Risks, Resources, Readiness
3 things to consider when adapting or adopting research evidence to/in a particular practice setting according to Stetler (2001).
Check out the 1-minute video summary by DrH at https://www.instagram.com/martyhrn/
Category Archives: Evidence based nursing
EBP: OpEd – What it is and what it isn’t
Evidence-based nursing. I have heard and seen the terms evidence-based nursing & evidence-based practice sometimes mis-used by well-educated RNs. Want to know what it is? Here’s the secret (or at least some things you should think about says Dr. Ingersoll). https://www.nursingoutlook.org/article/S0029-6554(00)76732-7/pdf
First, she rightly differentiates 2 processes: research as discovery and evidence-based practice as application.
Too, Ingersoll argues that best evidence may include more than the much-vaunted systematic reviews or randomized controlled trials. Relying only on systematic, scientific research findings, she argues, is not enough to guide evidence-based practice. Her arguments provide a basis for discussion with those who might disagree.
[Note: Ingersoll uses the term “positivist thinking” at one point. For those uncertain about the term, I would define positivists as those who assume that reality and truth are objective, measurable, and discoverable by a detached, impartial researcher. Positivism underlies the empirical scientific process that most readers think of when they hear the word research.]
Do you agree with her that anecdotal and traditional knowledge make valuable contributions to evidence-based practice? Your thoughts about her thoughts?
“How many articles are enough?” Is that even the right question?
How do you know when you have found enough research evidence on a topic to be able to use the findings in clinical practice? How many articles are enough? 5? 50? 100? 1000? Good question!
You have probably heard general rules like these for finding enough applicable evidence: Stick close to your key search terms derived from PICOT statement of problem; Use only research published in the last 5-7 years unless it is a “classic; & Find randomized controlled trials (RCTs), meta-analyses, & systematic reviews of RCTs that document cause-and-effect relationships. Yes, those are good strategies. The only problem is that sometimes they don’t work!
Unfortunately, some clinical issues are “orphan topics.” No one has adequately researched them. And while there may be a few, well-done, valuable published studies on the topic, those studies may simply describe bits of the phenomenon or focus on how to measure the phenomenon (i.e., instrument development). They may give us little to no information on correlation and causation. There may be no RCTs. This situation may tempt us just to discard our clinical issue and to wait for more research (or of course to do research), but either could take years.
In her classic 1998 1-page article, “When is enough, enough?” Dr. Carol Deets, argues that asking how many research reports we need before applying the evidence may be the wrong question! Instead, she proposes, we should ask, “What should be done to evaluate the implementation of research findings in the clinical setting?”
When research evidence is minimal, then careful process and outcome evaluation of its use in clinical practice can: 1) Keep patient safety as the top priority, 2) Document cost-effectiveness and efficacy of new interventions, and 3) Facilitate swift, ethical use of findings that contributes to nursing knowledge. At the same time, Deets recognizes that for many this idea may be revolutionary, requiring us to change the way we think.
So back to the original question…How many articles are enough? Deets’ answer? “One study is enough” if we build in strong evaluation as we translate it into practice.
Reference: Deets, C. (1998). When is enough, enough? Journal of Professional Nursing, 14(4), 196. doi.org/10.1016/S8755-7223(98)80058-6
Evidence-based Practice Institute
I recommend this event. I have no conflict of interest.
New virtual EBP Institute – Advanced Practice Institute: Promoting Adoption of Evidence-Based Practice is going virtual this October.
This Institute is a unique advanced program designed to build skills in the most challenging steps of the evidence-based practice process and in creating an organizational infrastructure to support evidence-based health care. Participants will learn how to implement, evaluate, and sustain EBP changes in complex health care systems.
Each participant also receives Evidence-Based Practice in Action: Comprehensive Strategies, Tools, and Tips From the University of Iowa Hospitals and Clinics. This book is an application-oriented EBP resource organized based on the latest Iowa Model and can be used with any practice change. The Institute will include tools and strategies directly from the book.
3-Day Virtual Institute
Wednesday, October 7
Wednesday, October 14
Wednesday, October 21
(participation is required for all 3 days)
Special pricing for this virtual institute: 5 participants from the same institution for the price of 4
Learn more and register for the October 2020 Advanced Practice Institute: Promoting Adoption of Evidence-Based Practice.
Kristen Rempel
Administrative Services Specialist | Nursing Research & Evidence-Based Practice
University of Iowa Health Care | Department of Nursing Services and Patient Care
200 Hawkins Dr, T155 GH, Iowa City, IA 52242 | 319-384-6737
uihc.org/nursing-research-and-evidence-based-practice-and quality
Collection of covid19 data sites
HOMEMADE cloth masks: The good, the bad, & the Ugly
So I’ve been pretty skeptical about people sewing protective face masks at home. And, as with a lot of things we don’t have all the data that we wish we had. So…I’m putting this scientific evidence out there and encouraging you to contribute to this blog by adding other scientific data.
