. Creating an effective poster presentation
• Visually appealing
• 30/90 rule
• Graphics, photos, figures or tables
• font and size and color
• Design the printing service uses
• How big a font will appear
• Concise, use bullet points or summaries
12. Creating an effective poster presentation
• Acronym use
• Keep your message clear and explicit
• Mind your grammar and spelling
• Make sure that your poster has a good
organization meaning
• emphasize a point use italics or bold format
rather than using all caps
• Design to read from left to right
• Review your APA format
13. Creating an effective poster presentation
• Poster size & style
• Design format
• Use a service that would print a copy if your final
poster in smaller size
• Plan extra time to allow changes if needed
• Inquire about the processing time, which is
usually 7 to 10 days
14. Planning and next steps
• Capitalize on your project by submitting it for
consideration in a conference
• Plan wisely, distribute tasks among team
members. this would be especially helpfulwhen
appraising the articles
• Stick to deadlines and allow enough time for each
step of your project
15. Introduction
Pediatric patients are anxious when they come
to the emergency room.
Distraction is a cognitive-behavioral
intervention to reduce pain and distress.
An effective distractor stimulates the senses, is
developmentally suitable, and able to compete
with negative stimuli to get the child’s attention.
Objective
This Evidence-Based Project suggests that
distraction is an easy intervention to ease
procedural anxiety, distress and pain in children.
P.I.C.O. Question
Patient population: Pediatric oncology patients
ages 0-18
Intervention: Age appropriate distraction therapy
like Nintendo Wii, toys and cartoon stickers.
Comparison: Distraction versus routine care.
Outcome: Decrease procedural anxiety and fear
Distraction Therapy to Relieve Anxiety and Fear in Pediatric Oncology Patients during ER Visits
Participants: Maureen Fernandes RN, BSN, CPON; Lyla Jacob RN, BSN
Mentors: Ahmad Amirdash, RN, BSN, CCRN; Faisal Aboul-Enein, DPH, MSN, RN, FNP-BC
Citation Research
Question/
hypothesis
Design &
level of
Evidence
Independent
Variables &
measures
Dependent
Variables &
measures
Sample
size
Results Strengths Weakness/bias
/ Limitations
Uman et al
(2010)
The use of
psychological
interventions to
reduce
procedural pain
Systematic
Review.
Level 1
• Cognitive
interventions
(Distraction,
imagery, hypnosis,
parent education,
and virtual reality)
• Behavioral
interventions
(behavioral
distraction,
breathing
exercises, parent
training, virtual
reality)
• Cognitive
and behavioral
combined
( Nonspecific
treatment, standard
care)
Pain and distress
as measured by
• self report
(VAS, NRS,
VRS,)
• Observation
reports
• Behavioral
measures
(FLACC)
• Physiological
measures (HR,
RR, BP, O2 sat,
cortisol levels)
28 trials with
1951
participants
were
included.
Together,
these
studies
included
1000
participants
in treatment
conditions
and 951 in
control
conditions
Largest effect size
and efficacy
compared to controls
in order:
• Distraction
95% CI (-0.45,-0.04)
• Hypnosis
95%CI (-2.67,-0.27)
• Combined
cognitive behavioral
interventions
95% CI (-1.65,-0.12)
• Limited evidence
for other psychological
interventions.
• Only
randomized
control trials
included.
• Two
independent
reviewers for
data
extraction
using Rev-
Man 4.0.
• Oxford
quality scale
used to rate
studies and
assign
scores.
• Many studies
lacked
randomization
procedure
description, drop
out rates and
reasons.
• Studies
With negative
results lacking.
• Exact
definition for
intervention not
always consistent.
Yip et al
(2010)
The use of non
pharmacological
interventions for
assisting pain.
Systematic
Review.
Level 1
Non
pharmacological
adjunctive
therapies(NAT)
• Hypnosis.
• Complementary
and alternative
medicine
Presence or
absence of:
• Children
distress or
anxiety
• Children
cooperation
• Caregiver
anxiety
Measures:
• Psychological
• Behavioral
17 Trials
from
developed
countries,
involving
1796
children,
ages 0-17
years
• Presence of
parents during
induction of general
anesthesia does not
reduce their child’s
anxiety (8 trials).
