Professional Practice Development Putting Evidence-based Practice Into Play

Stacy Davis BS, BSN, RN Pediatric CNS Graduate Student Intern MSN-Children’s Health candidate May 2009

Objectives “ Define

evidence-based practice (EVP) “ Discuss why EVP is important “ Demonstrate formulation of a PICO question “ Describe where to find EVP and how to create EVP “ Explain how to incorporate EVP into school nursing

EVP – What Is It? “ It

answers the question of

“Why do we do what we do?”

EVP – What is it? (con’t) EVP involves… - a search and appraisal of evidence - clinical experience - the patient’s input …to help guide the care of patients or delivery of health care services Melynk, B., M., & Fineout-Overholt, E. (2005). Making the case for evidence-based practice. In Melynk, B. M., & Fineout-Overholt, E. Evidence-based practice in nursing & healthcare: A guide to best practice (pp. 3-24). Philadelphia: Lippincott Williams & Wilkins.

The 5 ‘W’s’ and ‘H’ of EVP Who = You “ When = Anytime you wonder, question, or are challenged “ Where = Anywhere, anytime “ Why = To do what is best “

“

“

What = High volume, risk, frequency “

“

See ‘when’ Or see ‘when’

How = Finding, creating, implementing EVP

History and Importance of EVP “ Edward

Jenner (1796)

“ Smallpox

“ Dr.

vaccine

Ignaz Semmelweis (1847)

“ ‘Savior

“ Florence “ Notes

of Mothers’

Nightingale (1860)

on Nursing

History and Importance (con’t) “

Louis Pasteur (1861) “

“

French chemist and microbiologist

Father of EVP- Dr. Archie Cochrane (1970’s) “ Cochrane Collaboration “

www.cochrane.org

www.Wikipedia.com for info on historical figures

So, now the ‘How’ “

Putting EVP into Play…. “

Participate in surveys or data collection “ Although not all school nurses want…to actually conduct research studies, all are encouraged to participate... One way that school nurses can be a part of school nursing research is to participate in data collection…completing surveys…[and] pilot studies…” “

J Denehy - Journal of School Nursing (2006) Volume 22 Number 3 pg 129

So, now the ‘How’ (con’t) “ Example:

AR Dept of Ed state health initiative to pilot improvements in health screenings of students

The 5 steps of EVP “

Formulate the ‘burning’ question

“

Search for best evidence

“

Critical appraisal

“

Integrate the evidence

“

Evaluate the effectiveness

Melynk, B., M., & Fineout-Overholt, E. (2005). Making the case for evidence-based practice. In Melynk, B. M., & Fineout-Overholt, E. Evidence-based practice in nursing & healthcare: A guide to best practice (pp. 3-24). Philadelphia: Lippincott Williams & Wilkins

Formulate the Question - Step 1 “ Ask:

Why do we do what we do? ‘When’: z

You wonder why I have to do something? Why I have to do it that way? Something drives you crazy!!!!! Someone else asks why? You think there might be a better way…

Step 1 (con’t) What needs to change (or be better)? ‘What’: z Frequent occurrences (ex: head lice) High risk (ex: office staff giving meds)

“ Now

you have your question!

“ Define

so as to Refine your search….

Defining the Question “ Develop “

“

“

“

a PICO question!

Patient population of interest z Ex: certain age, race, location of persons Intervention of interest z Specifically defined Comparison of interest z Ex: compared to ‘what we always do’ or a placebo Outcome of interest z May be specific but may also need to use umbrella term Nolan, R., Fineout-Overhold, E., & Stephenson, P. ( 2005). Asking compelling clinical questions. In In Melynk, B. M., & Fineout-Overholt, E. Evidence-based practice in nursing & healthcare: A guide to best practice (pp. 3-24). Philadelphia: Lippincott Williams & Wilkins.

