Problem Solving Process (Evidence Based Practice)

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1. The need for evidence-based practice (EBP)

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Evidence based care improves the quality, safety, patient outcome and nurse satisfaction while reducing cost.

It allows for effective, timely and appropriate clinical decisions in response to the broad political, professional and societal forces present in today's health care environment.

It is important to translate best evidence into best practices at patient's bedside.

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2 key elements needed in EBP

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1. Best evidence - which is relying on research - based evidence.

Having the strongest available evidence.

2. Clinical expertise - application of available evidence safety and appropriately.

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2. Sources of best evidence

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1. Textbooks

2. Articles

3. Scientific journals

4. Quality improvement data

5. Risk management data

6. Standards of care

7. Infection control data

8. Chart review

9. Clinicians expertise

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Factors affecting evidence based practice

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Patient's : values, preferences, concerns, expectations

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3. PICOT

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(P) patient Population of interest

(I) intervention of interest

(C) comparison of interest

(O) outcome

(T) time

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(P) patient Population of interest

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Identifying patient by age, gender, ethnicity, and disease or health problem.

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(I) intervention of interest

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Which intervention is worthwhile to use in practice: a treatment, a diagnostic test, prognostic factor

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(C) comparison of interest

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What is the usual care, current intervention used in practice.

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(O) outcome

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What result do you wish to achieve or observe as a result of an intervention. (change in patient behavior, physical findings, patient perception.)

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(T) time

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What amount of time is needed for an intervention to achieve an outcome (or the amount of time needed to change patient's behavior)

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Important guidelines in using PICOT questions

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1. PICOT questions do not necessarily follow the format P-I-C-O-T.

2. I, C and T are not appropriate to be used in every question.

3. The goal is to ask a question that contains as many PICOT elements as possible.

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4. The 0-6 steps in evidenced - based practice

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0. Cultivate a spirit of inquiry

1. Ask a clinical question using PICOT

2. Collect the best evidence

3. Critically appraise the evidence

4. Integrate evidence

5. Evaluate the practice decision or change.

6. Share the Outcomes with others.

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0. Cultivate a spirit of inquiry

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Inquire continuously to become an effective change agent and to be able to foster optimal patient care.

Inquire intelligently to gain knowledge and skills associated with EBP, and maintain a commitment to provide the best care possible for your patients and families.

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1. Ask a clinical quotation using PICOT

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Think about a problem that is fine consuming, costly or illogical.

It is a situation faced during patient care or a trend you observe in a nursing unit.

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2. Collect the best evidence

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Look in yo searchable scientific literature

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3. Critically appraise the evidence

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This is the most difficult step in the EBP process.

It involves analyzing available evidence

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4. Integrate evidence

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If you decide that the evidence is strong and applicable to your patients and to the clinical situation, the first step is simply to apply the research in your plan of care

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5. Evaluate the practice decision or change.

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Evaluating if outcome.

How effective was the clinical decision for your patient or practice setting.

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Share the Outcomes with others.

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Communicating the results of an EBP implementation.

When a practice change occurs in a nursing unit level, the first group to discuss the outcomes of change is the clinical staff in that unit.

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Elements of evidence - based articles

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1. Abstract

2. Introductio

3. Literature review/background

4. Narrative

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1. Abstract

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A brief summary that tells you if the article is research or is clinically based. It summarize the purpose of the article.

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2. Introduction

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Contains more information about the purpose of the article.

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3. Literature review / background

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Offers an agreement about what led the author to conduct a study or report on a clinical topic.

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4. Narrative

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The middle section of an article that describes a clinical topic ex. Nature of disease and the appropriate nursing interventions.

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Parts of a narrative

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1. Purpose statement

2. Methods of design

3. Conclusion / result

4. Clinical implications

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1. Purpose statement

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Explains the focus or intent of a study

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2. Methods of design.

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Explain the type of study that was conducted.

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3. Conclusion / result

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Include a statistical analysis if it is a quantitative study.

*a qualitative study summarizes the descriptive themes and ideas that arise from the researchers analysis or data.

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4. Clinical implications

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Researcher explains how to apply findings in a practice setting for the type of subject studied.