Discussion Question

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Chapter 2

Evidence-Based Nursing: Translating Research Evidence into
Practice

Question

Tell whether the following statement is true or false:

The use of study findings in a practical application unrelated to the original research is evidence-based practice.

Answer

False

Research utilization is the use of study findings in a practical application unrelated to the original research. Evidence-based practice is basing clinical decisions on best possible evidence.

Research Utilization versus Evidence-Based Practice

Research utilization (RU)

The use of study findings in a practical application unrelated to the original research

Evidence-based practice (EBP)

Basing clinical decisions on best possible evidence—especially high-quality research

Underpinning for Evidence-Based Nursing

Cochrane Collaboration
McMaster Medical School: evidence-based medicine

Question

What may be used to rank study findings according to the strength of evidence provided?

Evidence hierarchy

Systematic review

Randomized controlled trials

Electronic databases

Answer

An evidence hierarchy may be used to rank study findings according to the strength of evidence provided. Systematic reviews, randomized controlled trials, and electronic databases are resources that are used.

Resources for Evidence-Based Practice

Systematic reviews
Clinical practice guidelines
Care bundles
Other preappraised evidence
Clinical decision support tools

Barriers to Using Research in
Nursing Practice

Quality and nature of the research
Characteristics of nurses
Organizational factors

Question

Tell whether the following statement is true or false:

Systematic reviews can involve quantitative meta-analysis methods that integrate findings statistically.

Answer

True

Systematic reviews can involve either qualitative, narrative approaches to integration including metasynthesis of qualitative studies, or quantitative meta-analysis methods that integrate findings statistically.

Research Integration and Synthesis

Forms of integrative reviews:

Narrative, qualitative integration (traditional review of quantitative or qualitative results)
Meta-analysis (statistical integration of results)
Metasynthesis (theoretical integration of qualitative findings)

Care Bundles

Set of interventions
Treat or prevent cluster of symptoms

Two Models for Evidence-Based
Nursing Practice

The Stetler Model of research utilization to promote evidence-based practice
The Iowa Model of evidence-based practice to promote quality care

Iowa Model of Evidence-Based Practice to Promote Quality Care

The Iowa Model outlines a series of activities with three critical decision points:

Decide whether problem is a sufficient priority for the organization exploring possible changes.

Decide whether there is a sufficient research base.

Decide whether change is appropriate for adoption in practice.

Question

Individual nurses can put research into practice. What is the first step?

Searching for relevant research evidence

Appraising and synthesizing the evidence

Framing an answerable clinical question

Assessing effectiveness

Answer

The correct order of steps is

framing an answerable clinical question,

searching for relevant research evidence,

appraising and synthesizing the evidence,

integrating evidence with other factors, and

assessing effectiveness.

Steps of Individual EBP

Framing an answerable clinical question

Searching for relevant research-based evidence

Appraising and synthesizing the evidence

Integrating evidence with other factors

Assessing effectiveness

Appraisal of Evidence

Validity of study findings
Clinical importance of findings
Precision of estimates of effects
Associated costs and risks
Utility in a particular clinical situation

EBP in Organizational Context

More formalized than individual EBP
Must take organizational and interpersonal factors into account
“Triggers” include both pressing clinical problems and existing knowledge.

Organizational (Team-Based)
EBP Projects

Involve the development or adaptation of clinical practice guidelines or clinical protocols
Assessment of implementation potential of the innovation

Transferability

Feasibility

Cost–benefit ratio

Implementing and Evaluating the Innovation

Pilot Test

Develop an evaluation plan.
Collect information on outcomes.
Train staff in the use of the new guideline and, if necessary, “market” the innovation.
Try the guideline out on one or more units or with a group of clients.
Evaluate the pilot project.

Nurses’ Role in Using Research Evidence

Read widely and critically.
Attend professional conferences.
Learn to expect on evidence that a procedure is effective.
Become involved in a journal club.
Pursue and participate in RU/EBP projects.