Applying nursing research to practice

Apply Rubrics Approach to Care 2 1 Less Than Unsatisfactory Satisfactory 0-72% 72-75% 0.00% 75.00% 80.0 %Content 30.0 % Explanation of the Diagnosis and Staging of Cancers is Provided. 3 5 4 Satisfactory Excellent 90Good 80-89% 76-79% 100% 89.00% 79.00% 100.00% An explanation An explanation An explanation An explanation An explanation of the diagnosis of the diagnosis of the diagnosis of the diagnosis of the diagnosis and staging of and staging of and staging of and staging of and staging of cancers is not cancers is cancers is cancers is cancers is provided. provided but is provided that provided that is provided that is missing meets the offered in a offered in a relevant assignment detailed detailed information. criteria. manner. manner, while demonstrating higher level or critical thinking. 20.0 % At Less than three At least three At least three More than More than Least Three complications complications complications three three Complications of cancer are of cancer are of cancer are complications complications of Cancer are identified. identified but identified with of cancer are of cancer are Identified With lacking a a identified with identified with Comprehensive comprehensive comprehensive a a Discussion of discussion of discussion of comprehensive comprehensive Available available available discussion of discussion of Treatments. treatments. treatments. available available treatments. Applying nursing research to practice

treatments, while demonstrating higher level or critical thinking. 30.0 % Recommendati Recommendati R Provides ons to address ons to address ons to address ons to address ons to address Recommendati physiological physiological physiological physiological physiological ons to Address and and and and and Physiological psychological psychological psychological psychological psychological and side effects of side effects of side effects of side effects of side effects of Psychological care are care are care meet the care are offered care are offered Side Effects of lacking. missing assignment in a detailed in a detailed Care. relevant criteria. manner. manner, while information. demonstrating higher level or critical thinking. 15.0 %Organization and Effectiveness 5.0 % Thesis Paper lacks any Thesis and/or Development discernible main claim are and Purpose overall purpose insufficiently or organizing developed claim. and/or vague; purpose is not clear. 5.0 % Paragraph Development and Transitions Thesis and/or main claim are apparent and appropriate to purpose. Applying nursing research to practice

Paragraphs and Some Paragraphs are transitions paragraphs and generally consistently transitions may competent, but lack unity and lack logical ideas may coherence. No progression of show some apparent ideas, unity, inconsistency connections coherence, in organization between and/or and/or in their paragraphs are cohesiveness. relationships to established. Some degree of each other. Transitions are organization is inappropriate to evident. purpose and scope Applying nursing research to practice Applying nursing research to practice

. Organization is disjointed. 5.0 % Surface errors Frequent and Some Mechanics of are pervasive repetitive mechanical Writing enough that mechanical errors or typos (includes they impede errors distract are present, but spelling, communication the reader. are not overly punctuation, of meaning. Inconsistencies distracting to grammar, Inappropriate in language the reader. language use) word choice choice Correct and/or sentence (register), sentence construction sentence structure and are used. structure, audience- Thesis and/or Thesis and/or main claim are main claim are clear and comprehensive; forecast the contained development of within the the paper. It is thesis is the descriptive and essence of the reflective of the paper. Thesis arguments and statement appropriate to makes the the purpose. purpose of the paper clear. A logical There is a progression of sophisticated ideas between construction of paragraphs is paragraphs and apparent. transitions. Paragraphs Ideas progress exhibit a unity, and relate to coherence, and each other. cohesiveness. Paragraph and Topic transition sentences and construction concluding guide the remarks are reader. appropriate to Paragraph purpose. structure is seamless. Prose is largely Writer is free of clearly in mechanical command of errors, although standard, a few may be written, present. A academic variety of English. sentence structures and effective figures of and/or word choice are present. appropriate language are used. speech are used. 5.0 %Format 2.0 % Paper Template is not Template is Template is Template is All format Format (1- inch used used, but some used, and fully used; elements are margins; 12- appropriately elements are formatting is There are correct. point-font; or missing or correct, virtually no double-spaced; documentation mistaken; lack although some errors in Times New format is rarely of control with minor errors formatting Roman, Arial,

followed formatting is may be present. style. or Courier) correctly. apparent. 3.0 % Research No reference Reference page Reference page Reference page In-text citations Citations (In- page is is present. is included and is present and and a reference text citations included. No Citations are lists sources fully inclusive page are for citations are inconsistently used in the of all cited complete. The paraphrasing used. used. paper. Sources sources. documentation and direct are Documentation of cited sources quotes, and appropriately is appropriate is free of error. reference page documented, and GCU style listing and although some is usually formatting, as errors may be correct. appropriate to present. assignment) 100 % Total Weightage CHAPTER 19 Strategies and

