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EBN 6/13/2021 EBN dr yekefalah-phd of nursing 2012 2

Objectives • Describe evidence based practice from a nursing perspective • Compare and contrast evidence based nursing and medicine • Identify challenges to using evidence based practice in nursing • Identify resources relevant to nursing 6/13/2021 EBN dr yekefalah-phd of nursing 2012 3

What is - Evidence? Anything that provides material or information on which a conclusion or proof may be based; used to arrive at the truth, used to prove or disprove the point at issue. (Webster) 6/13/2021 EBN dr yekefalah-phd of nursing 2012 4

What is ‘evidence-based’? Knowledge about ‘what works’ must come from … Intervention, not description Evaluation, not common sense 6/13/2021 EBN dr yekefalah-phd of nursing 2012 5

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Increasing Medical Knowledge/day • 27 Kg of Guidelines • New papers 3, 200 • Medline New articles 1, 000 • RCT’s 60 10

Understanding Some Work Processes Inherently Dangerous Medication administration – 770, 000 annually killed or injured from adverse drug events in hospitals – In two studies, 34 -38% of 6/13/2021 medication errors occurred EBN dr yekefalah-phd of nursing 2012 11

Outdated knowledge of practitioners because of: Time spent to publish new findings as books (considering the half-life & doubling time of knowledge) Coverage of knowledge included in books Large volume of a book cause never be fully seen Carrying books in hand or in mind are impossible 6/13/2021 EBN dr yekefalah-phd of nursing 2012 12

Evidence Based Medicine Evidence that gets incorporated into practice Available evidence 6/13/2021 EBN dr yekefalah-phd of nursing 2012 EBM helps shift this balance so that more research gets translated into medical practice 14

Definition Evidence-based nursing “Process by which nurses make clinical decisions using best available evidence, clinical expertise, & patient preferences in the context of available resources” 6/13/2021 EBN dr yekefalah-phd of nursing 2012 15

Definitions Evidence-based nursing is an approach to health care practice that enables nurses to provide the highest quality care based on the best evidence available to meet the needs of their patients. Melnyk & Fineout-Overholt, 2005 The integration of the best research evidence with clinical expertise and patient values. 6/13/2021 EBN dr yekefalah-phd of nursing 2012 16

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EBP in Nursing 6/13/2021 EBN dr yekefalah-phd of nursing 2012 18

What is Evidence-based nursing? /? 6/13/2021 EBN dr yekefalah-phd of nursing 2012 19

Evidence-Based Nursing • Asking Answerable Questions Best Evidence Patient Preference Clinician’s experience • Finding the Best Evidence • Appraising Validity of Evidence • Integrating Evidence (clinician/patient) • Evaluating Effectiveness Sackett et al (2000) . Applied to diagnosis, interventions (treatments), and outcomes 6/13/2021 EBN dr yekefalah-phd of nursing 2012 20

What is Evidence-Based Nursing Practice • Builds on process of research use, but more encompassing • More specific than term ‘best practices’ • Does not foster rigid adherence to standardized guidelines • Recognizes the role of clinical expertise • 6/13/2021 EB nursing practice is a state of mind! 21 EBN dr yekefalah-phd of nursing 2012

What Is Evidence-based Practice? Professional Judgment Best available evidence Client Values Best Professional Available Judgment Evidence • EBP is a decision-making approach that places emphasis on evidence to: – guide decisions about which interventions to use; 6/13/2021 EBN dr yekefalah-phd of – evaluate the effects nursing 2012 of an intervention. 22

Why Practice EBN? • Standard of Care: EBNER recommendations • Assures patient receives most up-to-date care possible • Assists practitioner in dealing with increasing volume of medical literature • Allows patient and practitioner to work 6/13/2021 dr yekefalah-phd of together to make. EBNinformed decisions nursing 2012 23

Why Evidence-Based Practice in Nursing • Potential to improve quality, reduce variations in care • Focus on practices that result in best possible outcomes at possibly lower cost • Provides a way to keep pace with advances 6/13/2021 EBN dr yekefalah-phd of nursing 2012 24

