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Evidence-Based Project

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Carlye Green

on 26 July 2014

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Transcript of Evidence-Based Project

Evidence-Based Project
Carlye Green RN, BSN CEN CPEN

Conducting Evidence-Based Project: Identify Problem
Conducting Evidence-Based Project:
Form Clinical Question
Develop evidence-based problem question that can be answered by research

PICO (T) format:
Conducting Evidence-Based Project:
Collecting Evidence
Goal is to find evidence through a literature review to support best practices

Conclusion
While evidence-based practice and research differ, they are interrelated
Following a process for forming a clinical question and implementing best practice is advantageous
Adapting the research to the individual facility is key
It is imperative the project is measurable
Evidence-Based Research VS Practice
Research defined as: "systematic inquiry that uses disciplined methods to answer questions and solve problems" (Polit & Beck, 2010, p. 4)

Evidence-based practice is the implementation of proven interventions based on the clinical research and best evidence (Polit & Beck, 2010)

To successfully translate research to practice:
must be applicable
must be realistic
must be financially feasible
culture must be receptive to change
Problem-Focused

Knowledge-Focused
What isn't working?

What could improved?

Identified by looking at hospital specific data/problems
What is current research?

What are other hospitals doing that works well?

Identified by knowing current knowledge base
P- Patient/Population/Problem
I- Intervention or Issue
C- Comparison of Interest
O- Outcome
T- Time
Examples
Family Presence During Trauma
Activations and Medical Resuscitations
in a Pediatric Emergency Department:
An Evidence-based Practice Project
(Kingsnorth et al., 2010)
Evidence-Based Practice and
Family Presence: Paving the Path
for Bedside Nurse Scientists
(Nykiel et al., 2011)
Article 1:
Article 2:
P:
I:
C:
O:
T:
P:
I:
C:
O:
T:
Pediatric patients/families during
medical emergencies/trauma
family presence
no family present in room
behavior of family is safe and care
of patient uninterrupted
included first 100 eligible families
Research Question
Article 1:
Article 2:
1. Is it feasible to implement a family
presence policy and procedure for
patients during trauma stats and
medical alerts in a pediatric emergency
department (process evaluation)?

2. Is the implementation of a family
presence policy and procedure during
trauma stats and medical alerts effective
in ensuring safe and appropriate family
member behavior while at the bedside
that results in uninterrupted patient care
(outcome evaluation)?
1. Does the implementation of an
FFP program improve ED staffs'
perceptions of their role in providing
psychosocial and emotional support
to families?

2. Does the implementation of an
FFP program improve ED staffs'
beliefs about making FFP an option
for families?

FFP (Facilitated Family Presence)
(Kingsnorth et al., 2010)
(Nykiel et al., 2011)
Performing Literature Review:
Use keywords from problem
statement/question
Narrow year
Narrow journals
Narrow to peer-reviewed
What Does Peer-Reviewed Mean?
evaluated by experts in the same field that are "blind" to the authors
ensures article is scholarly
may have symbol similar to referee shirt to identify as peer-reviewed
(Angelo State University, n.d.)
(Furman University Libraries, 2014)
image from http://libguides.furman.edu/content.php?pid=308864&sid=2552682
Conducting Evidence-Based Project:
Adapt to Facility
Crucial Step!
Evidence-Based Practice is not a recipe to be exactly followed
Must take into consideration
facility needs
patient population
available resources
staff
Examples
Article 1:
Article 2:
Surveyed staff to identify
barriers
Named key staff to act as
facilitators
Additional education for
facilitators
Pre and Post intervention survey to determine staff beliefs
2 months of educational in-services regarding family presence
Addressed staff concerns identified through pre-surveys during in-services
(Kingsnorth et al., 2010)
OBJECTIVES
Conducting Evidence-Based Project:
Evaluation
How do you know your project was effective?
Objective Data versus Subjective Data

Compare outcomes from before and after the evidence-based project intervention

Recording patient and staff satisfaction
Evaluation Article 1
Is it feasible to implement a family presence policy and procedure for patients during trauma stats and medical alerts in a pediatric emergency department (process evaluation)?
Is the implementation of a family presence policy and procedure during trauma stats and medical alerts effective in ensuring safe and appropriate family member behavior while at the bedside that results in uninterrupted patient care (outcome evaluation)?
Question 1
Question 2
Did the department implement and
FOLLOW the policy during the project
timeline?
96 of 106 families screened were present during emergency
Social workers/Charge nurses facilitated family presence cases
Policy was followed
Did the patient experience uninterrupted care?