Tools for Developing an EvidenceBased Practice Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 2 TOOL #1: ASKING A FOCUSED CLINICAL QUESTION Develop the question by addressing these four issues: 1. 2. 3. 4. Population Intervention Comparison Outcome Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 3 CATEGORIZE THE CLINICAL QUESTION 1. Therapy category: ➢ Experimental or quasi-experimental ➢ Outcome known ➢ Therapy appraisal tool at: http://www.casp-uk.net/wpcontent/uploads/2011/11/CASP_RCT_Appraisal_Checklist_1 4oct10.pdf. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 4 CATEGORIZE THE CLINICAL QUESTION 2. Diagnosis category: ➢ Cross-sectional ➢ Comparison of the new and the “gold standard” ➢ Diagnostic tool at: http://www.casp-uk.net/wpcontent/uploads/2011/11/CASP_Diagnostic_Appraisal_Che cklist_14oct10.pdf. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 5 CATEGORIZE THE CLINICAL QUESTION 3. Prognosis category: ➢ Nonexperimental ➢ Follow-up ➢ Determination of factors ➢ Prognosis tool at:

http://www.casp-uk.net/wpcontent/uploads/2011/11/CASP_Cohort_Appraisal_Checkli st_14oct10.pdf Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 6 CATEGORIZE THE CLINICAL QUESTION 4. Harm category: ➢ Nonexperimental ➢ Exposure ➢ Harm appraisal tool at: http://www.casp-uk.net/wpcontent/uploads/2011/11/CASP_CaseControl_Appraisal_Checklist_14oct10.pdf. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 7 TOOL #2: SEARCHING THE LITERATURE Consult librarian Tutorial for PubMed at www.nlm.nih.gov/bsd/disted/pubmed.html#qt Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 8 TOOL #3: SCREENING YOUR FINDINGS Peer-reviewed journal? Similar setting and sample? Study sponsorship? Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. TOOL #4: APPRAISE EACH ARTICLE’S FINDINGS Therapy studies ➢ Is there a difference between two or more treatments? ➢ Numerical values are either continuous or discrete. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 9 10 CONTINUOUS AND DISCRETE VARIABLES Objective Variable Outcome CONTINUOUS VARIABLES Change after exposure to intervention Pain score Applying nursing research to practice

Levels of distress Blood pressure Weight Measures of central tendency DISCRETE VARIABLES “Event” occurred or did not occur Death Diarrhea Pressure ulcer Pregnancy Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. Measures of event probability 11 DIAGNOSIS ARTICLES Sensitivity is the proportion of those with disease who test positive; that is, sensitivity is a measure of how well the test detects disease when it is really there—a highly sensitive test has few false negatives. Specificity is the proportion of those without disease who test negative. It measures how well the test rules out disease when it is really absent; a specific test has few false positives. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 12 SENSITIVITY Measure of Accuracy Sensitivity Definition Comments Ability of the test to detect the proportion of people with the disease or disorder of interest TP/(TP + FN), where TP and FN are number of true-positive and falsenegative results, respectively Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 13 SPECIFICITY

Measure of Accuracy Specificity Definition Comments Ability of the test to detect the proportion of people without the disease or disorder TN/(TN + FP), where TN and FP are number of true-negative and falsepositive results, respectively Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 14 PROGNOSIS ARTICLES Odds ratio: Probability of developing the outcome or a particular disease. Indicates how much more likely certain independent variables (factors) predict the probability of developing the dependent variable (outcome or disease). Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 15 ODDS RATIO Odds ratio ➢ The odds ratio (OR) best describes the data in casecontrol studies. ➢ The OR = probability of an event ➢ Calculated by dividing the odds in the treated or exposed group by the odds in the control group Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 16 HARM ARTICLES Used to determine if an individual has been harmed by being exposed to a particular event Case-control design: investigators select the outcome they are interested in (e.g., pressure ulcers), and examine if any one factor explains those who have and do not have the outcome of interest. The measure of association that best describes the analyzed data in case-control studies is the odds ratio. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 17 META-ANALYSIS