Why Evidence-Based Practice in Nursing • Potential to narrow the ‘research-practice gap’: adoption of research findings into practice can take as long as 17 years (Balas & Boren) • Provides a means to answer problematic clinical • practice issues • supports/improves clinical decision-making skills • Bedside nurse as conduit!! 6/13/2021 EBN dr yekefalah-phd of nursing 2012 25

Closing the Gap… EBN leads to: • improved patient outcomes • avoidance of unnecessary procedures • reduction of complications Nurses should feel empowered to change practice using proven methods 6/13/2021 EBN dr yekefalah-phd of nursing 2012 26

Misconception EBN is not a collection of statistical summaries, ignoring patient preferences and clinical expertise. 6/13/2021 EBN dr yekefalah-phd of nursing 2012 27

Goals of EBN • Provide practicing nurses with evidencebased data • Resolve problems in the clinical setting • Introduce innovation • Reduce variations in nursing care • Assists with efficient and effective decisionmaking 6/13/2021 EBN dr yekefalah-phd of nursing 2012 28

The Ultimate Goal Keeping up with valid information to provide quality patient care and feel good about what we do. Information Mastery 6/13/2021 EBN dr yekefalah-phd of nursing 2012 29

Values and Preferences EBN - integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities … 6/13/2021 EBN dr yekefalah-phd of nursing 2012 30

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Evidence-based Steps 1. 2. 3. 4. 5. 6/13/2021 Formulation of a question Literature search Critical appraisal Clinical decision Performance evaluation EBN dr yekefalah-phd of nursing 2012 32

What EBN originally advocated… Ask a Focused Clinical Question Become a life-long learner Go to the medline and search for the Best available evidence Incorporate it in your practice 6/13/2021 Appraise it Fordr validity EBN yekefalah-phd nursing 2012 of 33

• ﻣﺮﺍﺣﻞ 6/13/2021 EBN dr yekefalah-phd of nursing 2012 34

EBN Steps: • • • Problem Identification Discovery Critique Summary Translation Evaluation 6/13/2021 EBN dr yekefalah-phd of nursing 2012 35

Step 1: • Problem Identification: Converting information needs into an answerable question – PICO • Patient or Problem • Intervention • Comparison Intervention • Outcomes 6/13/2021 EBN dr yekefalah-phd of nursing 2012 36

: PICO ﻓﺮﻣﻮﻝ • P= Participant • I= Intervention • C= Comparison • O= Outcome 6/13/2021 EBN dr yekefalah-phd of nursing 2012 37

What is the 1 st step toward EBP for the practicing nurse? • Asking good clinical questions • Nurses must be empowered to ask critical questions in the spirit of looking for opportunities to improve nursing care and patient outcomes • Risk-taking environment 6/13/2021 EBN dr yekefalah-phd of nursing 2012 43

Clinical Nursing Questions • In postoperative patients, does prn or ATC analgesic administration yield better pain relief? • Among critically ill patients, is controlled or open visitation more effective in reducing patient anxiety? 6/13/2021 EBN dr yekefalah-phd of nursing 2012 44

What kind of questions might the Nurse Manager ask? • On medical-surgical units, do 12 hour or 8 hour shifts result in more medication errors? 6/13/2021 EBN dr yekefalah-phd of nursing 2012 45

Key Questions to Ask When Considering EBP • Why have we always done “it” this way? • Do we have evidence-based rationale? • Or, is this practice merely based on tradition? • Is there a better (more effective, faster, safer, less expensive, more comfortable) method? • • What approach does the patient (or the target group) prefer? 6/13/2021 EBN dr yekefalah-phd of 46 • What do experts in this nursing 2012 specialty recommend?

