EvidenceBased Nursing Part Two Integrating EBP Knowledge into
Evidence-Based Nursing Part Two Integrating EBP Knowledge into Clinical Practice
Four Tools for Integration n Iowa Model for Evidence-Based Practice n Journal clubs n Critical Appraisal of Topics n Clinical Audit
Iowa Model for EBP
Highlights of the Model n Triggers: Problem-based and Knowledge- based n Organizational Priorities n Sufficiency of the Research Base n Appropriateness of change for the patient population/organization n Continuous feedback loops
Triggers
Triggers n Problem focused n Risk management data n Process improvement data n Internal / external benchmarking data n Financial data n Identification of clinical problem (first and last are original) n Knowledge focused n New research or other literature n Nat’l Agencies or Organizational standards n Philosophies of care n Questions from Institutional Standards Committee (first is new)
Priorities of the Institution
If Yes then…. n Form a team n Assemble relevant research & related literature n Critique and synthesize research for use in practice n Sufficient research to guide practice? (“no” is not a stopping point) n Develop a guideline or standard of practice n Pilot change in practice / is change appropriate? n Monitor process and outcome data / share results
Journal Clubs
Journal clubs n Teaching-based: emphasis on skill building, such as honing searching skills n Topic-based: often focused on critical appraisal n EBP skills-based: participants go through each step of EBP process n Can be nursing staff only or multidisciplinary n All clubs need a clinically meaningful context for their topics!
Critical Appraisal of Topics (CATS) n Assess the quality of a single study n Can results be applied to your patients?
Critical Appraisal of Topics n National Guideline Clearinghouse http: //www. guideline. gov n Journals such as Evidence Based Nursing n EBM Tools at Centre for Evidence-based Medicine site http: //www. cebm. net
Clinical Audit Examine your care practices and compare your results with clinical guidelines or best practice statements n Define best practice n Measure and compare n Act to achieve change
Audit Cycle (simplified) Defining quality Take action to improve Measuring and comparing
Reilly, L et al. “Reducing Foley Catheter Device Days in an Intensive Care Unit: Using the Evidence to Change Practice. ” AACN Advanced Critical Care 17(3): 272 -83
Change: the final step
Method Smackdown n Discuss strengths and weaknesses of each method/approach to integrating EBP n Best area(s) for application of a method? Image courtesy WWE
Method Review n Iowa Model for Evidence-Based Practice n Journal clubs n Critical Appraisal of Topics n Clinical Audit n Strengths and weaknesses n Best time/place for application
Good Luck!
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