PICOT Question from week 1
P: Patients with advanced cancer
I: Keeping a pain journal
C: No interventions
O: Lower reported pain scored
T: in a period of 2 years
Review the resources found in the Week 2 Module and the Rating System for the Hierarchy of Evidence (Levels I-VII) found in Melnyk and Fineout-Overholt, 4th edition, Box 1.3 on page 18.
- State the approved PICOT question from Week 1 using the intervention
- Select one peer-reviewed nursing research article that supports the problem and/or intervention stated in the PICOT question and discuss the Level of Evidence found in the chosen article using Levels I-VII from the text (Reminder: The initial post requires two (2) references). Post the article as a pdf with the Initial Post.
Reviewing Evidence for Practice
NSG 5111
Evidence and Practice
Nova Southeastern University
Ron and Kathy Assaf College of Nursing
Goals of Evidence-Based Practice (EBP)
Improve patient interventions and outcomes
Cost-effective care
Reduce variations in patient care
Increase efficient and effective decision-making
Increased job satisfaction
Levels of Evidence/Evidence Hierarchies
Models are used to rate strength and quality of individual studies, position statements, clinical practice guidelines, systematic reviews, and other types of evidence
Posing the Question Using PICOT
Consistent PICOT format drives a successful search
Intervention questions: Asks what intervention most effectively leads to an outcome
Purpose of the PICOT intervention format:
Guides the systematic search of healthcare data bases to find the best and current answer to the question
Patient population (P)
Intervention (I)
Comparison intervention (C)
Outcome (O)
Time (T)
Question Template for an Intervention PICOT
In_____________(P), how does___________(I),
compared with _____________(C), affect _________(O)
within ___________(T).
Hints for Successful Searches
Start with a well formulated PICOT question
Patience-searching takes time and practice
Search all relevant data bases
Do not limit the search to all full text
Use key words from the PICOT question
Use Boolean connectors
AND narrows the search
OR expands the search
Do not hesitate to contact the NSU Library for assistance. They are a wealth of information and help!!
Search Strategies
WHO-WHAT-WHERE-WHY?
What is the purpose of the search?
Practice guidelines
Developing guidelines and need evidence
Comparing past, current, and future practices
Research study
Quality improvement project
Evidence-based practice project
Search Strategies: Where do I Start?
PubMed
Large database that includes over 20 million citations from various sources such as MEDLINE and on-line books. Full text for some sources
ScienceDirect
Online collection of published scientific research
Mosby’s Nursing Consult
Separate tab for EBP. Very good resource
Evidence-Based Nursing Monographs
GATEWAY (entrance to resources from National Library of Medicine)
Search Strategies
CINAHL ® (Cumulative Index of Allied Health Literature)
Begin with search terms. May combine terms using ‘and’, ‘or’
Called Boolean searching technique
Several choices to limit your results
Publication date
Author
Journal
Language
Full text, abstract only
Evidence-based practice
Randomized control trials
Sources
Filtered
Appraise the quality of studies and often make recommendations for practice
Systematic reviews; meta-analysis
Cochrane Database of Systematic Reviews
National Guideline Clearinghouse
Unfiltered
Primary literature reviews
Utilize specific search strategies in various databases (MEDLINE; CINAHL)) to find the best available evidence
The Joanna Briggs Institute
Membership required but many resources are free to non-members
Provides Best Practice Summary Sheets
International collaboration with nursing, medical and allied health researchers, clinicians, academics and quality managers
http://joannabriggs.org/
The Cochrane Collaboration
Over 4,000 reviews in the Cochrane Library
Plain language summaries are free
Membership needed for full guidelines
Interdisciplinary and multifocal
Interventions to improve question formulation in professional practice and self-directed learning
The effects of on-screen, point of care computer reminders on processes and outcomes of care
Best Practice Web Resources
Agency for Healthcare Research and Quality (AHRQ)
https://www.ahrq.gov/
https://www.ahrq.gov/prevention/guidelines/archive.html
https://www.ahrq.gov/gam/index.html
National Guideline Clearinghouse™
https://www.ahrq.gov/gam/updates/index.html
Large database of EBP guidelines and other documents
EBP
Clinical practice guidelines
Guidelines synthesis
Compare guidelines among groups
Example-Prevention of Pressure ulcers
Hartford Institute for Geriatric Nursing & Wound, Ostomy, and Continence Nurses Society
Professional Nursing Organizations with Published Guidelines
Oncology Nursing Society
https://voice.ons.org/topic/clinical-practice-guidelines
American Society of PeriAnesthesia Nurses (ASPAN)
https://www.aspan.org/
Registered Nurses’ Association of Ontario
https://rnao.ca/bpg
Guideline Central
https://www.guidelinecentral.com/
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Models of EBP
University of Iowa
Johns Hopkins Nursing EBP Model
Joanna Briggs Institute (JBI ) Model
Stetler Model
Evidence-Based Advancing Research and Clinical Practice Through Close Collaboration Model (ARCC)
References
Melnyk, B., & Fineout-Overholt, E. (2019) Evidence-based practice in nursing and health care. A guide to best practice (4rd ed.). Philadelphia: Wolters Kluwer.