Key Questions to Ask When Considering EBP • Do the findings of recent research suggest an alternative method? • Are organizational barriers inhibiting the application of best practices in this situation? • Is there a review of the research on this topic? • Are there nationally recognized standards of care, practice guidelines, or protocols that 6/13/2021 EBN dr yekefalah-phd of 47 nursing 2012 apply?

• Once we agree upon the question that poses an opportunity for improvement, then we must find the evidence • Where should we look? • Are all forms of evidence equivalent in quality? 6/13/2021 EBN dr yekefalah-phd of nursing 2012 48

Step 2: • Discovery: • Finding, with maximum efficiency, the best evidence with which to answer the question 6/13/2021 EBN dr yekefalah-phd of nursing 2012 49

Step 3: • Critique: • Determining the merit, feasibility and utility of evidence. – The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. (http: //www. evidence-basedmedicine. co. uk) 6/13/2021 EBN dr yekefalah-phd of nursing 2012 51

Step 4: • Summary: • Combining findings from all evidence to make a practice recommendation 6/13/2021 EBN dr yekefalah-phd of nursing 2012 53

Step 5: • Translation: Placing evidence into context, incorporating recommendation into a clinical setting or organization 6/13/2021 EBN dr yekefalah-phd of nursing 2012 55

Step 6: • Evaluation: • Determining and measuring the effectiveness of the practice change over time 6/13/2021 EBN dr yekefalah-phd of nursing 2012 57

• Most nurses agree that EBP is important… but how do we make it happen? 6/13/2021 EBN dr yekefalah-phd of nursing 2012 59

Factors Contributing to Emphasis on Evidence-Based Nursing Practice • Scientific knowledge expansion – Knowledge expands exponentially q 2 yrs • Knowledge availability -- The Internet • Highly educated nurses in clinical settings – APNs – focusing on evidence-based clinical problem -solving – Clinical Nurse Researchers – DNP Movement 6/13/2021 EBN dr yekefalah-phd of nursing 2012 60

Factors Contributing to Emphasis on Evidence-Based Nursing Practice • Aggressive pursuit of costeffectiveness • Focus on quality of care, Risk & error reduction • Highly educated consumers • Increased attention to institutional image – 6/13/2021 EBN dr yekefalah-phd of nursing 2012 61

What is Evidence? • Primary Studies: – Clinical Trials – Randomized Controlled Trials – Multicenter studies • Secondary Studies – Reviews – Meta-analyses 6/13/2021 EBN dr yekefalah-phd of nursing 2012 62

Establishing Validity • What are the results of the study? • Are the results valid? • How do the results affect the patient? 6/13/2021 EBN dr yekefalah-phd of nursing 2012 63

Levels of Evidence 6/13/2021 EBN dr yekefalah-phd of nursing 2012 64

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AACN Levels of Evidence (Armola, et al. , C C Nurse, 2009) • Level A • Level B • Level C • Level D • Level E • Level M 6/13/2021 • Meta-analysis or metasynthesis of multiple controlled studies, supporting a specific action • Controlled, randomized, or nonrandomized studies, supporting a specific action • Qualitative, descriptive or correlational studies or systematic reviews with consistent results • Peer-reviewed prof. organ. standards with studies to support them • Theory-based evidence from expert opinion or case studies • Manufacturer’s recommendations only EBN dr yekefalah-phd of nursing 2012 66

Levels of Evidence • I • • • Evidence - Systematic reviews, meta-analysis RCTs, EB clinical practice guidelines based on RCTs II Evidence - One well designed RCT III Evidence - CTs without randomization IV Evidence - Well-designed case control or cohort studies V Evidence - Systematic reviews of descriptive or qualitative studies VI Evidence - Single descriptive or qualitative study VII Evidence – Opinions of authorities, reports of 6/13/2021 EBN dr yekefalah-phd of 67 nursing 2012 experts

Levels of Evidence Hierarchy (Stetler et al. )* • Level I: Meta-analysis of multiple RCTs • (‘gold standard’) • Level II: Individual RCTs • Level III: Quasi-experimental • Level IV: Non-experimental; qualitative • Level V: Program evaluation; QI; RU; case reports 6/13/2021 VI: Opinion of respected EBN dr yekefalah-phd of • Level authorities nursing 2012 68

