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Evidence Based Practice

Premise and Project
by

Patty Averre

on 19 October 2016

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Transcript of Evidence Based Practice

There will be 3 groups of four students and 2 groups of three students. You can choose your own groups. The sign-up sheet will be posted on the board in HS2 302.
EBP Project
EBP Project
Scenario #6
The common cold persists as one of the most frequent illnesses. Mrs. Harris visits the ambulatory care center with symptoms of a common cold. She has lost time from work due to a cough, nasal congestion, and malaise. You are interested in the use of Zinc to alleviate cold symptoms. Does taking oral zinc or nasal zinc effectively reduce the symptoms of the common cold in adults and which delivery method works best?
Create a PICO Question
Scenario #5
As a nurse on a pediatric medical surgical floor, you have noticed several nurses and nursing assistants inconsistently taking patient blood pressures. Sometimes they attach the cuff to the right arm, sometimes the left, and sometimes they apply the blood pressure cuff to a leg. You want to research if this affects the BP readings and is a sound clinical practice or if it should be done more consistently.
Create a PICO Question
Scenario #4
While in nursing school you were taught to insert IV needles with the bevel up. Several nurses that you work with consistently insert them bevel down. You want to determine if this is incorrect or if research has determined if it makes a difference.
Create a PICO Question
Scenario #2
As a nurse in a neonatal intensive care unit, you are always interested in identifying interventions that will assist these little patients to grow and thrive. You recently read an article about “kangaroo care” and wonder if it might benefit this population.
Create a PICO Question
Scenario #1
As a nurse in an intensive care unit, you are concerned with the amount of ventilator-acquired pneumonia that patients contract. You have read that oral care may reduce the incidence of pneumonia in this group of patients.
Create a PICO Question
Please get into groups of 3 students. You will be given a clinical situation. Please create a PICO question for each scenario.
Now it’s your turn!
Does exercise improve overall blood glucose levels in Type 2 Diabetes patients?
Does the use of chlorhexidine as a preoperative prep
reduce the incidence of surgical site infections?
PICO
Read widely and wisely
Attend professional conferences
Expect evidence that a procedure is effective
Seek environments that support research utilization
Become involved and communicate professionally
Participate in institutional research utilization and EBP projects
Implications for Nurses
Gather in-depth understanding of human behaviors

Often used to study culture, values, and perceptions
Qualitative Studies
Use numbers to describe data and report findings

Involve measurement of some “Quantity” result
Quantitative Studies
A planned experiment designed to compare outcomes of an intervention group and a control group of patients followed over identical periods.

The methodologic standard of excellence for scientific experiments.
Randomized Controlled Trial

The RCT has probably contributed more than any single scientific discovery to the improvement in medical care.

(Lancet, 1987)
Randomized Controlled Trial
7/2/2012

A problem solving approach to the delivery of health care that integrates
the best evidence
from studies and patient care data with
clinician expertise
and
patient preferences and values.

(Melnyk, et.al, 2009)
Evidence Based Practice
How would YOU define it?

Why should YOU learn about it?

Have YOU ever participated in it?

Will YOU ever participate in it?
“Evidence Based Practice”
NUR 212
Averre

Module: EBP
Scenario #3
You are a nurse in a geriatric practice. Many of the patients take multiple prescriptions each day. They sometimes forget to take their medications or take them irregularly. You wonder if the use of compartmentalized pill boxes will increase medication compliance.
Create a PICO Question
Which of my current practices are supported by current evidence?
Why am I doing something the way that I am?
Could there be a better way?
Who could act as my EB mentor?
What is the preferred method to question policy?
Igniting a “Spirit of Inquiry”
Randomized
….Random placement in either a control or intervention group to remove risk of any bias on the part of the researchers….blinding or double-blinding further removes risk of bias.
Controlled
….A group without intervention serves as the comparison for the intervention/ experimental group
Trial
….Carefully designed experiment with deliberate methodology and documentation
Randomized Controlled Trial
Evidence based practice incorporates all of the following EXCEPT

A. Expert clinical opinions
B. Teamwork
C. Client wishes
D. Credible research
1:
RCT
& Systematic Review
2: Experimental Studies & Integrative Reviews
3: RT not controlled
4: Cohort Studies & Quasi-experiments
5: Correlation designs
6: Qualitative studies
7: Expert Opinions & Surveys
Evidence Hierarchy
True or False
Quantitative studies are more scientifically credible than qualitative studies.

A. True
B. False
Independent

variables
Interventions being manipulated or controlled during a study
Dependent

variables
Outcomes being measured or affected during a study
Variables
Confounding variables

Affect the outcomes AND vary between the intervention and control groups
Variables
Nurses in CCU want to determine the effect of repositioning on heart rate following an MI. Which of the following is correct?

A. IV- MI, DV- heart rate, CV- none
B. IV- repositioning, DV- MI, CV- heart rate
C. IV- heart rate, DV- repositioning, CV- none
D. IV- repositioning, DV- heart rate, CV- beta blockers ordered
Clicker ?
P value <0.05
The lower the p value, the more statistically credible the study methodology

Confidence interval (CI) >95%
The higher the CI, the more statistically credible the study methodology
Statistical Credibility
Which value indicates the strongest statistical credibility with regard to evidence-based practice research?

A. P value 0.01
B. Confidence Interval 97%
C. P value 0.001
D. Confidence Interval 95%
Clicker ?
Patients / Problem
Intervention
Comparison
Outcome
P: Surgical patients
I: Chlorhexadrine prep used preoperatively
C: No soap used preoperatively
O: Reduction in risk of surgical site infection
P: Patients with Type 2 diabetes
I: Exercise
C: No exercise
O: Benefit of exercise improving overall blood glucose levels
The purpose if this project is to introduce you to the practice of reading research critically. You will see this is a necessary step in applying the results to your clinical practice!!!
PICO Worksheet
Topic of interest within the scope of nursing practice!!!
Group Members
PICO description
Complete article citation in APA format
Article cannot be changed!!!
RCT Article Worksheet
RCT Article Worksheet
RCT Article Worksheet
RCT Article Worksheet
Project Presentation
We are here for you!
Good Luck!
Introduction
Methodology and Results
Your Analysis of Research and
Application of EBP
(I, II, & III)
Your Overall Summary
Please refer to Project Guidelines & Rubric!
Sections of a research article:
Abstract
Introduction
Methods
Results
Conclusion
Full transcript