EBP Lasagna: A Tried and True Recipe

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EBP LasagnaA Tried and True Recipe

• JoAnne Herman PhD, RN
• Assistant Dean for Graduate Studies
• College of Nursing

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What can you expect for the next two hours?

• A picture of the finished product
• A recipe for analyzing the literature
• Practice using puzzles
• A chance to try the recipe yourself

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What ingredients do I need for EBP lasagna?

• A burning clinical question
• The most relevant and best evidence
• Analysis of the evidence
• Integrate evidence with ones clinical expertise,
  patient preferences, and values in making a
  practice decision
• Evaluate the practice decision

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Evidence fromResearch/Opinion Leaders/ Expert
Panels and Evidence- Based Theories
Evidence from Clinical Expertise and Assessment
of the Patients History and Condition as well as
Healthcare Resources
QualityPatientCare and Outcomes
Shared Clinical Decision-Making Between
Patient and Practitioner
Context of Caring
Clinical Experience
The merging of science and art EBP within a
context of caring results in the highest quality
of patient care
Information aboutPatient Preferences And Values
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Today we will focus on two ingredients

• A burning clinical question
• The most relevant and best evidence
• Analysis of the evidence
• Integrate evidence with ones clinical expertise,
  patient preferences, and values in making a
  practice decision
• Evaluate the practice decision

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How do you collect the most relevant and best
evidence?

• PICO definitions
• Search process
• Search engines

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Using fresh ingredients makes the literature
search better

• Search for articles 2000-2008
• Check the bibliographies
• to make sure you are not missing
• a classic article

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Here is where you can find the fresh ingredients

• PubMed
• CINHAL
• Medline
• PsycINFO
• SSCI
• ERIC
• WWW
• Cockran Review

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Here is how you get the ingredients

• Start broad and see how many citations you get
• Narrow if necessary
• Use alternative terms to make sure you are
  getting all the citations
• As you get studies, start comparing
  bibliographies to see if you are getting articles
  on the bibs

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Puzzle Time
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Research synthesis is the way we analyze the
evidence
An integration of research according to
scientific principles and rules.
Definition
Research synthesis that can be replicated by
others, can create consensus among scholars, and
can focus debate in a constructive fashion.
Goal
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If life were perfect, research synthesis would
give you

• State of the science
• Protocol
• Care map
• Best practices
• Standard of care

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What is required to do research synthesis?

• A burning question
• A body of research
• An evidence table
• Systematic analysis
• Logical conclusion

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Caution

• Because the standard of care comes from a
  research synthesis, new research will impact the
  conclusion of the research synthesis and may
  suggest a change in the established standard

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So, now we have the evidence. What do we do with
it?
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We build an evidence table!
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What is the purpose of an evidence table?

• Juxtapose literature elements for easier
  comparison

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What does an evidence table look like?

• Citation
• Quality rating
• Setting
• Participants-characteristics and number
• Hypothesis and/or research questions
• Methods-design, instrument, procedures
• Treatment groups
• Statistics-finding, p value, statistic, df
• Conclusions
• Comments

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Your turn!

• Complete the evidence table using the four
  articles provided
• Collaborate with people at your table to agree on
  your evidence table
• Be prepared to report

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Now that we have an evidence table, we examine
the data for quality

• Determine if the study should be included in the
  analysis
• Determine if the study is valid

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Data Evaluation

• Threats to internal and external validity
  approach
• Methods description approach

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Quality of Evidence

• Level I - Systematic review,
• meta analysis
• Level II - Randomized clinical trial
• Level III - Experimental and quasi-experimental
  research without randomization
• Level IV - Evidence from case control and cohort
  studies

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Quality of Evidence

• Level V - Evidence from systematic reviews of
  descriptive and qualitative research
• Level VI - Evidence from a single descriptive or
  qualitative study
• Level VII - Evidence from opinions of experts or
  expert panels

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How do I make sure that I am not introducing
bias?

• Your predisposition about the relationships among
  your variables will influence how critical you
  are of the research methods
• Two approaches
• Have someone else read the articles
• Bracket

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Questions? Comments?

• JoAnne Herman PhD, RN
• College of Nursing
• University of South Carolina
• 803-777-4993
• joanne.herman_at_sc.edu