Tag Archives: evidence based practice

Clinical practice guidelines, Evidence based nursing, evidence based practice, reading research, research, Research class

It’s Up to you: Accept the Status Quo or Challenge it

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Yes.  Change can be painful.question

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.Tension

 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:

  1. I’m not a researcher.
  2. I don’t value research.
  3. 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.]

TensionHow 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

Clinical practice guidelines, Data, EBP, Evidence based nursing, evidence based practice, Evidence hierarchy, NNT, research, Safety

More? Not always better! Check out NNT.

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EBPPractice 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,  ratiothe Number Needed to Treat (NNT).   This is not mumbo -jumbo.   NNT explained here–short & sweet: http://www.thennt.com/thennt-explained/ 

FindingsCRITICAL 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/ 

Disseminating findings, EBP, evidence based practice, research

Creation & Use of Evidence: Different!

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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 themagnifyingGlassmeaning 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 EBPresearch 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.

CreateCar
Creating a car!

 

  • Designers & factory workers create new cars.

    UseCar
    Using a car!
  • 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.

Evidence based nursing, evidence based practice, Evidence hierarchy

“Here Comes Santa Claus?” What IS the Evidence?

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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.

Discovering Your Inner Scientist

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.).santa3

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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Clinical practice guidelines, Disseminating findings, Evidence based nursing, Publishing, quality improvement, RCT, research, School papers, Writing

Write Away!

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Want to know the standardized format for writing up your research study, QI report, Writing1case study, systematic review, or clinical practice guideline?    Check out these standardized reporting guidelines: http://www.equator-network.org/reporting-guidelines/

Of course you should always give priority to the author instructions for the particular journal in which you want to publish, but most adhere generally or fully to these standardized guides.

Write away!

Data, Data collection, Disseminating findings, Evidence based nursing, evidence based practice, Florence Nightingale, History of research, Outcome measurement, Professional Nursing, quantitative research, research, Uncategorized

Nightingale: Avant garde in meaningful data

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In honor of Nurse Week, I offer this tribute to the avant garde research work of Florence Nightingale in the Crimea that saved lives and set a precedent worth following.

Nightingale was a “passionate statistician” knowing that outcome data are convincing when one wants to change the world.  She did not merely collect the data, but also documented it in a way that revealed its critical meaning for care.

As noted by John H. Lienhard (1998-2002): Nightingale coxcombchart“Once you see Nightingale’s graph, the terrible picture is clear. The Russians were a minor enemy. The real enemies were cholera, typhus, and dysentery. Once the military looked at that eloquent graph, the modern army hospital system was inevitable.  You and I are shown graphs every day. Some are honest; many are misleading….So you and I could use a Florence Nightingale today, as we drown in more undifferentiated data than anyone could’ve imagined during the Crimean War.” (Source: Leinhard, 1998-2002)

As McDonald (2001) writes in the BMJ free, full-text,  Nightingale was “a systemic thinker and a “passionate statistician.”  She insisted on improving care by making policy & care decisions based on “the best available government statistics and expertise, and the collection of new material where the existing stock was inadequate.”(p.68)

Moreover, her display of the data brought its message home through visual clarity!

Thus while Nightingale adhered to some well-accepted, but mistaken, scientific theories of the time (e.g., miasma) her work was superb and scientific in the best sense of the word.   We could all learn from Florence.

CRITICAL THINKING:   What issue in your own practice could be solved by more data?  How could you collect that data?   If you have data already, how can you display it so that it it meaningful to others and “brings the point home”?

FOR MORE INFO:

HAPPY NURSE WEEK TO ALL MY COLLEAGUES.  

MAY YOU GO WHERE THE DATA TAKES YOU!

Disseminating findings, Publication, quality improvement, Writing

Share for Sure! Quality it is

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Share your quality projects for sure!  You learned from them & so can the larger community.   Make your voice heard.

Let below encourage you to encourage you to publish, present, disseminate your quality improvement projects!!share

Davidoff & Batalden in 2005 wrote these words that still apply today:

In contrast with the primary goals of science, which are to discover and disseminate new knowledge, the primary goal of improvement is to change performance. Unfortunately, scholarly accounts of the methods, experiences, and results of most medical quality improvement work are not published, either in print or electronic form. In our view this failure to publish is a serious deficiency: it limits the available evidence on efficacy, prevents critical scrutiny, deprives staff of the opportunity and incentive to clarify thinking, slows dissemination of established improvements, inhibits discovery of innovations, and compromises the ethical obligation to return valuable information to the public.The reasons for this failure are many: competing service responsibilities of and lack of academic rewards for improvement staff; editors’ and peer reviewers’ unfamiliarity with improvement goals and methods; and lack of publication guidelines that are appropriate for rigorous, scholarly improvement work. We propose here a draft set of guidelines designed to help with writing, reviewing, editing, interpreting, and using such reports. We envisage this draft as the starting point for collaborative development of more definitive guidelines. We suggest that medical quality improvement will not reach its full potential unless accurate and transparent reports of improvement work are published frequently and widely.
share2
Critical thinking: What is a QI project on your unit in which others might be interested? Sketch out an outline using headings recommended here: http://ocpd.med.umich.edu/moc-qi/presenting-publishing-qi

For more Info see Davidoff & Batalden. (2005). Toward stronger evidnece on quality improvment. Draft publication guidelines: the beginning of a consensus project. Quality & Safety in Health Care, 14, 319-32. doi:10.1136/qshc.2005.014787

evidence based practice, reading research, research, Writing

“Here Comes Santa Claus?” What IS the Evidence?

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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.).santa3

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 through the eyes of Dutch children
(https://www.ncbi.nlm.nih.gov/pubmed/27322583 ).   Write a follow-up research question based on the findings of this study & post in comments below.

For more info: For those unfamiliar with ResearchGate, it is a site where you can track authors who publish in your area of interest, and you can set up your own profile so that people can track your work.  Take a look.   

Evidence based nursing, evidence based practice, Outcome measurement, research methods

Bake it into your project cake!

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In the last post we compared stronger direct measures of outcomes with weaker indirect
measuremeasures of project outcomes.

So…what direct measures are you “baking into your project cake”? What do you hope will be your project outcome & what measurement will show that you achieved it? –pain scores? weight? skin integrity? patient reports of a sound night’s sleep?  Share your story.  Help others learn.

Or if you just stuck with HCAHPS (or other) as outcome measure, explain why that was the best choice for your project.  (Maybe in your case it was a direct measure!)

Happy measuring!

For More Info on direct vs. indirect measures & Critical thinking: Check out t Direct speaking about INdirect outcomes: HCAHPS as a measurementquestion

Disseminating findings, Evidence based nursing, research

Your chance to shine!

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Join the Honor Society of Nursing, Sigma Theta Tau International and more than 2,000 of your peers in Indianapolis, Indiana, USA, 28 October – 1 November 2017, for the 44th Biennial Convention. Experience STTI’s largest event, which features more than 800 oral and poster presentations, networking opportunities, and more.

Call for Abstracts
Opportunities are now available to submit abstracts for the 44th Biennial Convention.
Submission Deadline: 9 November 2016.

For more information: http://www.nursingsociety.org/connect-engage/meetings-events/biennial-convention/call-for-abstracts