Strength of Evidence • • • Level I - meta-analysis of multiple studies Level II - experimental studies, RCTs Level III - quasiexperimental studies Level IV - nonexperiemental studies Level V - case reports, clinical examples AHCPR/AHRQ • At what level is most nursing evidence? 6/13/2021 EBN dr yekefalah-phd of nursing 2012 69

Preprocessed Evidence 6/13/2021 EBN dr yekefalah-phd of nursing 2012 (A. Di. Censo, 2009) 70

Types of Research Experimental Evidence Experimental Quasi-Experimental Counterfactual Social Ethics Public Consultation Cost-Benefit Cost-Effectiveness Cost-Utility Econometrics Implementation Evidence Ethical Evidence Impact Evidence Economic and Econometric Evidence 6/13/2021 Quasi-Experimental Qualitative Theories of Change Statistical Modelling Descriptive Analytical Evidence Surveys Qualitative Attitudinal Evidence Linear and Logistic yekefalah-phd of Regression EBN dr nursing 2012 Surveys Admin Data Comparative Qualitative 71

CRITICAL APPRAISAL 6/13/2021 EBN dr yekefalah-phd of nursing 2012 72

Critical Appraisal Questions • Are the results of the study valid? • What were the results? • Will the results help me in caring for my patients? 6/13/2021 EBN dr yekefalah-phd of nursing 2012 73

Critical Appraisal terminology • Null Hypothesis • P-value • Confidence intervals • Relative vs Absolute Risk Reduction 6/13/2021 EBN dr yekefalah-phd of nursing 2012 74

Null hypothesis • Tylenol is better than Advil for headaches • States that there is no relationship between the variables being • Exercising 30 minutes studied. a day is good for your health • Opposite of what you are trying to find out. • Lefthanders are prone to accidents 6/13/2021 EBN dr yekefalah-phd of nursing 2012 75

P-value • Probability that the • Small p-value outcomes are due to dismiss chance • Large p-value • Accepted reference means that point is. 05 anything is possible (chance, actual effect, or • Less than. 05 is confounding statistically significant factors) 6/13/2021 EBN dr yekefalah-phd of nursing 2012 76

Confidence intervals • The ranges of values within which a researcher can be confident that the population value falls. • A 95% confidence interval (CI 95) means that one can be 95% confident that the population value falls within a certain range • Example: A study states that 40% of a sample of 1000 people are smokers with a CI of 95% +/- 3% means the frequency of smoking is between 37% and 43%. 6/13/2021 EBN dr yekefalah-phd of nursing 2012 77

Risk RR (Relative Risk) is the risk for achieving an outcome in the treatment group relative to that in the control group 6/13/2021 EBN dr yekefalah-phd of nursing 2012 78

Challenges of EBN • • New, Unfamiliar Need to develop good search strategies Must identify best databases Need to do critical appraisals • Much of relevant research is qualitative; need more systematic reviews of qualitative research 6/13/2021 EBN dr yekefalah-phd of nursing 2012 79

Challenges and Misconceptions • Merely a collection of statistics? • Need more qualitative research • Nurses need to develop good search strategies • Nurses must learn to do critical appraisals • Faculty members must embrace and learn EBP 6/13/2021 EBN dr yekefalah-phd of nursing 2012 80

Problems with Finding and Using Evidence • Sheer amount and flow of information/research • Variable quality of research outputs • Problems of publication bias • Need for the balance of evidence • Limitations of single studies 6/13/2021 EBN dr yekefalah-phd of nursing 2012 81

BARRIERS TO EVIDENCE-BASED PRACTICE • Knowledge… lack of knowledge/awareness. … unfamiliar with guidelines and guideline accessibility • Attitudes …. lack of confidence in the guideline developer, lack of motivation to perform the guideline recommendations • Behaviors …. inability to incorporate patient preferences into the clinical decision making 6/13/2021 EBN dr yekefalah-phd of 82 nursing 2012 process

