Description
Instructor’s Commentary
Back in module one, we discussed what Evidence-Based Practice is and why it is important to nursing. In module one’s commentary, it was said that according to Polit and Beck (2022) EBP is “a practice that involves making clinical decisions based on clinical judgment, patient preferences, and on the best available evidence, usually evidence from disciplined research” (p. 384). When nursing uses evidence in their practice patients have better outcomes, nursing care becomes more efficient, errors within the decision-making process are less frequent and consumers become more informed when making decisions.
Evidence can be used in nursing practice as a basis for Nursing care processes such as assessment, diagnosis, treatment, and evaluation. Policies and procedures that guide nursing practice within an organization. Patient care management tools such as care maps, standard order sets, and critical paths care decisions regarding individual patient needs.
Knowing how important EBP is to nursing practice, why are there still barriers to deliver EBP care to patients. Barriers include organizational constraints, lack of time and resources, EBP knowledge and skills, misconceptions or negative attitudes about research and evidence-based care, and a culture steeped in tradition. So how can nurses overcome barriers and be facilitators in the delivery of the best care possible?
Polit and Beck (2022) discuss the major steps in Evidence-Based Practice:
Step 1: Ask a well-worded clinical question.
Step 2: Acquire: Search for and retrieve the best evidence to answer the question.
Step 3: Appraise: Critically appraise the evidence for validity and applicability to the problem and situation.
Step 4: Apply: after integrating clinical expertise, patient preferences, and local context, apply it to clinical practice.
Step 5: Assess: Evaluate the outcome of the practice change. (p. 315).
In this course, we have gone through steps 1-3 and now we need to look at step 4. Once we have the findings how do we disseminate the information to our colleagues? How do we get our colleagues on board? How can a change be made?
As nurses, we need to have a foundation of different change theories (Change Curve Model, Kotter and Cohen’s Model of Change, Roger’s Diffusion of Innovations, and the Transtheoretical Model of Health Behavior Change) to help move everyone forward. Nurses also should understand the different models of the EBP process (IOWA Model, John Hopkins, Stetler Model to name a few).
These processes can take time before an EBP is applied. Then once applied to practice it needs to be evaluated
ASSIGNMENT:
After reviewing module seven overview, discuss one possible barrier of implementing EBP and one way you could remove that barrier.
Discuss what is statistical and clinical significance and which do think is more important to your clinical practice.
How could you disseminate research to others?
Unformatted Attachment Preview
Chapter 18
Putting Research Evidence
Into Practice: Evidence-Based
Practice and Practice-Based
Evidence
Test Yourself!
Copyright © 2022 Wolters Kluwer. All Rights Reserved.
Test Your Knowledge:
Enhancing Applicability #1
• Five nursing inquiries will be briefly described. For each,
indicate whether you think the strategy represents:
– A. Comparative effectiveness research
– B. Pragmatic clinical trial or
– C. Neither CER nor a pragmatic trial
Please answer A, B, or C for each question.
2
Copyright © 2022 Wolters Kluwer. All Rights Reserved.
Test Your Knowledge:
Enhancing Applicability #2
1. Loughlin conducted a trial that compared the effect of
music versus massage on reducing anxiety in nursing
home residents with dementia.
– A. Comparative effectiveness research
– B. Pragmatic clinical trial
– C. Neither CER nor a pragmatic trial
3
Copyright © 2022 Wolters Kluwer. All Rights Reserved.
Test Your Knowledge:
Enhancing Applicability #3
2. Forbes conducted a trial that was designed and modified
based on the application of the PRECIS tool.
– A. Comparative effectiveness research
– B. Pragmatic clinical trial
– C. Neither CER nor a pragmatic trial
4
Copyright © 2022 Wolters Kluwer. All Rights Reserved.
Test Your Knowledge:
Enhancing Applicability #4
3. Rivera and a team of nurses implemented practice
changes designed to increase screening of chronically ill
patients for depression; the team then evaluated changes in
screening rates.
– A. Comparative effectiveness research
– B. Pragmatic clinical trial
– C. Neither CER nor a pragmatic trial
5
Copyright © 2022 Wolters Kluwer. All Rights Reserved.
Test Your Knowledge:
Enhancing Applicability #5
4. Lowe compared daily number of cigarettes smoked for
smokers participating a smoking cessation intervention
implemented in a large medical center compared to smokers
who received no special intervention.
– A. Comparative effectiveness research
– B. Pragmatic clinical trial
– C. Neither CER nor a pragmatic trial
6
Copyright © 2022 Wolters Kluwer. All Rights Reserved.
Test Your Knowledge:
Enhancing Applicability #6
5. Post compared quality-of-life outcomes for caregivers of
palliative care patients who received home-based
assistance versus those who received support via video
consultations.
– A. Comparative effectiveness research
– B. Pragmatic clinical trial
– C. Neither CER nor a pragmatic trial
7
Copyright © 2022 Wolters Kluwer. All Rights Reserved.
Test Your Knowledge:
Enhancing Applicability #7
1. Loughlin conducted a trial that compared the effect of
music versus massage on reducing anxiety in nursing home
residents with dementia.
– ANSWER: A. Comparative effectiveness
– The study involves a direct comparison of the effectiveness
of two alternative treatments, either one of which might be
more beneficial than the other.
8
Copyright © 2022 Wolters Kluwer. All Rights Reserved.
Test Your Knowledge:
Enhancing Applicability #8
2. Forbes conducted a trial that was designed and modified
based on the application of the PRECIS tool.
– ANSWER: B. Pragmatic clinical trial
– Forbes used a tool called PRECIS to understand how
“pragmatic” the design for the trial would be—an
approach that is used by those seeking to have their
studies closer to “pragmatic” than to “explanatory.”
9
Copyright © 2022 Wolters Kluwer. All Rights Reserved.
Test Your Knowledge:
Enhancing Applicability #9
3. Rivera and a team of nurses implemented practice
changes designed to increase screening of chronically ill
patients for depression; the team then evaluated changes in
screening rates.
– ANSWER: C. Neither CER nor pragmatic trial
– The team undertook an EBP project, not a comparative
effectiveness study nor a pragmatic trial.
10
Copyright © 2022 Wolters Kluwer. All Rights Reserved.
Test Your Knowledge:
Enhancing Applicability #10
4. Lowe compared daily number of cigarettes smoked for
smokers participating a smoking cessation intervention
implemented in a large medical center compared to smokers
who received no special intervention.
– ANSWER: C. Neither CER nor pragmatic
– The study described has features of an explanatory trial,
not a pragmatic one. The trial does not compare two
alternative interventions.
11
Copyright © 2022 Wolters Kluwer. All Rights Reserved.
Test Your Knowledge:
Enhancing Applicability #11
5. Post compared quality-of-life outcomes for caregivers of
palliative care patients who received home-based assistance
versus those who received support via video consultations.
– ANSWER: A. Comparative effectiveness research
– In this study, two viable intervention alternatives are being
compared, consistent with the characteristics of
comparative effectiveness research.
12
Copyright © 2022 Wolters Kluwer. All Rights Reserved.
Test Your Knowledge:
Enhancing Applicability #12
• So the answers are:
–A B C C A
• How many got all 5 right?
Congratulations!!!
13
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