Did family members display safe behavior?
In 100% of cases, patient care was not interrupted
53% families were quiet
33% anxious but cooperative
17% distracted but able to follow directions
14% distressed and crying but consolable
1 family member became overwhelmed, but left the room
Evaluation Article 2
Question 1
Question 2
Does the implementation of an
FFP program improve ED staffs'
perceptions of their role in providing
psychosocial and emotional support
to families?
Does the implementation of an
FFP program improve ED staffs'
beliefs about making FFP an option
for families?
Did staff perceptions get better?
Comparing staff surveys before and after intervention
Likert scale used
Analysis of surveys found staff perceptions did not change in regards to providing psychosocial/emotional support
Did staff beliefs get better?
Compared surveys before and after intervention
Likert scale used
Analysis found a significant improvement in staff beliefs about providing family presence
Emergency Department Staff
facilitated family presence (FFP)
Staff beliefs/perceptions prior to intervention
Improvement in measured staff beliefs/perceptions
6 months
Image by Greenhalgh et al. as cited by Carman et al., 2007
(Polit & Beck, 2010)
(New York University Libraries, 2014)
(Polit & Beck, 2010)
(Riva, Malik, Burnie, Endicott, & Bussie, 2012)
(Polit & Beck, 2010)
(Polit & Beck, 2010)
(Kingsnorth et al., 2010)
(Nykiel et al., 2011)
Define the differences between evidence-based practice and research
Identify steps to conducting an evidence-based project
State at least one objective way to evaluate an evidence-based project
Name steps of PICO (T) in reference to developing an evidence-based problem statement
By the end of the presentation the student will be able to:
(Carman et al,2013)
(Nykiel et al., 2011)
Angelo State University. (n.d.). Library guides: How to recognize peer-reviewed (refereed) journals Retrieved June 16, 2014, Retrieved from
http://www.angelo.edu/services/library/handouts/peerrev.php

Carman, M. J., Wolf, L. A., Baker, K. M., Clark, P. R., Henderson, D., Manton, A., & Zavotsky, K. E. (2013). Translating research to practice:
Bringing emergency nursing research full circle to the bedside. Journal of Emergency Nursing, 39(6), 657-659. doi:http://ezproxy.twu.edu:2079/10.1016/j.jen.2013.09.004

Furman University Libraries. (2014). What is peer review? Retrieved June 16, 2014, Retrieved from http://libguides.furman.edu/content.php?
pid=308864&sid=2552682

Kingsnorth, J., O'Connell, K., Guzzetta, C. E., Edens, J. C., Atabaki, S., Mecherikunnel, A., & Brown, K. (2010). Family presence during trauma
activations and medical resuscitations in a pediatric emergency department: An evidence-based practice project. Journal of Emergency Nursing, 36(2), 115-121. doi:http://ezproxy.twu.edu:2079/10.1016/j.jen.2009.12.023

New York University Libraries. (2014). Search strategies: Framing the question (PICO) . Retrieved June 12, 2014, Retrieved from http://
tinyurl.com/nyuframing

Nykiel, L., Denicke, R., Schneider, R., Jett, K., Denicke, S., Kunish, K., . . . Williams, J. A. (2011). Evidence-based practice and family presence:
Paving the path for bedside nurse scientists. Journal of Emergency Nursing, 37(1), 9-16. doi:http://ezproxy.twu.edu:2079/10.1016/j.jen.2010.01.010

Polit, D. F., & Beck, C. T. (2010). Essentials of nursing research: Appraising evidence for nursing practice (7th ed.). Philadelphia, PA: Lippincott
Williams & Wilkins.

Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? an introduction to the PICOT format
for clinicians. Journal of the Canadian Chiropractic Association, 56(3), 167-171.
References
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