BARRIERS TO EVIDENCE-BASED PRACTICE • Overwhelming patient workloads • Misperceptions about EBP and research • Lack of time and resources to search for and appraise evidence • Organizational constraints – lack of support • Peer pressure to continue with practices that are steeped in tradition – “we’ve always done it this way and we are not changing now” 6/13/2021 Melnyk & Fineout-Overholt EBN dr yekefalah-phd of 2005 nursing 2012 83

Overcoming the Barriers Summary of Barriers Strategies for Success • Administrative support • Teacher/educator/stakeholder support • Secure financial resources • Provide high-quality training to ensure program fidelity • Align intervention with school/community goals, policies and programs • Make program outcomes visible • Cultural competency • Develop strategy for staff 84 6/13/2021 EBN dr yekefalah-phd of nursing 2012 turnover • Difficult to find the right program • Fear of change • Organizational barriers: personnel rules, staff turnover • Limits to the flexibility of the system

Creating an EBP culture • Internal Expertise – Identified leaders for EBP – Collaboration with outside experts • Educating Frontline staff – Enhancing staff awareness and understanding – Grooming staff to become leaders in EBP 6/13/2021 EBN dr yekefalah-phd of nursing 2012 94

Strategies • Strong supportive leadership • Mentorship • Staff education regarding research and evidence based practice. • Time to conduct or use research • Routine performance expectations in research use (Fink, et al, 2005)

Key Message RECOMMENDATION NO. 1 Nurses • Remove should scope-ofpractice to practice the full barriers extent of their education & training 6/13/2021 EBN dr yekefalah-phd of nursing 2012 96

The many faces of advanced practice registered nurses in 2011 High quality, safe, affordable health care provided by teams of health care professionals 6/13/2021 EBN dr yekefalah-phd of nursing 2012 97

“Messaging” ü Barriers to practice reduce access to care ü Main issue is access to care and this should define our focus 6/13/2021 EBN dr yekefalah-phd of nursing 2012 98

Key Message Nurses should achieve higher levels of education & training through an improved education system that promotes seamless academic progression 6/13/2021 RECOMMENDATION NO. 2 • Implement nurse residency programs New graduates and nurses in transition EBN dr yekefalah-phd of nursing 2012 99

Key Message Nurses should achieve higher levels of education & training through an improved education system that promotes seamless academic progression 6/13/2021 RECOMMENDATION NO 3 • Increase the proportion of nurses with a baccalaureate degree to 80% by 2020 EBN dr yekefalah-phd of nursing 2012 100

Key Message Nurses should achieve higher levels of education & training through an improved education system that promotes seamless academic progression 6/13/2021 RECOMMENDATION NO. 4 • Ensure that nurses engage in lifelong learning EBN dr yekefalah-phd of nursing 2012 101

Institute of Medicine October 2010 Report: The Future of Nursing Leading Change, Advancing Health 1. Remove scope-of-practice barriers 2. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts 3. Implement nurse residency programs 4. Increase the proportion of nurses with a baccalaureate degree to 80% in 2020 5. Double the number of nurses with a doctorate by 2020 6. Ensure that nurses engage in lifelong learning 7. Prepare and enable nurses to lead change to advance health 8. Build an infrastructure for the collection and analysis of interprofessional health care workforce data 6/13/2021 EBN dr yekefalah-phd of 102 nursing 2012

Key point: EBN should be considered as: - A part of educational curriculum 6/13/2021 EBN dr yekefalah-phd of nursing 2012 103

LITERATURE SEARCHING 6/13/2021 EBN dr yekefalah-phd of nursing 2012 104

Resources to Support Evidence-Based Practice • • 6/13/2021 Government agencies Cochrane Collaboration Professional Organizations Benchmark Institutions EBN dr yekefalah-phd of nursing 2012 105

