Evidencebased nursing implementation and utilisation

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Evidence-based nursing - implementation and
utilisation
Hilary Jacobsen 2005
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Teaching Aims

• To understand the nature of evidence-based
  nursing
• To have knowledge about evidence-based nursing
  resources
• To have knowledge of barriers to the utilisation
  of evidence-based nursing
• To have knowledge of a method for implementing
  evidence-based nursing

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Definition Evidence- based nursing practice

• The conscientious, explicit and judicious use of
  theory derived, research-based information in
  making decisions about care delivery to
  individuals or groups of patients and in
  consideration of individual needs and
  preferences.
• Ingersol, Gail L. Nursing Outlook, 2000 484,
  152

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Evidence-based nursing resources

• Evidenced-based journals
• Systematic reviews
• Report series
• Centres for Evidence-based nursing
• Evidence-based practice guidelines

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Knowledge utilisation in practice.

• Instrumental utilisation
• Conceptual utilisation
• Personal competence
• Evaluation competence
• Utilisation competence

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Barriers preventing the use of evidence-based
nursing

• Insufficient authority
• Insufficient time
• Unfamiliar with relevant research
• Doctors will not co-operate
• Lack of support
• Difficulty in understanding research results

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A model for evidence utilisationadapted from
Tove Aminda Hanssen 2001. Rubin et.al in 1998

• Step 1 Ask a question from clinical practice
• Step 2 Look for the best knowledge
• Step 3 Evaluate the relevance, validity and
  evidence level of the knowledge
• Step 4 Utilisation of the best available
  knowledge in decisions about patient care

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Step 1 Ask a question from clinical practice

• Features of a good question
• Which people or situations are involved
• Which interventions we are interested in
• Which results or effects are of interest (Hanssen
  2001)

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Central questions in health care(Bjørndal in
Hanssen 2001)

• Why some people become ill whilst others remain
  well (this is related to the cause)
• How we can determine if someone is ill (this is
  related to diagnosing illness)
• What we can do for the ill person (this is
  related to prevention, treatment, care and
  rehabilitation)
• How the illness can develop (this is related to
  the prognosis)
• How illness is experienced (this is connected to
  the patients experience)

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Step 2 Look for the best knowledge
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Step 3 Evaluate the knowledges relevance,
validity and evidence level

• reliability - how many studies of the phenomenon
  have been carried out, is the method used
  suitable with regards the research question, how
  big was the sample, how was the data collected,
  when was the research carried out
• whether the results can be transferred to the
  specific practice situation in question, is the
  context so similar that this is possible
• does the evidence have sufficient weight to be
  trustworthy, do the advantages outweigh the
  disadvantages/costs, are the values of the
  patients in questions taken into account?

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Level of evidence(from Jennings 2001, adapted
after Stetler et.al. 1998)

• I Meta-analysis of randomized controlled trials
• II Individual experimental study
• III Quasi-experimental study
• IV Non-experimental study (f.ex. descriptive,
  qualitative, case studies)
• V Systematically obtained, verifiable quality
  improvement program evaluation or case report
  data
• VI Opinions of nationally known authorities based
  on their experience or the opinions of an expert
  committee, including the interpretation of
  non-research-based information regulatory or
  legal opinions

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Weight of the evidence(from Hanssen 2001)

• A At least one randomized controlled trial (level
  I II)
• B Good clinical studies (level III IV)
• C Expert committee or authoritative opinions
  (level V VI) when good clinical studies are not
  available.

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Step 4 Utilisation of the best available
knowledge in decisions about patient care.

• Develop a concrete proposal for changing practice
• Set objectives
• Identify barriers to change
• Link interventions to obstacles
• Develop and implement the plan
• Evaluate the result

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Literature

• Oversikt over literature