Nevertheless, the expert opinion at CDC is that they are in the “Better Than Nothing” category and gives this additional advice. “In settings where N95 respirators are so limited that routinely practiced standards of care for wearing N95 respirators and equivalent or higher level of protection respirators are no longer possible, and surgical masks are not available, as a last resort, it may be necessary for HCP to use masks that have never been evaluated or approved by NIOSH or homemade masks. It
may be considered to use these masks for care of patients with COVID-19, tuberculosis, measles, and varicella. However, caution should be exercised when considering this option.1,2“
Anecdotally, providers are using them to extend the life of other masks or N95s. Women are also making some with little pockets for other filters, and a material called HANIBON that can be purchased online is used often on the outer layer of disposable masks and works to block out dust and fluids from entering.
References
- Dato, VM, Hostler, D, and Hahn, ME. Simple Respiratory Maskexternal icon, Emerg Infect Dis. 2006;12(6):1033–1034.
- Rengasamy S, Eimer B, and Shaffer R. Simple respiratory protection-evaluation of the filtration performance of cloth masks and common fabric materials against 20-1000 nm size particlesexternal icon, Ann Occup Hyg. 2010;54(7):789-98.
“Sew” there you have it. Expert opinion is that as a last resort you may use inadequately tested cloth masks if it is all you have. I am grateful for all those sewists out there responding to medical center calls to supply them with cotton and elastic homemade masks, and sending out the patterns to do so. Field medicine.
CDC also says “The filters used in modern surgical masks and respirators are considered “fibrous” in nature—constructed from flat, nonwoven mats of fine fibers” If this is true then would nonwoven interfacing 
improve the homemade masks?
A practical place to start
Enrolled in an MSN….and wondering what to do for an evidence-based clinical project?
Recently a former student contacted me about that very question. Part of my response to her is below:
“One good place to start if you are flexible on your topic is to look through Cochrane Reviews, Joanna Briggs Institute, AHRQ Clinical Practice Guidelines, or similar for very strong evidence on a particular topic and then work to move that into practice in some way. (e.g., right now I’m involved in a project on using evidence of a Cochrane review on the benefits of music listening–not therapy–in improving patient outcomes like pain, mood, & opioid use).
Once you narrow the topic it will get easier. Also, you can apply only the best evidence you have, so if there isn’t much research or other evidence about the topic you might have to tackle the problem from a different angle” or pick an area where there IS enough evidence to apply.
Blessings! -Dr.H
Challenges to “Medical dogma” – Practice your EBP skills
Medscape just came out with Eric J. Topol article: 15 Studies that Challenged Medical Dogma in 2019. Critically check it out to practice your skills in applying evidence to practice. What are the implications for your practice? Are more or stronger studies needed before this overturning of dogma becomes simply more dogma? Are the resources and people’s readiness there for any warranted change? If not, what needs to happen? What are the risks of adopting these findings into practice?
“Two roads diverged in a yellow wood…” R.Frost
TIME TO REPUBLISH THIS ONE:
Below is my adaptation of one of the clearest representations that I have ever seen of when the roads diverge into quality improvement, evidence-based practice, & research. Well done, Dr. E.Schenk PhD MHI, RN-BC!
Trial Balloons & Pilot Studies
A pilot study is to research what a trial balloon is to politics.
In politics, a trial balloon is communicating a law or policy idea via media to see how the intended audience reacts to it. A trial balloon does not answer the question, “Would this policy (or law) work?” Instead a trial balloon answers questions like “Which people hate the idea of the policy/law–even if it would work?” or “What problems might enacting it create?” In other words, a trial balloon answers questions that a politician wants to know BEFORE implementing a policy so that the policy or law can be tweaked to be successfully put in place.
In research, a pilot study is sort of like a trial balloon. It is “a small-scale test of the methods and procedures” of a planned full-scale study (Porta, Dictionary of Epidemiology, 5th edition, 2008). A pilot study answers questions that we want to know BEFORE doing a larger study, so that we can tweak the study plan and have a successful full-scale research project. A pilot study does NOT answer research questions or hypotheses, such as “Does this intervention work?” Instead a pilot study answers the question “Are these research procedures workable?”
A pilot study asks & answers: “Can I recruit my target population? Can the treatments be delivered per protocol? Are study conditions acceptable to participants?” and so on. A pilot study should have specific measurable benchmarks for feasibility testing. For example if the pilot is finding out whether subjects will adhere to the study, then adherence might be defined as “70 percent of participants in each [group] will attend at least 8 of 12 scheduled group sessions.” Sample size is based on practical criteria such as budget, participant flow, and the number needed to answer feasibility questions (ie. questions about whether the study is workable).
A pilot study does NOT: Test hypotheses (even preliminarily); Use inferential statistics; Assess safety of a treatment; Estimate effect size; Demonstrate safety of an intervention.
A pilot study is not just a small study.
Next blog: Why this matters!!
For more info read the source of all quotes in this blog: Pilot Studies: Common Uses and Misuses @ https://nccih.nih.gov/grants/whatnccihfunds/pilot_studies
Discovering Your Inner Scientist 