Developing Best Practices for the Nursing Profession through Research

(Evidence-Based Practice in Nursing and Health Care) 2nd Collegiate Nursing Research Congress

Erlinda Castro-Palaganas, PhD, RN

Benguet State University November 27, 2010

Objectives
At the end of the presentation, the participants will be able to:  Explain the role of developing best practices vis--vis evidence-based practice visevidencein patient care outcomes in the context of research;  Appreciate role of EBP in individual, organizational and community dynamics.

Community-Engaged Teaching, Research and Service Scholarship in discovery, integration, application and teaching.
Practice-based research Communitybased learning

Research

Teaching

Practice-based learning Service-learning

CommunityEngaged
Community/communityoriented service Academic community practice

Service

What is Nursing Research



Systematic inquiry designed to develop knowledge about issues of importance to the nursing profession It is a diligent, systematic inquiry or study that validates and refines existing knowledge and develops new knowledge; indicates planning, organization and persistence. The ultimate goal of research is the development of a research body of knowledge for a discipline or profession, such as nursing.

Why Nursing Research?



Nursing is a practice profession, thus research is essential to develop and refine knowledge that can be used to improve clinical practice. Professional Nurses need to be able to: - read research reports, - identify effective interventions for practice, and - implement these interventions to promote positive outcomes for patients and families

What is your role in nursing research?



BSN: Critique research findings for use in practice; use research findings in practice MSN/MAN: Collaborate in research projects; provide clinical expertise for research PhD: Develop nursing knowledge through research and theory development; conduct funded independent research projects PostDoc: PostDoc: Develop and coordinate funded research programs

How do we acquire knowledge in Nursing?



Knowledge is essential information acquired in a variety of ways, expected to be accurate reflection of reality, and incorporated and used to direct a persons actions. The quality of nursing practice depends on the quality of the knowledge that you acquired.

How do we acquire knowledge in Nursing?

    

  

Traditions Authority Borrowing Trial and Error Personal Experience (Novice, advanced beginner, competent, proficient, expert) Role Modeling (mentorship) Intuition Reasoning (Inductive vs. Deductive)

For nursing as a discipline to be effective in research, the focus of research-directed activity researchshould be creating a culture

within nursing that values, uses, and supports research.

As practitioners of a discipline, nurses must perceive that research is important in developing evidenceevidence-based nursing practice in all settings and specialties.

Developing Best Practices for the Nursing Profession through Research: Building an Evidence-Based Practice

From best evidence to best practice: effective implementation of change in patients care
Richard Grol, Jeremy Grimshaw Grol,

What is Best Practice?



A best practice is a technique, technique, method, process, activity, incentive, or reward which conventional wisdom regards as more effective at delivering a particular outcome than any other technique, method, process, etc. when applied to a particular condition or circumstance.

Best Practices and EvidenceEvidenceBased Practice

 An

approach to clinical practice

A

way to keep current with new developments

What is Evidence-Based EvidencePractice?

 an approach to health care

practice in which the clinician is aware of the evidence that bears on her/his clinical practice, and the strength of that evidence

What is Evidence-Based EvidencePractice?



an approach to decision making in which the clinician uses the best evidence available, in consultation with patient, to decide upon the option which suits that patient best

Therefore: Evidence-Based Practice

is the use of the best research, theory or expert opinion, plus the patients unique circumstances and personal values, combined with clinical judgment to achieve the best outcomes.

Best Practice and Evidence Based Nursing Practice

Knowledge Standard


Each nurse possesses, through basic education and continuing learning, knowledge relevant to her/his professional practice

Best Practice and Evidence Based Nursing Practice

Knowledge Standard Indicators
Providing a theoretical and/or evidenceevidencebased rationale for all decisions  Understanding the knowledge required to meet the needs of complex clients  Knowing where/how to access learning resources when necessary


Best Practice and Evidence Based Nursing Practice

Knowledge Standard Indicators


Seeking and reviewing research in nursing, health sciences and related disciplines Using research to inform practice/professional service

Best Practice and Evidence Based Nursing Practice

Knowledge Application Standard
 Each

nurse continually improves the application of professional knowledge

Best Practice and Evidence Based Nursing Practice

Knowledge Application Standard Indicators


Ensuring practice is based in theory and evidence and meets all relevant standards/guidelines Assessing/describing the client situation using a theory, framework or evidence-based tool evidenceManaging multiple nursing interventions simultaneously

Best Practice and Evidence Based Nursing Practice

Knowledge Application Standard Indicators


Evaluating/describing the outcome of specific interventions and modifying the plan/approach Integrating research findings into professional service and practice

The cognitive continuum.