• Promising non
pharmacologic and
hand held video
games proved
effective at induction
compared to controls
(significant results but
in single trials).
• Above measures
were promising but
need further
investigation and
validation in more
than one study.
• Search not
limited by
language or
publication
status.
• Large
Sample
studies
conducted in
USA and
Europe
• Data
extraction
conducted
independently
by 2 authors
using Rev
Man 5.0
software and
checked by a
3rd reviewer.
• Not all included
studies were
blinded and some
did not report
randomization.
• Trials were
specific to induction
of general
anesthesia only.
• Measures of
pain, anxiety, and
stress were not
consistent.
Rheingans
(2007)
The use of non
pharmacological
adjunctive
therapy for
symptom
management
Systematic
Review
Level 1
Hypnosis,
distraction,
relaxation, cognitive
behavioral
therapies,
relaxation, imagery,
play, art therapy,
Breathing and hand
holding.
Pain, distress,
anxiety, nausea,
vomiting, fear and
depression.
41 eligible
studies
publication
dates
ranged from
1975 to
2006 with
37% within
the past 10
years.
Non pharmacologic
adjunctive therapies
(NAT) for procedures:
• Age appropriate
distraction was
successful in general ,
same for hypnosis.
Ex: video games.
• NAT for
procedures
significantly reduced
anxiety (breathing and
distraction) and
improved cognitive
behavior
• Wide
search and
trials from
many
countries.
73% of
studies
examined
procedural
symptoms.
• Some non
randomized trials or
case studies were
included.
• Most studies
lacked specific
definitions of
“anxiety” “distress”
and “hypnosis”.
• Lack of sample
size in some
studies to establish
NAT effectiveness.
Evidence Table
Emergency Center
References
• Cavender K, Goff MD, Hollon EC, Guzzetta CE. Parents' positioning and
distracting children during venipuncture: Effects on children's pain, fear, and
distress. Journal of Holistic Nursing. 2004;22:32–56.
• Dahlquist LM, McKenna KD, Jones KK, Dillinger L, Weiss KE, Ackerman CS.
Health Psychol. 2007 Nov;26(6):794-801.
• Kleiber C, Harper DC. Effects of distraction on children's pain and distress during
medical procedures: A meta-analysis. Nursing Research. 1999;48(1):44–49.
• Rheingans JI. A systematic review of nonpharmacologic adjunctive therapies for
symptom management in children with cancer. J Pediatr Oncol Nurs. 2007 Mar-
Apr;24(2):81-94. Review.
• Salmon K, Price M, Pereira JK. Factors associated with young children's long-
term recall of an invasive medical procedure: A preliminary investigation. Journal
of Developmental & Behavioral Pediatrics. 2002;23:347–352.
• Uman LS, Chambers CT, McGrath PJ, Kisely S. A systematic review of
randomized controlled trials examining and distress in children and adolescents:
An abbreviated Cochrane review. psychological interventions for needle-related
procedural pain Journal of Pediatric Psychology. 2008;33:842–854.
• Yip P, Middleton P, Cyna AM, Carlyle AV. Non-pharmacological interventions for
assisting the induction of anaesthesia in children. Cochrane Database of
Systematic Reviews 2009,
Project Plan
Provide children with
age appropriate
distractions like toys,
stickers, cartoons, video
games and movies
Educate staff about
age-appropriate care.
Outcome
Providing age appropriate distractions will
decrease the pediatric patients stress and
anxiety and increase the ER staff’s
efficiency in giving optimal care to the
patients and satisfaction to the parents.
16. Introduction
Pain, stress, and anxiety are common problem
among cancer patients.
Treatments like chemotherapy, radiation and
hormone therapy cause muscular neuropathic,
and herpetic pain along with mucositis.
In addition to medication, it is important to
have further options such as music therapy to
help manage pain and discomfort.
Objective
This Evidence-Based project attempts to
examine the effects of Music Therapy on stress,
anxiety, and pain in cancer patients.
P.I.C.O. Question
• P – All cancer patients.
