nursing research week 14
Chapter 25
Evidence-Based Practice
Why Evidence-Based Practice?
The most recent emphasis on evidence-based practice comes from a recognition that healthcare practitioners’ perceptions of the efficacy of their care may or may not be accurate
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Why Evidence-Based Practice?
The implementation of evidence-based practice is a means for reducing dependence on:
Intuition
Unsystematic clinical observation
Ungrounded opinion
Ritual and tradition
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The Evolution of Evidence-Based Practice
The evidence-based practice movement emphasizes appraisal of all relevant studies and consideration of their applicability to a particular patient, setting, and situation (Melnyk and Fineout-Overholt, 2004)
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The Evolution of Evidence-Based Practice
Evidence-based medicine is the use of current test evidence in making decisions about the care of individual patients (Sackett et al., 1996)
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The Evolution of Evidence-Based Practice
Evidence-based nursing is the 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 (Ingersoll, 2000)
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Basic Criteria for Evidence-Based Practice
Demonstrated efficacy in two or more RCTs
Include comparison or control group
Tested by more than one research team
Primary outcomes measured
Follow-up testing done if appropriate
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Expanded Criteria for Evidence-Based Practice
Is the study relevant to the topic of interest?
To what extent is the study well designed and well controlled?
Was the purposed intervention effective?
Are these results relevant to practice?
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Panel Reviews and Meta-analyses for Evidence-Based Practice
Summary in language that can be understood by nonprofessionals
Abstract that summarizes each section of the review
Background that includes details of what is known
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Panel Reviews and Meta-analyses for Evidence-Based Practice
Aim of the review
Criteria for selection of studies reviewed
How the search for relevant studies was conducted
Conduct of the review
Description of the studies included
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Panel Reviews and Meta-analyses for Evidence-Based Practice
Assessment of the quality of the included studies
Results of the review
Interpretations of the results
Implications for practice and for research
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Analyses Performed
When there is a substantial number of eligible studies to appraise, a meta-analysis on pooled data from all of the studies is performed
The goal is to assess the efficacy and safety of the intervention being appraised (Sackett, 1996; Sacket & Cook, 1994)
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Analyses Performed
Once an intervention shows some benefit, the researcher must look at the clinical significance of the effect
This may be expressed as relative risk reduction, absolute risk reduction, number needed to treat, or number needed to produce harm
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Analyses Performed
Relative risk (RR) is the ratio of the estimated probabilities of the risk given one treatment versus the risk given another treatment
Absolute risk reduction (ARR) is the difference in the rates of harmful outcomes in the experimental group versus the control group
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Analyses Performed
Number needed to treat (NNT) is calculated by dividing the ARR into 1 to estimate the number of people who would need to receive this treatment in order to increase the number who received a benefit by one
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Analyses Performed
Number needed to harm (NNH) indicates how many people would need to receive the treatment to produce a harmful outcome for one additional person
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From Evidence Review to Practice
Critical appraisals of the evidence for healthcare practices are only useful if put into practice (Barends and Briner, 2014)
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Research Evidence and Healthcare Policy
Although it is not always the case that the development of healthcare policy is based on research evidence, such evidence can have influence on healthcare policy as well as on practice
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Contribution of Qualitative Research to Evidence-Based Practice
Shows how qualitative research is conducted and what constitutes rigor in qualitative research
Best addresses humanistically oriented questions by providing explanations and insights into human behavior
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