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?
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!
For RNs wanting to pursue a doctorate, it is important to pick a degree that best matches your anticipated career path. The shortest simplest explanation of the difference in these degrees is probably:
- PhD – If you want to be a nurse scientist & teach in a university & conduct nursing research.
- DNP – If you want to be an advanced practice nurse, who primarily uses research in leadership, QI, patient care, etc. along with measuring project outcomes.
An excellent, free full-text, critique can be found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547057/
Of course, some DNPs teach in universities, particularly in DNP programs. PhDs may otherwise be better prepared for faculty roles. I encourage you to look carefully at the curriculum at the school where you hope to study and expectations of a university where you hope to teach. Speak with faculty, & choose wisely.
Yes. Change can be painful.
Yes. It is easier to do things the way we’ve always done them (and been seemingly successful).
Yet, most of us want to work more efficiently or improve our own or patients’ health.
So, there you have the problem: a tension between status quo and change. Perhaps taking the easy status quo is why ‘everyday nurses’ don’t read research.
Ralph (2017) writes encountering 3 common mindsets that keep nurses stuck in the rut of refusing to examine new research:
- I’m not a researcher.
- I don’t value research.
- I don’t have time to read research.
But, he argues, you have a choice: you can go with the status quo or challenge it (Ralph). And (admit it), haven’t we all found that the status quo sometimes doesn’t work well so that we end up
- choosing a “work around,” or
- ignoring/avoiding the problem or
- leaving the problem for someone else or
- ….[well….,you pick an action.]
How to begin solving the problem of not reading research? Think of a super-interesting topic to you and make a quick trip to PubMed.com. Check out a few relevant abstracts and ask your librarian to get the articles for you. Read them in the nurses’ lounge so others can, too.
Let me know how your challenge to the status quo works out.
Bibliography: Fulltext available for download through https://www.researchgate.net/ of Ralph, N. (2017 April). Editorial: Engaging with research & evidence is a nursing priority so why are ‘everyday’ nurses not reading the literature, ACORN 30(3):3-5. doi: 10.26550/303/3.5
Practice based in evidence (EBP) means that you must critique/synthesize evidence and then apply it to particular setting and populations using your best judgement. This means that you must discriminate about when (and when NOT) to apply the research. Be sure to use best professional judgment to particularize your actions to the situation!
Add to your repertoire of EBP tools, the Number Needed to Treat (NNT). This is not mumbo -jumbo. NNT explained here–short & sweet: http://www.thennt.com/thennt-explained/
CRITICAL THINKING: Check out this or other analyses at the site. How does the info on antihypertensives for mild hypertension answer the question of whether more is better? Are there patients in whom you SHOULD treat mild HTN? (“We report, you decide.”) http://www.thennt.com/nnt/anti-hypertensives-for-cardiovascular-prevention-in-mild-hypertension/
MORE INFO: Check out what the data say about other risk/benefit treatments at http://www.thennt.com/
The difference between research and evidence-based practice (EBP) can sometimes be confusing, but the contrast between them is sharp. I think most of the confusion comes because those implementing both processes measure outcomes. Here are differences:
- RESEARCH : The process of research (formulating an answerable question, designing project methods, collecting and analyzing the data, and interpreting themeaning of results) is creating knowledge (AKA creating research evidence). A research project that has been written up IS evidence that can be used in practice. The process of research is guided by the scientific method.
- EVIDENCE-BASED PRACTICE: EBP is using existing knowledge (AKA using research evidence) in practice. While researchers create new knowledge,
The creation of evidence obviously precedes its application to practice. Something must be made before it can be used. Research obviously precedes the application of research findings to practice. When those findings are applied to practice, then we say the practice is evidence-based.
A good analogy for how research & EBP differ & work together can be seen in autos.
- Designers & factory workers create new cars.
- Drivers use existing cars that they choose according to preferences and best judgments about safety.
CRITICAL THINKING: 1) Why is the common phrase “evidence-based research” unclear? Should you use it? Why or why not? 2) What is a clinical question you now face. (e.g., C.Diff spread; nurse morale on your unit; managing neuropathic pain) and think about how the Stetler EBP model at http://www.nccmt.ca/registry/resource/pdf/83.pdf might help. Because you will be measuring outcomes, then why is this still considered EBP.
It’s that time of year again! Enjoy this illustration of how to use one model in applying best, available evidence to practice. Have fun and a merry and bright season.
How strong is the evidence regarding our holiday Santa Claus (SC) practices? And what are the opportunities on this SC topic for new descriptive, correlation, or experimental research? Although existing evidence generally supports SC, in the end we may conclude, “the most real things in the world are those that neither children nor men can see” (Church, as cited in Newseum, n.d.).
If you want to know the answers, check out: Highfield, M.E.F. (2011). Here comes Santa Claus: What’s the evidence? Advanced Emergency Nursing Journal, 33(4), 354-6. doi: http://dx.doi.org.libproxy.csun.edu/10.1097/TME.0b013e318234ead3 Using bona fide published work, the article shows you how to evaluate the strength of evidence and how to apply it to practice. You can request a full-text for your personal use from your library or from the author via www.researchgate.net/home .
Critical thinking: Check out this related research study with fulltext available through PubMed: Black Pete…
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