AHRQ – Agency for Healthcare Research and Quality

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Cochrane Collaboration • “an international, independent, not-for-profit organization of over 27, 000 contributors from more than 100 countries, dedicated to making up-to-date, accurate information about the effects of health care readily available worldwide. • Contributors produce systematic assessments of healthcare interventions, known as Cochrane Reviews, which are published online in The Cochrane Library. • Rely heavily on RCTs • Primarily focused on effectiveness of interventions, more medical and pharmaceutical than nursing 6/13/2021 EBN dr yekefalah-phd of nursing 2012 109

Cochrane Collaboration http: //www. cochrane. org 6/13/2021 EBN dr yekefalah-phd of nursing 2012 110

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Professional Nursing Organizations Supporting Evidence-Based Practice • • • 6/13/2021 AACN AWHONN AORN ONS Sigma Theta Tau EBN dr yekefalah-phd of nursing 2012 112

Am. Assoc. of Critical Care Nurses Succinct dynamic directives…supported by evidence to ensure excellence in practice and a safe and humane work environment. • • • Venous Thromboembolism Prevention Oral Care in the Critically Ill Noninvasive BP Monitoring Verification of Feeding Tube Placement Ventilator Associated Pneumonia Dysrthymia Monitoring • Published since 2005 • Available free on AACN website • Include ppt presentations and audit tools 6/13/2021 EBN dr yekefalah-phd of nursing 2012 113

Oncology Nursing Society • EBP Resource Center • http: //onsopcontent. ons. org/toolkits/evidence/ • Also provides topical toolkits, on specific topics, plus: • How To Find The Evidence • How To Critique Evidence • How To Develop An Evidence Based Presentation • Evidence Based Practice Education Guidelines • Evidence on Clinical Topics • How to Change Practice • Levels of Evidence Table 6/13/2021 EBN dr yekefalah-phd of nursing 2012 114

Sigma Theta Tau EBP Initiatives • Strategic Plan • Online Resources – NKI http: //www. nursingknowledge. org > 200 resources for EBP – some free, some for purchase • New Award for EBP (formerly Clin Scholarship) • Conferences – – 6/13/2021 International EBP and Research Congress July, 2010 – Orlando July, 2011 – Cancun July, 2012 – Australia EBN dr yekefalah-phd of nursing 2012 115

Journals Supporting EBP – – Evidence-Based Nursing Online Journal of Clinical Innovations World. Views on Evidence-Based Nursing The Online Journal of Knowledge Synthesis for Nursing – (archived, no longer being published) – Reflections on Nursing Leadership (Vol 28, 2) 6/13/2021 EBN dr yekefalah-phd of nursing 2012 116

Resources Pub. Med/Medline • Citations and Abstracts • Includes over 4600 journals worldwide • More than 17 million citations • Approximately 1/3 full text articles available • Uses Me. SH controlled vocabulary • Updated daily • Available anywhere, anytime • Searching help available • Must do one’s own quality filtering 6/13/2021 EBN dr yekefalah-phd of • Must learn how to search the database nursing 2012 117

Medline: • The National Library of Medicine in Maryland, USA produces Medline (Index Medicus). • It contains over 73, 000 citations indexed as medical education and over 300, 000 additional citations that are considered educationally relevant. 6/13/2021 EBN dr yekefalah-phd of nursing 2012 118

CINAHL: • The Cumulative Index to Nursing and Allied Health Literature is the world’s largest database for nursing and the professions allied to medicine • Although there are less than 1, 500 citations indexed as medical education there are over 100, 000 educationally relevant ones that could inform a medical education query 6/13/2021 EBN dr yekefalah-phd of nursing 2012 119

Resources CINAHL • • Dates back to 1981 Contains more than a million records Indexes almost 3, 000 journals Searchable cited references for more than 1, 200 journals • Full text for 71 journals • Covers nursing, biomedicine, health science librarianship, alternative/complementary medicine, consumer health and 17 allied health disciplines • Now features Clinical Query Functionality 6/13/2021 EBN dr yekefalah-phd of nursing 2012 120

