computer based teaching programme regarding Evidece Based Nursing

Information about computer based teaching programme regarding Evidece Based Nursing

Published on July 30, 2014

Author: priyankajohn86



Evidence Based Nursing Practice: Evidence Based N ursing P ractice Prepared by : Priyanka Jose OBJECTIVES: OBJECTIVES Explain the concept of Evidence based nursing practice(EBNP) Define evidence based nursing practice Identify the significance of EBNP Describe the steps in EBNP and its application in clinical setting Identify steps in conducting online literature search Identify the barriers and facilitators of EBNP CONCEPT OF EBP: CONCEPT OF EBP In the past the practices of many profession were relay up on the traditional and ritualistic practice PowerPoint Presentation: In the past many professions had no truly scientific evidence on which to justify various practices……………. PowerPoint Presentation: But today , most of these professions are in the track of evidence based practice where the practices are based on best available research evidences and client preferences . PowerPoint Presentation: Evidence Base For Nursing Practice Florence Nightingale (1859) focused on the importance of ventilation, cleanliness, temperature, purity of water and patient’s health . These interventions drastically reduced the mortality rate from 43% to 2 % in cremean war ( Cook, 1913) Evidence based practice: Evidence based practice PowerPoint Presentation: EBP – means many things to many people Within one decade, the concept of evidence-based practice has evolved and been embraced by nurses in nearly every clinical specialty, across a variety of roles and positions, and in locations around the globe. What is Evidence ?: What is Evidence ? EVIDENCE- Is the available facts, circumstances etc. indicating whether or not a thing is true or valid. ( Oxford dictionary,2003) What is Evidence-Based Practice?: What is Evidence-Based Practice? It is the integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making . ( Sacket et al 2000 ) What is evidence based nursing practice ?  : What is evidence based nursing practice ?   It is the best available evidence from research, along with patient preferences and clinical experience, when making nursing care decisions . ( Dicenso 2005 ) Nursing Research: Nursing Research "A scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice." Traditional Basis for Nursing Practice : Traditional Basis for Nursing Practice Rituals, unverified rules Anecdotes, isolated experiences Customs, opinions, unit cultures Physicians’ authority Why Evidence-Based Practice in Nursing: Why Evidence-Based Practice in Nursing Potential to improve quality of nursing care, reduce variations in care Focus on practices that result in best possible outcomes at possibly lower cost Provides a way to keep pace with advances Why Evidence-Based Practice in Nursing: Why Evidence-Based Practice in Nursing EBP provides scientific basis for nursing practice provides accountability to profession helps in application of research in to practice promotes patient’s safety helps to make appropriate decision about clinical management Features of EBNP: Features of EBNP EBNP is problem based It narrows the research practice gap EBNP helps in application of research in to practice It is a quality assurance activity It requires team support and communication and collaborative action EBNP support research project and outcome that are effective PowerPoint Presentation: Most nurses agree that EBP is important… but how do we make it happen ? Evidence-based practice is every nurses’ responsibility What can you do to make this goal a reality? Closing the gap from evidence to action………….: Evidence-based practice is every nurses’ responsibility What can you do to make this goal a reality? Closing the gap from evidence to action…………. Core Competencies: Core Competencies Ask: why are we doing this.. what is the evidence? Think critically! Think out of the box! Key Questions to Ask When Considering EBP: Key Questions to Ask When Considering EBP Why have we always done “it” this way? Do we have evidence-based rationale? Or Is this practice merely based on tradition? Is there a better (more effective, faster, safer, less expensive, more comfortable) method? What approach does the patient (or the target group) prefer? What do experts in this specialty recommend? To carry out evidence based nursing in your practice,: 22 To carry out evidence based nursing in your practice , The following factors must be considered: -sufficient research must have been published on the specific topic -the nurse must have skill in accessing and critically analyzing research -the nurse's practice must allow implementation of changes based on EBN What is the 1st step toward EBP for the practicing nurse?: What is the 1 st step toward EBP for the practicing nurse? It all starts with a good question or a problem! Nurses must be empowered to ask critical questions in the spirit of looking for opportunities to improve nursing care and patient outcomes. PowerPoint Presentation: The best source for problem identification is……………………. your clinical area PowerPoint Presentation: PICO and IOWA model are the two commonest model used for the implementation of evidence based nursing practice Creating a Clear Clinical Question: Creating a Clear Clinical Question Use PICO format P = patient population / problem I = intervention in question C = compared to? O = outcome of action Example……..: Example…….. PICO Patient or Problem : stroke patients at an acute rehabilitation hospital Intervention : enhanced patient and family education Comparison intervention : existing education Outcomes : increased patient satisfaction with instructions regarding home care and medications Sources of literature search: Sources of literature search Primary Sources: Original Journal articles that report original work Print Electronic Secondary Sources Textbooks Review Articles Alternative Sources Government publications, Doctoral dissertations, Unpublished data Sources of Literature: Sources of Literature Nursing journals Clinical work station sites Up-to-date Digital Library Cochrane Reviews The traditional library: The traditional library Browsing the shelves Books are permanent written records Journals