Thompson, C. et al. Evid Based Nurs 2004;7:68-72

How to we derive evidence EBP?

Evidence-based practice relies on rigorous integration of research evidence on a topic through: systematic review of quantitative findings and meta syntheses of qualitative findings both which are rigorous, systematic inquiries with many similarities to original primary studies.
Polit and Beck, 2008

How to we derive evidence best practice and EBP?

Systematic reviews often involve statistical integration of findings through meta-analysis, a procedure whose advantages include objectivity, enhanced power, however, for broad questions or when there is substantial inconsistency of findings.
Polit and Beck, 2008

A Model for Evidence-based Practice by Rosswurm & Larrabee (1999)

1.Assess
Need for change

2. Link
Problem, interventions, outcomes

3.Synthesize 3.
Best evidence

4. Design
Practice change

5.Implement
& evaluate change in practice

6.Integrate &
Maintain change in practice

Include stakeholders Collect internal data about current practice Compare internal data with external data Identify problem

Use standardized classification systems and language Identify potential interventions and activities Select outcomes indicators

Search research literature related to major variables Critique and weigh evidence Synthesize best evidence Assess feasibility, benefits and risks

Define proposed change Identify needed resources Plan implementation process Define outcomes

Pilot study demonstration Evaluate process and outcome Decide to adapt, adopt, or reject practice change

Communicate recommended change to stakeholders Present staff in service education on change in practice Integrate into standards of practice Monitor process and outcomes

Rosswurm, M. A. & Larrabee, J. H. (1999). A model for change to evidence-based practice. Image: Journal of Nursing Scholarship, 31(4), 317-322. doi: 10.1111/j.1547-5069.1999.tb00510.x

Evidence Pyramid

SUNY Downstate Medical Center, 2003

Evidence Based Resources Models

Evidence Based Resources Models

Best Practice and Decisions Towards Change

 

Make decisions about patient care Implement proven and accepted best practice Utilize to its maximum available resources Advance profession, enhance quality of life and learning, keep practice up-toup-todate and current

Things that make us say, hmmm

The use of evidence is critical to the novice and experienced nurse  Nursing practices are rooted in tradition=outdated  Tradition and the old-way do not oldlead to best practice  Research findings are not integrated into practice


Reasons why Best Practices and EBP is taking too long to take root
 

Attitudes: lack of value for research Presence of other goals with higher priorities: money, leadership gradient Huge gap between information literacy and computer skills Limited access to high quality information resources (whats going on with the rest of the world?)

The Tasks-at Hand for the Tasksdeveloping best practice and EBP
 

Obtain knowledge and skills Disseminating that EBP improves care and outcomes Believing in the ability to foment change in the front line among healthcare practitioners Developing mentorship and practice

 Gain

administrative and organizational buy-in in order buyto be able to change policy where it is identified and needed common terms and processes to make EBP one of the global languages of nursing

 Develop

A Global Language

  

Nursing research Nursing education EvidenceEvidence-based practice

Congratulations ! You are doing your share towards developing best practices and evidence basedbased-practice.

Thank You for Your Attention!

References
1. Ackley B, Ladwick G, Swan B, Tucker S. Evidence-Based EvidenceNursing Care guidelines, Medical- Surgical Interventions. MedicalMosby Elsevier St Louis Missouri, 2008. 2. Fineout-Overholt E, Melnyk B. Building a culture of best Fineoutpractice. Nurse Leader. 3:6, Dec 2005, pp 26-30 263. Polit, D.F and Beck, C.T. Nursing Research: Generating Polit, and Assessing Evidence for Nursing Practice. Lippincott Williams and Wilkins, USA. 2008