Nova Southeastern University
Ron and Kathy Assaf College of Nursing (ACON)
NSG 5111 Evidence and Practice
Evidence Based Practice: Getting Started
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Evidence-Based Practice (EBP) Impact in Nursing:
A Paradigm Shift
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Evidence-Based Practice Movement
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Evidence-Based Practice translates current knowledge applied into common care decisions to improve care processes, improve patient outcomes, reduce costs, and empowers clinicians
It is a systematic methodology that integrates best scientific research ( external evidence), clinical expertise (internal evidence) and patient values and preferences
External Evidence
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Evidence generated through rigorous research
Systematic reviews
Meta-analyses
Evidence based theories
National and professional benchmarks
Opinion leaders and expert panels
Internal Evidence
Generated from Clinical Expertise:
Outcomes management projects
Quality improvement projects
Quality improvement data
Patient assessment and evaluation
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Patient Values and Preferences
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Patient care decisions made in the context of caring
Individual patient’s concerns and preferences
Patient-centeredness leads to patient centered care
Shared decision making to promote patient engagement
EBP-Impact on Nursing Practice
EBP must be successfully adopted and sustained by all key stakeholders (e.g. system leaders, policy makers, etc.).
EBP must be achieved across the organization culture to eliminate significant barriers EBP must incorporate a strategy application of “Team Strategies and Tools to Enhance Performance and Patient Safety
Nurses must have positive attitudes and desire additional knowledge and skills to face the significant barriers; then effectively demonstrate evidence-based practice interventions.
Magnet Recognition Program – Nurse leaders adopting EBP as a marker of excellence
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Building an Evidence-Based Practice
Cultivate a spirit of Inquiry (clinicians must be comfortable with and excited about asking questions about patient care and institutional or unit-based practices
Nurses and health professionals are encouraged to question current practices
Cadre of EBP mentors needed
Infrastructure with tools needed
Administrative support and leadership needed
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Steps of Evidence-Based Practice
P Patient Population
I Intervention or Issue of Interest
C Comparison intervention or group
O Outcome
T Time Frame
Ask Clinical questions in PICOT format
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Steps of Evidence-Based Practice
In teenagers (the patient population)
How does cognitive-behavioral skills building (the experimental intervention) compared to yoga (comparison intervention) affect anxiety (the outcome) after 6 weeks of treatment (time frame)?
Example of PICOT question:
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Steps of Evidence-Based Practice
Search for best evidence (conduct a systemic, integrated review of literature). Look for peer review citations
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Steps of Evidence-based Practice
Are the results of the study valid? (Are the results as close to the truth as possible?)
What are the results? (Did the intervention work? How Large was the treatment effect? Would replication of the study yield similar results?)
Will the results help me in caring for my patients? (Are the subjects in the studies similar to my patients? (Are the subjects in the studies similar to my patients? Are the benefits greater than the risks? It the treatment feasible? Does the patient desire the treatment?)
Critical appraisal of evidence found
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Steps of Evidence-Based Practice
Integrate the evidence with clinical expertise and patient preferences to make the best clinical decision
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Steps of Evidence-based Practice
Generate internal evidence through an EBP implementation or outcomes management project or a research study
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Models to Guide Implementation of EBP
The Advancing Research and Clinical practice (ARCC)
Clinical Scholar Model
Iowa Model of Evidence-Based Practice
John Hopkins Nursing of Evidence –Based Practice
The Model for Evidence-Based practice change
The Setler Model
The Promoting Action on Research Implementation in Health Services (PARIHS)
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Steps of Evidence-Based Practice
Evaluate the outcomes of the practice change based on evidence (Measure patient outcomes or health care quality to determine if this clinical decision was effective)
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Steps of Evidence-based Practice
Disseminate the outcomes of the evidence-based practice change (locally, regionally, nationally)
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Barriers to Evidence-based Practice
Staff lack EBP knowledge and skills
Lack of belief that EBP will result in better outcomes that traditional care
Amount of information published
Lack of time to appraise evidence
Overwhelming patient loads
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Barriers to Evidence-Based Practice
Lack of administrative support
Peer pressure to “not make waves”
Resistance to change
Lack of autonomy over practice
Lack of consequences for not implementing EBP
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References
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Philadelphia: WoltersKluwer/Lippincott Williams & Wilkins.
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