• I – Music Intervention
• C – Standard care alone
• O – Improved psychological and physical
outcome
Outcomes
1. Different age groups (23-91) had different
preference of music therapy.
2. Positive impact on mood after therapy.
3. Significantly less pain with the music
therapy group versus control group.
Next Steps
1. Initiate patient education on arrival and
promote awareness.
2. Elicit patient feedback to assess efficacy.
3. Encourage participation from staff in
implementing music therapy.
References
• Cole LC, Lobiondo-Wood G. Music as an Adjuvant
Therapy in Control of Pain and Symptoms in Hospitalized Adults: A Systematic
Review. Pain Manag Nurs. 2012 Oct 26. doi:pii: S1524-9042(12)00144-0.
0.1016/j.pmn.2012.08.010.0
• Huang ST, Good M, Zauszniewski JA. The effectiveness of
music in relieving pain in cancer patients: a randomized controlled trial. Int J
Nurs Stud. 2010 Nov;47(11):1354-62. doi: 10.1016/j.ijnurstu.2010.03.008.
• Zhang JM, Wang P, Yao JX, Zhao L, Davis MP,
Walsh D, Yue GH. Music interventions for psychological and physical outcomes
in cancer: a systematic review and meta-analysis. Support Care Cancer. 2012
Dec;20(12):3043-53. doi:10.1007/s00520-012-1606-5.
Music Therapy: Pain and Stress Relief in Adult Cancer Patients
Participants: Giovanni Maloto, RN; Priya George, RN; Cicily Cyriac, RN
Mentors: Ahmad Amirdash, RN, BSN, CCRN; Faisal Aboul-Enein, DPH, MSN, RN, FNP-BC
Citation Research
Question/
hypothesis
Design &
level of
Evidence
Independent
Variables &
measures
Dependent
Variables &
measures
Sample size Results Strengths Weakness/bias /
Limitations
Cole &
Lobiondo
-Wood
2012
review the use
of music as an
adjuvant
therapy for pain
control in adult
hospitalized
patients.
Systematic
Review.
Level 1
• Music was
played for
different
RCTs for
• 15-60
minutes
daily.
• Music
delivered
one time, or
before
surgery, or
daily.
• Music-based
imagery
(MBI) was
provided in
one study.
• Pain
• Anxiety
• Physical
discomfort
• Mood
Combination
of
complaints.
Measures:
• Vital
signs
• VAS.
• Other
pain
scales.
• Opioid
use.
• Labs e.g.
cortisol
• A
Cochrane
collaboration
review of
studies
between
1966-2004.
• 60 trials
identified.
• 17 met
inclusion
criteria for
RCTs.
• Music group had
less pain than
control group.
• Pain and opioid
use lower in study
group.
• Analgesia use
higher in control
group
• Significant
changes in
muscle tension &
anxiety with music
therapy.
• All groups had
similar
demographics
on age,
anesthesia &
surgery.
• Several music
options
provided.
• Patients served
as own
controls.
• Study allowed self-
selection of music.
• No indication whether
effect of music sustains
further with post op stay.
• Limited music choices.
4 subjects withdrew
because of limited
selections.
• Authors did not identify %
of patients in each group
who had past experience.
• Sample size small. 50
participants needed for
power and only had 17.
Zhang et
al 2012
• Examine
effect of
music
interventions
on
psychologic
al & physical
outcome
measures in
cancer
patients.
Systematic
Review.
Level 1
• Music
intervention
or music
medicine
ranging from
15-60min/
• 1-2 times a
day for 5-15
days.
• Pain
• Fatigue
• Anxiety
• Quality Of
Life.
• Nine
databases
reviewed
from 1966
to March
2011.
• All
randomized
controlled
trials were
included.
• 32
randomized
trials met
inclusion
criteria (10
english and
22 chinese
articles).
• Most studies
reported music
interventions
reduced anxiety
and depression
before, during and
after procedures.
• To some extent,
music improved
quality of life.
• No restrictions
on age, gender,
ethnicity, or
type of setting.
• English and
Chinese-
speaking
cancer patients
were included.
• Interventions
compared with
standard care
alone or plus
other therapies.
• Treatment effect may be
small & unconvincing to
caregivers, patients and
families.