Supporting EBNP: Journals Supporting EBNP Evidence-Based Nursing Online Journal of Clinical Innovations WorldViews on Evidence-Based Nursing The Online Journal of Knowledge Synthesis for Nursing – Reflections on Nursing Leadership The World Wide Web: The World Wide Web Two billion pages of information Lacks bibliographic control standards Most documents lack even the name of the author and the date of publication Person working in remote area with no good library can access information Search Engine: Search Engine Google ( Largest database Best for ranking results Saves web pages Google scholar ( Provides academic information only AltaVista ( ) Medical databases: Medical databases MEDLINE OMIM CDC WONDER The Cochrane library For evidence based medicine National Guideline Clearinhouse For guidelines on various diseases. Medical Matrix OMNI Cochrane Collaboration – most reliable source : Cochrane Collaboration – most reliable source Medline: Medline MEDLINE ( Medical Literature Analysis and Retrieval System Online ) Over 10 million articles published in 4300 journals in 40 different languages from 75 countries Pubmed: Pubmed PubMed is a search interface from the National Library of Medicine.It is free Coverage includes medicine, dentistry, nursing, health care literature, veterinary medicine, and the pre-clinical sciences Covers 4,600 biomedical journals Contains over 14 million records dating back to 1950s PubMed includes MEDLINE records PowerPoint Presentation: How to conduct an online literature search??????? Assembling Relevant Research and Literature : 41 Assembling Relevant Research and Literature Define search terms Request literature review Review listing of articles Select articles Filter the articles by relevance Focus on those closest to topic Basic PubMed Searching: Basic PubMed Searching State what you want to find Eg : Prognosis of carcinoma breast Identify keywords Prognosis Carcinoma breast Basic PubMed Searching: Basic PubMed Searching Enter one or more terms in query box (terms are automatically combined with “AND”) Hit “Search” PubMed displays results in Summary format Learn to use……: Learn to use…… Boolean operators Limits Tags Citation matcher Related PubMed Articles Link Bookshelf Boolean operators: Boolean operators PubMed Boolean operators : AND, OR, NOT ( must be typed in upper case) Terms are automatically combined with AND – don’t have to type this AND – retrieves what 2 or more sets have in common Tags : Tags (AB) Abstract; (AD) Affiliation; (AU) Author; (PDAT) Publication Date; (TI) Title; (TA) Journal Title Abbreviation IMAGES: IMAGES SOUND & VIDEO: SOUND & VIDEO PowerPoint Presentation: After collecting literature from various sources, Determine the sufficiency of evidence base for use in practice Check for the evidences that shows quality outcome for the patient, nurse and agency Try out the change in practice : Try out the change in practice Once the evidence has been formed, this information needs to be integrated with the clinical expertise, patient preferences and values of the patients, families and communities in making the change. Apply the change in practice: Apply the change in practice Once the quality of care and cost savings of a particular practice documented by nurse, physician and hospital administrators it requires institutional approval, physician approval and approval of nurses managing patient Evaluation: Evaluation Evaluating care delivery should be second nature for nurses Familiar from the nursing process Collecting data to drive the evaluation Decide what is going to be measured EVALUATION………: EVALUATION……… Look for - Improvement in quality of care Time saving Cost effectiveness Patient satisfaction Well done! : Well done! Now what? The last step in implementation of Evidence based nursing practice is …..…. DISSEMINATION! PowerPoint Presentation: EBP in reality Brett (1987) studied 14 research based interventions practiced by nurses. To test one of those interventions, he used stratified sample of 216 nurses from small, medium and large hospitals. PowerPoint Presentation: Area of study : Technique for giving IM injections. “Internal rotation of the femur during injection into the dorsogluteal site, in either the prone or the side lying position, results in reduced discomfort from the injection . PowerPoint Presentation: Internal rotation of the femur is achieved by having patients point their toes inwards. 49% of the nurses were aware of the findings. 34% were convinced that the findings was useful for practice. 29% were implementing this finding in practice sometimes But only 10% were implementing it always. PowerPoint Presentation: Still there is a gap……. between evidence and action Barriers of evidence based nursing practice: Barriers of evidence based nursing practice All the nurses do not have access to relevant literature and research reports Lack of time Communication gap between researcher and the institutional based practitioner Lack of valid researches Barriers……..cont.: Barriers ……..cont. Lack of organizational support Lack of fund to support researches Problems with dissemination of research findings Lack of continuing education and inservice programm What can... YOU & OTHER NURSES DO?: What can... YOU & OTHER NURSES DO? “Worry and Wonder” Be the Inquiring Mind Question clinical traditions Stay abreast of the literature - guidelines Be an advocate for evidence-based changes LISTEN to your PATIENTS – to guard patient & family preferences What can... YOU & OTHER NURSES DO?: What can... YOU & OTHER NURSES DO? think, conceptually “use” research findings regularly read research journals read critical reviews of research attend professional conferences PowerPoint Presentation: If we the nurses cannot implement our own research findings in our nursing practice, how are we expecting, government and authorities to implement nursing research findings for nation’s development ??? Reference……: Reference…… Mckee JM, Warren TA, Shell JA, Camphell VP. Evidence Based Nursing Practice. Nursing Times. 2005 June 15; 19-24 Homer C.Evidence based practice. American nurses association publication. Available from Wikipedia- The free encyclopedia. [ Internet] . Available from: PowerPoint Presentation: THANK YOU………

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