Defining the Question (con’t) “

Example PICO question “

For __P__ does the use of __I__ reduce/increase the risk of ___O___ compared with ___C___? In __P__, what is the effect of __I___ versus ___C____ on __O__? Are __P___ who have __P__ at risk for __O__ compared with __P__ with/without __I__?

**The words in the blanks are your key words to use in your literature search**

Search for Evidence – Step 2 “

But where is the Evidence? “

www.cochrane.org z

“ “

www.joannabriggs.edu www.guidelines.gov z

“

National Guidelines Clearinghouse

www.nursingsociety.org z

“

The Cochrane Library for systematic reviews

Sigma Theta Tau

Professional nursing journals z z z z z z

Journal of School Nursing Journal of Pediatric Nursing Pediatric Nursing Journal Contemporary Pediatrics Pediatric Research Nursing Research

Step 2 (con’t) American Academy of Pediatrics “ Centers for Disease Control and Prevention “ MEDLINE and CINAHL databases “ National Association of School Nurses “ Society of Pediatric Nurses “ NAPNAP “ National Association of Clinical Nurse Specialists “

Step 2 (con’t) “

The literature search “

Use your resources!!! “ “

“ “ “ “

Does your district subscribe to any search engines? Do you belong to a professional organization that you can search for journal articles for free? Local library – take the librarian your PICO question! University library Google! Look at the reference list of obtained literature…

So, now the ‘How’ (con’t) “ Examples “ PICO

of EVP

question related to head lice

policy For school children with head lice, does staying at school increase the risk of spreading head lice compared with no-nit policies?

So, now the ‘How’ (con’t) If you would have searched for this in CINAHL:

No-nit Policies in School P. Sciscione & C. A. Krause-Parello Journal of School Nursing (2007) Volume 23 Number 1 pp 13-20

Critical Appraisal – Step 3 “ Levels

of Evidence

I – Meta analysis or systematic review of randomized control trials (RCT’s) II – Experimental study III – Quasi-experimental study IV – Non-experimental study V – Clinical examples or expert opinion

Step 3 (con’t) “ Strength

of Evidence

A – (Highest) Type I or several consistent findings from II, III, or IV B – Multiple studies II, III, or IV generally consistent C – Inconsistent studies from II, III or IV D – Limited research or only one type II E – Type IV or V evidence only

Step 3 (con’t) “ Evaluate

‘No-nit Policy’ article

Rating system for Level of Evidence. The Nebraska Medical Center. Adapted from Joanna Briggs Institute and AHCPR (2005).

So, now the ‘How’ (con’t) “ What

if there is little or no evidence? “ We know what we should do, but how do we do it? “ Bridging

the Theory-Practice Gap

Segaric, C. A., & Hall, W. A. (2005). The family theory-practice gap: A matter of clarity? Nursing Inquiry, 12(3), 210-218.

Generate our own EVP to figure it out!

So, now the ‘How’ (con’t) “ Go

back in history:

“ Flo

knew there was something about cleanliness that kept the soldiers from dying, but what was it? “

It was her ‘observations’ that figured it out z

aka: Research

So, now the ‘How’ (con’t) “ Once

she figured it out it was hand washing, imagine the process of getting clean water and lime at their bedside (mid 1880’s….no running water…had to make the soap…) “

It was her trial and error that figured out a way z

aka: Research

This is what we now call EVP!!!

Step 4 & 5: Integrating Evidence and Evaluating Practice “ PDSA

cycle

“ Plan “ Do “ Study “ Act Speroff, T., and O’Connor. G., T. (2004). Study designs for PDSA quality improvement research. Quality Management in Health Care, 13(1), 17-32.

Step 4 & 5 (con’t) “ Sound

familiar?

Arkansas Dept of Ed State Health Initiative to Pilot Improvements in Health Screenings

Summary “ Journal

of School Nursing (2007)

“ Volume

23 Number 3 pp 128-136

Evidence-base Practice Guidelines and School Nursing Adams & McCarthy