• Differences in study
design, intensity of
interventions, type,
duration, and the
therapist may produce
varying results.
• Limited information was
reported regarding
rationale and process of
musical selections.
• Musical interventions
differ in mode of delivery,
onset and duration of
beneficial effects.
Huang et
al 2010
What is the
effect of music
on cancer
Pain?
Intent to
treat RCT
level 2
The
experimental
group listened
to sedative
music for 30min
(No.62).
Control group
rested in
bed(No.64).
Sensation
and distress
related to
cancer pain.
Measures:
Sensation
and distress
of pain using
Visual analog
scale(VAS)
N=126 • Decrease in pain
sensation and
distress in the
music group: 37%
less sensation
and 44% less
distress at post
test than control
group.
• On VAS scale 0-
10,the music
group averaged
1.5 units less pain
than controls.
• no side effects of
music reported.
• Results
clinically
significant
P< 0.001.
• Multivariate
analysis of
covariance
(MANCOVA),
with sensation
and distress as
the multivariate
factor.
• Large enough
sample.
• All oncology
patients.
• Patients with mild pain
VAS < 3 were excluded.
• Most participants had a
high school education or
less(92%).
• All participants
Taiwanese
• Only four types of music
were offered.
• Long term use of music
or longer duration of
effects not measured.
• Pain outcome measured
at only one time point.
Evidence Table
Emergency Center
17. Introduction
Blood Clots are the second leading cause of
death in cancer patients. It is preventable with
appropriate measures and treatment .
Prevalence
VTE’s (venous thromboembolism, ie DVT, PE)
higher prevalence among cancer patients
contributes to 2 fold or greater risk of mortality
compared to cancer patient who do not develop
thromboembolism.
• VTE prevalence in general population: 0.1%
• VTE among cancer patient 0.6% to 8%.
• Chemotherapy patients: 11 to 75%.
PICO QUESTION
P- Cancer patients aged 30 to 65 years old
I - Pharmacologic therapy & application of
GES
C - Pharmacologic therapy alone.
O -decrease incidence of VTE with the
addition of GES.
..
VTE Mortality in a population of >66,000 adult,
hospitalized neutropenic patients. 7
vvvv
Conclusion
The burden of VTE in cancer patient requires
multidisciplinary intervention i.e. both
pharmacological and non-pharmacological
measures. GES usage enables EC personnel
initiate early prevention.
The outcome will be measured by degree of
compliance and assessment of EC
personnel’s skills pertaining to GES utilization.
References
Di Nisio M, Porreca E, Ferrante N, Otten HM, Cuccurullo F, Rutjes AW. Primary prophylaxis for venous
thromboembolism in ambulatory cancer patients receiving chemotherapy. Cochrane Database Syst Rev. 2012
Feb 15;2:CD008500. doi: 10.1002/14651858.CD008500.pub2. Review.
Fig.1, http://www.stoptheclot.org/learn_more/learn_thrombosis.htm retrieved April 21, 2013
Fig. 2, Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008 Mar 6;358(10):1037-52.
doi: 10.1056/NEJMra072753. Review
Fig3. http://www.oref.org/site/PageServer?pagename=grants_dvt_results retrieved April 21, 2013
Fig.4 http://scienceroll.com/?s=virchow&searchbutton=go retrieved April 21, 2013
Fig.5 http://www.cancerthrombosis.org/moduleArticle? retrieved April 22, 2013
Fig.6 Khorana AA, Francis CW, Culakova E, Fisher RI, Kuderer NM, Lyman GH. Thromboembolism in
hospitalized neutropenic cancer patients. J Clin Oncol. 2006 Jan 20;24(3):484-90..
Giannoukas AD, Labropoulos N, Michaels JA. Compression with or without early ambulation in the prevention of
post-thrombotic syndrome: a systematic review. Eur J Vasc Endovasc Surg. 2006 Aug;32(2):217-21. Epub 2006
Mar 20. Review.
Ricky Autar, A review of the evidence for the efficacy of Anti-Embolism Stockings (AES) in Venous
Thromboembolism (VTE) prevention, Journal of Orthopaedic Nursing, Volume 13, Issue 1, February 2009, Pages
41-49, ISSN1361-3111, 10.1016/j.joon.2009.01.003.