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Evidence-Based Policies and Indicator Systems Conference, 2003 3 0 0 2 B E / k u. c a. r u d. m e c / / : p t t h 6/13/2021 EBN dr yekefalah-phd of nursing 2012 122

Embase: • This is the second largest medical database and is owned by Elsevier Science, Netherlands. • Embase contains over 43, 000 citations indexed as medical education and more than 100, 000 that are related to education in a health environment. 6/13/2021 EBN dr yekefalah-phd of nursing 2012 123

ERIC: • The Education Resource Information Centre is the world’s largest education database (1, 000 + records) • Although the emphasis on primary and secondary education, there are over 17, 000 citations related to medical education • Many more will be relevant in a supporting context, providing evidence in education that could be applied to medical education 6/13/2021 EBN dr yekefalah-phd of nursing 2012 124

British Education Index • The British Education Index is much smaller than ERIC but contains citations that are relevant to answering queries in medical education 6/13/2021 EBN dr yekefalah-phd of nursing 2012 125

Psyc. INFO: • While Psyc. INFO obviously concentrates on psychiatric and psychological content, there are over 4, 000 records indexed as medical education with well over 100, 000 concerning education in a broader context, as well as teaching and learning. 6/13/2021 EBN dr yekefalah-phd of nursing 2012 126

Additional Indexed Databases • Allied and Complementary Medicine Database (AMED) • Applied Social Sciences Index and Abstracts (ASSIA) • British Nursing Index (BNI) • Health Management Information Consortium (HMIC) • SOCIOFILE 6/13/2021 EBN dr yekefalah-phd of nursing 2012 127

Models of EBP • • John Hopkins Model Stetler Model CURN Iowa Model of Evidence Based Practice 6/13/2021 EBN dr yekefalah-phd of nursing 2012 128

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Steven’s ACE Star Model Summary • Synthesize all research into a single meaningful whole • This step differentiates research utilization from Evidence-based practice • Can be called evidence synthesis • Increase power and effect of data • Reduce bias • Assess consistencies • Establish generalizability • Reduce data into an manageable form 6/13/2021 EBN dr yekefalah-phd of nursing 2012 130

Steven’s ACE Star Model • • • Discovery Summary Translation Implementation Evaluation 6/13/2021 EBN dr yekefalah-phd of nursing 2012 131

Steven’s ACE Star Model Discovery • Original research • Conduct a literature search utilizing recognized techniques 6/13/2021 EBN dr yekefalah-phd of nursing 2012 132

Steven’s ACE Star Model Translation • Scientific evidence is considered in the context of clinical expertise and values • Results in clinical practice guidelines, best practices, protocols, standards or clinical pathways 6/13/2021 EBN dr yekefalah-phd of nursing 2012 133

Steven’s ACE Star Model Implementation • Translation of research into practice • Where changes take place 6/13/2021 EBN dr yekefalah-phd of nursing 2012 134

Steven’s ACE Star Model Evaluation • Impact of the change is measured • Assess variables (health outcomes, efficiency, cost or satisfaction) 6/13/2021 EBN dr yekefalah-phd of nursing 2012 135

Iowa Model • Successfully implemented since 1994 internationally • Infuses research into practice to improve quality of care • Planned change principles integrate research and practice • Utilizes a multidisciplinary team approach 6/13/2021 EBN dr yekefalah-phd of • Utilizes feed-back loops nursing 2012 136

Why the Iowa Model? • Multiple resources available to aid in implementation • Algorithm that can easily be applied to practice • Applicable to quality improvement projects as well as nursing research 6/13/2021 EBN dr yekefalah-phd of nursing 2012 137

Problem Focused Triggers Consider other triggers NO Knowledge Focused Triggers Priority for Organization YES Form a team 6/13/2021 EBN dr yekefalah-phd of nursing 2012 138

