Evidence-Based Practice for Nurses

Phase I:

Preparation

Phase II:

Validation

Phase III: Comparative

evaluation/decision

making

Phase IV:

Translation/application

Phase V:

Evaluation

sources of research Purpose, context, &

evidence:

Credibility of ndings& potential for/

detailed qualiapplication:ers of

recommendations per criteria ofSynthesis & decisions/

applicability:

Operational denition of use/actionsfor change: Alternative typesof evaluation:

• Po Catalyststential Issues/
  = a problem, including
  unexplained variations or
  less-than-best practice;
  or routine update of
  knowledge; or validation/
  routine revision of procedure, policy,
  etc; or innovative program goal


• Af profirm perceived blems with
  internal evidence


• Focus on high priority Issues


• Decide if need to form a team or
  inv “structures”/keyolve formal
  stake-holders


• Consider other inuential internal
  and external factors, such as
  beliefs, resources, or
  timelines


• Dene desired, measurable
  outcome/s Seek out
  s reviewsystematic


• Determine need for an explicit type
  of research evidence, if
  relevant


• Select research sources with
  conceptual t
  
  
  • Critique & synopsize essential
    components, operational details,
    and other qualifying factors, per source
  
  
  
  

(^) f• See instructions or use of
utilization-focused review tables to
f acilitate this task; ll in the tables for
group decision making or
potential future synthesis

• Critique s reviews ystematic


• Reassess t of individual sources


• Rate the le quality of each vel &
  e per a "table of vidence source
  evidence"


• Dif statistical and ferentiate
  clinical signicance


• Eliminate noncredible sources


• End the process if there is no
  e is clearly insufficient vidence or if there
  credible research evidence that
  meets your need

See Stetler et al. (1998) for noted

tables, resynthesis process.views, &

• Synthesize the cumulative ndings:

(^) the similarities and • Logically organize & display
dif ndings, per common ferences across multiple
aspects or sub-elements of the topic under review
(^) substantiation of each • Evaluate degree of
aspect/sub-element; reference any qualifying
conditions

• Evaluate degree & nature of other criteria:
  feasibility (r,r,r = risk, resources, readiness);
  pragmatic t; & current practice


• Make a decision whether/what to use:

(^) practitioner-level decision or • Can be a personal
a recommendation to others
(^) decision; indicate if primarily • Judge the strength of this
"research-based" or, per use of supplemental information,
"evidence-based"; qualify the related level of strength
of decision/ recommendations
per related table
(^) determine degree of • For formal recommendations,
stakeholder consensus

• If decision = "Not use" research ndings:

(^) or delay use until additional • May conduct own research
research is done by others
(^) on evidence of consensus or • If still decide to act now, e.g.,
another basis for practice, STOP use of model but
consider need for planned change and evaluation

• If decision = "Use/Consider Use," can mean a
  recommendation for or against a specic practice
  
  
  • Types = cognitive, symbolic &/or instrumental
  
  
  • Methods = informal or formal; direct or indirect
  
  
  • Lev organizationels = individual, group, or department/
  
  
  • Direct instrumental use: change individual behavior (vis-à-vis assessment; plan/
    intervention options; implementation details; &/or evaluation); or change policy,
    procedure, protocol, algorithm, program components, etc.
  
  
  • Cognitive use: validate current practice; change personal way of thinking; increase
    a appreciate condition/s or experience/swareness; better understand or
  
  
  • Symbolic use: develop position paper or proposal for change; persuade others
    regarding a way of thinking
    C product or use goes beyond actual AUTION: Assess whether translation/
    ndings/evidence:
  
  
  
  

(^) provide various details for a complete • Research evidence may or may not
polic to users, and note dify, procedure, etc.; indicate this fact ferential levels of
evidence therein

• F should be planned per relevant research ormal dissemination & change strategies
  (Include Dx analysis):

(^) e• Simple, passive education is rarely ffective as an isolated strategy.
Consider multiple strategies, e.g., interactive education, opinion leaders,
educational outreach, audit, etc.
(^) (e.g., Kitson or PRECEDE)• Consider implementation models

• C variationonsider need for appropriate, reasoned


• WITH B, where made a decision to use in the setting:

(^) e• Wvaluation to effectively implement & ith formal use, may need a dynamic
continuously imp available evidencerove/rene use of best

• WITH B', where made a decision to consider use & thus obtain additional,
  pragmatic information before a nal decision

(^) project• With formal consideration, need a pilot
(^) IRB revie• With a pilot project, must assess if need w, per relevant institutional
criteria

• Evaluation can be formal or
  informal, individual or
  institutional


• Consider cost- benet of various
  evaluation efforts


• Use RU as a process to
  enhance credibility
  of evaluation data


• For both dynamic & pilot
  e include tvaluations,wo
  types of evaluative
  information:

(^) r• formative,egarding
actual implementation
& goal progress
(^) r• summative,egarding
Phase I outcomes and
goal results
NOTE: Model applies to all forms
of practice, i.e.,educational,
clinical,managerial, or
other
FIGURE 16-1 Continued
16.1 Evidence-Based Practice Models to Overcome Barriers 429