(http://www.sciencedirect.com/science/article/pii/S1361311109000041)
0
10
20
30
40
50
60
70
80
Prevalence
Pharmacologic
Vitamin K antagonist
Unfractionated Heparin
LMWH eg Lovenox
Fondaparinux
Direct thrombin
inhibitor eg Pradaxa.
Non pharmacological:
IPC (Intermittent
pneumatic
compression).
GES (Graduated Elastic
Stockings).
Current VTE Prophylaxis Citation Research question/
Hypothesis
Design/Level
of Evidence
Independent/ Dependent
Variables
Nisio et
al
(2012)
1.Measure the effectiveness and
safety of blood thinning
agents(anticoagulant)/
Mechanical interventions when
used to prevent blood clots in
cancer patients receiving
chemotherapy.
2. compare the efficacy and
safety of primary
thromboprophylaxis with
placebo or no
thromboprophylaxis in
ambulatory patients with cancer
receiving chemotherapy.
3.The effectiveness of using
non-pharmacological
interventions in cancer patients
in high risk of major bleeding.
Cochrane
Database of
Systematic
Reviews
2012
Level 1
Pharmacologic
Interventions:
Anticoagulant:
1.Vitamin K antagonist
2.Unfractionated Heparin
3.Low molecular weight
heparin ( LMWH)
4.Fondaparinux
Mechanical Interventions:
1.IPC (Intermittent
Pneumatic Copmpression)
2.GES (Graduated elastic
stockings)
Placebo or no
thromboprophylaxis
Dependent Variable
VTE (DVT, PE)
Sample Size/
Who
Results
Nine RCT’s
with a total of
3538 patients.
Ambulatory
cancer
patients
receiving
chemotherapy
.
1.Overall LMWH, when compared with inactive control, there is significant
reduced incident of symptomatic VTE by 45%. However 60% increase in
major bleeding when compared with inactive control
2. lack of power hampers definite conclusions on the effect on major safety
outcomes, which mandates additional studies to determine the risk to
benefit ratio of LMWH.
3.The effect of K antagonist (warfarin) on preventing symptomatic VTE
showed insignificant result.
4.Mechanical Interventions ( IPC and GES) alone not tested.
Strengths Weakness/bias/Limitations
• Mechanical Interventions( Graduated
elastic stockings and Intermittent pneumatic
compression) maybe a valid option in cancer
patients who are at risk of bleeding and are
not candidate for pharmacologic
interventions. Needs further studies on this.
• The cost related to the management of
VTE may be considerable, resulting from the
expenses related to drugs and
hospitalization.
• The occurrence of (unrecognized) VTE
may delay the delivery of cancer treatments
such as chemotherapy with a further negative
impact on morbidity and potential mortality.
• Heparin and Fondaparinux requires
daily
subcutaneous injections, which represents
a considerable burden for the patient.
• Vitamin K antagonist requires frequent
monitoring for dose adjustments and can be
difficult to administer because of nausea
and vomiting, poor nutrition and interaction
with other medication.
• None of the studies tested other
anticoagulant treatment including
unfractionated heparin, fondaparinux, direct
factor Xa inhibitors or mechanical
interventions (IPC, GES).
Project Plan
• Educate EC personnel
about GES application and
indication.
• Patient education.
• Identify appropriate EC
patients for GES usage.
Assess for bleeding risks.
• Add GES application to
pharmacologic treatment
Develop a
protocol
utilizing
GES as
VTE
prophylaxis
in the EC.
Citation Research/
Hypothesis
Design/Level
of Evidence
Independent/ Dependent Variables
Measure
Ricky
Autar,
(2009)
Use of Anti-
embolism Stockings
(AES) alone or as
an adjuvant therapy
is very efficacious in
venous prophylaxis.
Systematic
review/Meta-
analysis
Level 1
Independent
Anti-embolic Stockings (AES), (thigh-
high/knee-high);
Pharmacologic agents, such as low-dose
Heparin, (LMWH) Low molecular weight
Heparin, Mechanical prophylaxis
Dependant VTE incidence
Sample size/
Who
Results Strengths Weakness/
Limitations
• Varied
studies of
surgical patients,
over 25-30 years
span;
• 70 to
2000 patients per
study
• When used alone,
AES (anti- embolic
stockings) reduced
incidence of VTE by
57-64%.
• As an adjuvant to
pharmacological or
mechanical method of
prophylaxis, use of AES
reduced DVT incidence
by up to 85%.
• AES (anti-embolic
stockings), used alone
or in conjunction with
mechanical or
pharmacological agents
has shown to decrease
incidence of VTE in
surgical patients.
• Also considered
the gold standard for
leg compression.
• There is no
evidence if knee-
high AES is more
effective than thigh
high AES.
• Currently, there
is limited information
of comparative
efficacy of different
brands of stockings.
Citation Research/Hypothesis Design/Level
of Evidence
Independent/ Dependent
Variables Measure
Giannoukas
et al (2006)
To assess if there is enough
evidence to suggest that
compression with or without
early ambulation after proximal
DVT reduces risk of post-
thrombotic syndrome (PTS).
Systematic
Review
Level 1
Independent
Compression stockings,
Ambulation
Dependant:
risk of post-thrombotic
syndrome (PTS).
Sample
size/ Who
Results Strengths Weakness/Limitations
Varied
studies
from
1997-
2004;
80-194
medical-
surgical
patients
2-25% developed
PTS (post 0
thrombotic
syndrome) in
patients who were
treated with elastic
compression
stockings, plus
early ambulation;
while 47-82% bed
rest and no
compression
• The study
significantly suggests
compression has
more favorable
outcome in
preventing PTS(post
thrombotic
syndrome); compared
to Bed rest without
compression.
• Due to diversity and subjectivity
in method of studies, there is no
definite conclusion.
• further research is needed on
optimal timing to start elastic
compress ion after episode of
DVT.
• The minimum required duration
wearing EAS to have the most of
benefit to patients.
Fig. 3
Fig. 1 Acute DVT Left Leg, Post Thrombotic
Syndrome Right Leg
The impact of cancer and its treatment on
each element of Virchow’s triad.
Virchow’s triad
Fig.5
Oral anticoagulants
18.7%
Compression stockings
18.2%
LMWH
16.6%
Pneumatic compression
15.0%
Aspirin
12.5%
Unfractionated heparin
10.0%
Pentasaccharides
8.9%
Fig.4
Fig.6
Fig.2
Venous Thromboembolism Prevention with GES
(Graduated Elastic Stockings) among cancer patients
Susan Gonzales BSN, RN; Marie Pansacola-Rouchon BSN, RN, CCRN
Ahmad Amirdash BSN, RN, CCRN; Faisal Aboul-Enein DPH, MSN, FNP-BC
Emergency Center
18.
19. LoBiondo-Wood, G. & Haber, J. (2006). Nursing Research: Methods and Critical Appraisal
for Evidence-Based Practice, 2006 6th Ed. Philadelphia: Elsevier-Mosby
Deliver highest quality of care
Decreased cost, enhanced safety, reduced mistakes, proven results. provide care that is based on Research instead of practices rooted in Tradition
Maintain consistency in practice and decrease pattern variation
Prepares you for a lifelong journey of learning professional development and the utilization of critical thinking
EBP is the initial step to establish updated guidelines, QI projects, Publications, and presentations
EBP Is the critical approach for evaluating the latest literature to support or discontinue a certain practice, however EBP is not research
Remember that at this stage you are gathering resources, and critically reviewing and appraising literature to collect evidence in order to come up with a conclusion that supports or answers your question
Initial approach begins with questioning a practice or to answer a burning question regarding a nursing intervention that is not fully explained or included in your facilities practice
Try to think of an issue related directly to your practice which is promising and could lead to positive change and quality improvement in the future
Once you determine your topic or subject of interest and before formulating a picot perform a quick literature search and determine the abundance and level of evidence of articles addressing your question
You can start with a broader or more General search to gather as many relevant articles as you can then transition to more specific terms that would apply to your picot
After searching several databases, if you are not able to find enough articles related to your topic, it may be very hard for you to continue your project
You may also find several articles that are based on a low level evidence such as expert opinion. Then you could predict that your project would be somewhat week
Conversely it is not advisable to pick a topic that is already well-established or is a guideline or gold standard of practice
You can speed up your initial search by focusing on titles or abstracts when available to get an idea of literature available and the level of evidence
This is where you do an in-depth search, note the results, and pick the articles that are most relevant and that meet you inclusion criteria
Remember the following
Know your available resources like the databases available to you, peer reviewed journals, and internet searches use this with caution, visit reputable sites such as AHRQ AACN ANA.