A research method that statistically combines the results of multiple studies (usually randomized clinical trials) to answer a focused clinical question through an objective appraisal of carefully synthesized research evidence Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 18 META-ANALYSIS Terms “meta-analysis,” “systematic review,” and “integrative review” are used interchangeably. Meta-analysis is a quantitative approach to a systematic review, whereas an integrative review uses a nonquantitative approach. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 19 META-ANALYSIS Meta-analyses and integrative reviews are both considered systematic reviews and provide level I evidence. Each uses a standardized process, which has a set of preestablished criteria that guide its implementation. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 20 STEPS IN A METAANALYSIS Clinical question Search for all relevant studies What studies are included Assess the quality of each study Studies statistically combined Conclusion Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 21 MEASURES IN METAANALYSIS SYSTEMATIC REVIEW The OR is the statistic of choice for use in a metaanalysis. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 22 INTERPRETING ODDS RATIOS Odds ratio Type of Outcome Adverse outcome Beneficial outcome Less than 1 Intervention better Intervention worse = to 1 (null) Intervention no better or worse Intervention no better or worse Greater than 1 Intervention worse Intervention better Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. WHAT IS THE MOST IMPORTANT STEP IN APPLYING EVIDENCE TO PRACTICE? 23 A. PICO (population, intervention, comparison, and outcome) B. Critically reviewing the literature C. Putting the research into practice D. Evaluating efficacy of the new practice Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. WHICH EBP CLINICAL CATEGORY WOULD THE NURSE BE USING IN THE FOLLOWING SCENARIO? 24 A clinical nurse has noticed an increased incidence in urinary tract infections and would like to find the best practice to minimize this. A. Therapy B. Diagnosis C. Prognosis D. Harm Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. WHEN COMPLETING A LITERATURE SEARCH FOR A CLINICAL QUESTION, WHAT IS THE FIRST RESOURCE THE NURSE SHOULD USE? 25 A. Evidence-based nursing B. CINAHL C. PUBMED D. Cochrane review Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. FOR THE NURSE WHO HAS LIMITED TIME TO REVIEW A RESEARCH ARTICLE, WHERE WOULD BE THE BEST PLACE TO FIND THE ANSWER TO THE Abstract CLINICAL QUESTION? 26 A. B. Method C. Conclusion D. Table Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. Developing an Evidence-Based Practice Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. Conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 2 Research utilization Evidence-based practice encompasses research utilization but also case reports and expert opinion Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 3 Multifaceted, systemic process of promoting adoption of evidence-based practices in delivery of health care services that goes beyond dissemination of evidence-based guideline Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 4 Dissemination: publications, conferences, consultations, and training programs Conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Applying nursing research to practice

Mosby, an imprint of Elsevier Inc. 5 Validates current practice, changes in practice, cost-effectiveness, and quality of care High-quality Cost-effective Outcomes Research Conduct Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. Research Utilization 6 Questions about current nursing practice Literature review Need for investigation Clinical research Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 7 Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 8 Develop and implement improved practice Other types of evidence Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 9 Priority is given to projects in which a high proportion of practice is guided by research evidence. If a practice change is warranted, changes are implemented using a process of planned change. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 10 EBP is refined based on evaluation data. Outcomes are monitored. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 11 Selecting a topic Problem-focused triggers

➢ Quality improvement data ➢ Risk-surveillance data ➢ Benchmarking data ➢ Financial data ➢ Recurrent clinical problems Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 12 Selecting a topic Knowledge-focused triggers ➢ Reading research ➢ Listening to scientific papers at research conferences ➢ Reviewing EBP guidelines published by federal agencies or specialty organizations Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 13 Critical that staff members:

➢ Be involved in selecting the topic ➢ View the potential practice as contributing significantly to patient care Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 14 Forming a team ➢ Composition of the team ➢ Key stakeholders identified Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 15 Identification of key stakeholders: ➢ How are decisions made? ➢ What types of changes will be needed? ➢ Who is involved in decision-making? ➢ Who is likely to lead and champion implementation? ➢ Who can influence the decisions? ➢ What type of cooperation is needed? Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 16 Question clearly defined: ➢ Types of people and patients ➢ Interventions or exposures ➢ Outcomes

➢ Relevant study designs Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 17 Consider using PICO ➢ Patient, population, or problem ➢ Intervention or treatment ➢ Comparison intervention or treatment ➢ Outcomes Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 18 Evidence examined should include: ➢ Clinical studies, meta-analyses, integrative literature reviews, and existing EBP guidelines Identify key search terms Use the expertise of health science librarians 19 Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. It is helpful to categorize articles and read in this order:

➢ Clinical (nonresearch) ➢ Theory articles ➢ Integrative and systematic reviews ➢ Synthesis reports ➢ EBP guidelines ➢ Research articles ➢ Meta-analyses Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 20 There are many grading schemas available but all address: ➢ Quality of the individual research ➢ Strength of the body of evidence Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 21 Before reviewing the literature, it is imperative that the team agree on: ➢ Methods for categorizing the type of research ➢ Rating the quality of individual articles ➢ Grading the strength of the body of evidence Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsev …