Nursing Theory

Nursing Theory week 8 2023 What is EBP? evidence based practice. The most commonly cited is that EBP is "the conscientious, explicit, and judicious use of current best evidence in making decisions The EBP process is comprised of six steps: 1. Defining a question that needs to be answered. 2. Acquiring the literature that will be analyzed. (building and executing the search) 3. Conducting a formal evaluation of the results; also referred to as critical appraisal. 4. Integrating the evaluated evidence into practice. 5. Re-evaluating the process to assess its efficacy and improve it in the future. 6. Share outcomes of EBP change with others. Cultivate a spirit of inquiry to assist you in developing a clinical question. Question what does not make sense to you and what needs to be clarified • Clinical or patient issue observed in practice • Local or National Initiatives focused on practice • Consider looking at data or new clinical evidence from the literature Defining the Question: In EBP, the clinical question is defined in a specific way, referred to as a PICOT question: P - Patient/Population of interest (identify patients by age, gender, ethnicity, and the specific health issue or problem) I - Intervention (drug, diagnostic test, etc.) C - Comparative Intervention (what, if anything are we comparing it to) O - Outcome (what is our desired result) T - Time (what is the amount of time needed for an intervention to achieve an outcome) PICOT P: Population I: Intervention C: Comparison O: Outcome T: Time Example PICOT Patient/Problem: Caucasian male with poorly controlled Type II diabetes taking metformin and a sulfonylurea Intervention: Actos (pioglitazone) Comparative Intervention: Insulin Outcome: HbA1c level Time: six-months PICOT Question: In Caucasian men with poorly controlled Type 2 diabetes receiving a combo therapy of metformin plus a sulfonylurea, how does Actos (pioglitazone) compare to insulin at regulating HbA1c levels over a six-month period? Locating the Evidence: Once you have developed your PICOT, the next step is to collect evidence that addresses your PICOT question. Ask experts for help o Nursing faculty o Advanced practice nurses o Staff educators o Risk managers o Librarians • Identify the databases that are available to you (e.g., CINAHL, PubMed via online library) • Identify key words that will provide the best answer to your PICOT question Critical Appraisal: The process of carefully and systematically examining research to judge its validity, reliability, and the relevance to a particular context. Consider the following when analyzing research articles and literature: • Does the article(s) together offer evidence to explain or answer my PICOT question? • Does the article contain the following: • Abstract • Introduction • Literature Review • Methods/Design • Results or Conclusions Critical Appraisal (cont'd): IMRAD For the convenience of readers, scholarly articles evolved to follow an IMRAD format (or something like it). This is just one type of critical appraisal; there are many more! = Introduction (Background, rationale, purpose) M= Methods (Study design, measurement instruments, rationale of use) R = Results (Describes results of study without repeating methodology) And D = Discussion (Presents principles, relationships and generalizations shown by work; how results support [or refute] previous work; theoretical implications; conclusions.) IMRAD Introduction