Get in the habit of searching literature and using the several databases to become more familiar with these. This will help you in your future practice as well as in school
Many databases will allow you to register and this may give you a chance to keep track of your searches, save your relevant articles, and sometimes even give you access outside your Institution
If you are conducting your project as a group, it may help that each of you perform their own search. This will increase the likelihood of finding articles that are more relevant to your topic
Try to pick the latest articles. A common practice is utilizing literature within the last 5 years
Familiarize yourself with the basic statistical terms such as significance, p-value or Alpha, specificity, sensitivity, type 1 and type 2 errors, measures of reliability, validity, nominal and ordinal data, scales of measurement, interval ratio, confidence intervals, mean, median, mode, standard deviation, sample skew, statistical tests used (Anova, correlation, chi-square). For example the P value determines the significance of your findings and is considered an approved Criterion that helps you form a conclusion
Know the types of studies, the design used and its meaning: what is a systematic review, meta-analysis, randomized controlled study (RCT), cohort, cross-sectional, descriptive, case studies, quantitative, qualitative, concepts of blinding, randomization, etc
Be weary of relying solely on the authors conclusions. look for conflicts of interest, for financial support from a private Institution like a pharmaceutical company
Study design, statistics used,samples can be found in the methods section.
Strengths, weaknesses, limitations are typically found in the body of the article or sometimes the conclusion
Be very cognizant of the hierarchy of evidence. When selecting youtr articles a stronger level of evidence supports a stronger conclusion
The evidence table
This is where you summarize your findings. Remember the level of evidence makes or breaks your project
Be very brief when forming your evidence table
Use a standard or common format
Creating an effective poster presentation
For an EBP project stick to a standard format. Example: title, introduction, objectives, PICOT question, evidence table, outcome, plus min future Direction or plans on how to utilize your findings. Finally list year references in APA format
For example the introduction may include the background of the topic, your inquiry, Gap in knowledge Etc
Phrase your PICOT and you may elaborate on each
Describe your search methods, databases used, number of articles found, number of Articles utilized depending on your inclusion criteria
Your evidence table is ideally based on a strong level of evidence and written in very concise manner
Remember you need to create a visually appealing and one that stands out. Ask yourself what is your trigger to choose which poster to view
You can use the rule of 30/90 which means that it could capture your viewers attention within 30 seconds and sustain their attention for at least 90 seconds
Since visual appeal is significant, remember to use Graphics, photos, figures or tables. These need to be related to your topic and listed next to the related text
Stick to one font and size and color for reading ease. Serif or non serif is at your discretion
An important factor is to find out what design the printing service uses and how big a font will appear
Less is more so keep your poster concise, use bullet points or summaries since you can always elaborate during a discussion about you poster
Try not to use too many acronyms and if you do spell it out. no one likes and alphabet soup
Keep your message clear and explicit
Mind your grammar and spelling
Make sure that your poster has a good organization meaning does it flow logically
If you need to emphasize a point use italics or bold format rather than using all caps
Design to read from left to right
Review your APA format
Decide on the size of your poster the format used for printing. Some use PowerPoint slides and paste in different Colunms
Find out about the kind of Imaging used such as digital, High acuity, lamination, framing, foldable type common is tri-fold, time to process and cost
Use a service that would print a copy if your final poster in smaller size
Plan extra time to allow changes if needed
Inquire about the processing time, which is usually 7 to 10 days
Capitalize on your project by submitting it for consideration in a conference
Plan wisely, distribute tasks among team members. this would be especially helpfulwhen appraising the articles
Stick to deadlines and allow enough time for each step of your project