Assemble Relevant Research & Related Literature Critique and Synthesize Research for Use in Practice Sufficient Research? Pilot Change in Practice 6/13/2021 Base Practice on other Types of Evidence EBN dr yekefalah-phd of nursing 2012 Conduct Research 139

Continue to Evaluate quality Care and New Knowledge No Should we Adopt this change into practice? Disseminate Results 6/13/2021 EBN dr yekefalah-phd of nursing 2012 Yes Institute Change Monitor and Analyze Structure, Process, and Outcome Data 140

Resources • Yale University Nursing Library and Information Resources http: //www. med. yale. edu/library/nursing/education/ebhc 2. ht ml • Oncology Nursing Society http: //onsopcontent. ons. org/toolkits/evidence/ • United States Department of Health and Human Services – Agency for Healthcare Research and Quality http: //www. ahrq. gov/clinic/epcix. htm • University of Iowa Hospitals and Clinics Nursing Services and Patient Care http: //www. uihealthcare. com/depts/nursing/rqom/evidenceb 6/13/2021 EBN dr yekefalah-phd of 141 asedpractice/index. html nursing 2012

Resources (con’t) • University of Texas Health Science Center at San Antonio – Acedemic Center for Evidence. Based Practice http: //www. acestar. uthscsa. edu/About. htm • Medical Library Association – Nursing and Allied Health Resources Section http: //nahrs. library. kent. edu/resource/symposium/ • University of Minnesota – Evidence-based Health Care Project http: //evidence. ahc. umn. edu/ebn. htm 6/13/2021 EBN dr yekefalah-phd of nursing 2012 142

Resources Addressing Barriers to Learning. (2007). Evidence-based practices in schools: Concerns about fit and implementation. UCLA Center, 12(3). Dunifon, R. , Duttweiler, M. , Pillemer, K. , Tobias, D. , & Trochim, W. M. K. (2004). Evidence-based extension. Journal of Extension, 42(2). Forman, S. F. , Olin, S. S. , Hoagwood, K. E. , Crowe, M. , & Saka, N. (2008). Evidence-based interventions in schools: Developers’ Views of implementation barriers and facilitators. School Mental Health, 1. Henderson, M. L. , Mathias-Humphrey, A. , & Mc. Dermott, M. J. (2008). Barriers to effective program implementation: Rural school-based probation. Federal Probation, 72(1). Identifying barriers to evidence-based uptake. (2006). National Institute of Clinical Studies, Melbourne VIC. Research Development Associates. Evidence-based Practices. Power Point retrieved from http: //www. resourcedevelopment. net/projects/workshops. html 6/13/2021 EBN dr yekefalah-phd of nursing 2012 143

References • Chitty, K. K. (2005). Professional nursing: Concepts and challenges. 4 th ed. Philadelphia: Saunders. • Spector, N. (n. d. ). Evidence-Based Health Care in Nursing Regulation. Retrieved on October 8, 2006 from Nation Council of State Boards of Nursing web site on World Wide Web: http: //www. ncsbn. org/pdfs/Evidencebased_NSpector. pdf#s earch=%22 evidence%20 based%20 practice%20 in%20 nurs ing%22 • Yale University. (2005). Evidence-Based Practice. Nursing Library and Information Resources. Retrieved on October 8, 2006 from World Wide Web: 6/13/2021 EBN dr yekefalah-phd of 144 http: //www. med. yale. edu/library/nursing/education/ebhc 2. nursing 2012 html

REFERENCES • Burns & Grove (2005). The Practice of Nursing Research (5 th ed). St. Louis: Elsevier Saunders • • Polit & Beck (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice. Philadelphia : Lippincott Williams & Wilkins • Melnyk & Fine-Overholt (2005). Evidence-Based Practice in Nursing & Health Care. Philadelphia: Lippincott Williams & Wilkins • ACE Star Model: http: //www. acestar. uthscsa. edu/Learn_model. htm 6/13/2021 EBN dr yekefalah-phd of nursing 2012 145