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research utilization [RU]
- the use of study in a practical application unrelated to the original research
- the emphasis is on repeating research findings into real-world applications
evidence-based practice [EBP]
- broader than research utilization
- basing clinical decisions on best possible evidence, typically high-quality research
- starts with a clinical question
types of research utilization
- instrumental (direct) utilization
- conceptual (indirect) utilization
- persuasive utilization
Instrumental research utilization
A concrete application of the research, which is normally translated into a material and usable form, such as a protocol or set of guidelines.
Conceptual research utilization
Research findings from one or more studies that may change one’s thinking but not necessarily one’s particular or observable action
Symbolic (persuasive) utilization
Involves the use of research findings from one or more studies as a persuasive (or political) tool to legitimate a position or practice
key components of EBP [evidence-based practice]
- Archie Cochrane
- David sackett
- efforts led to development of Cochrane center in Oxford and the Cochrane Collaboration
- proposed an evidence hierarchy for weighing evidence
its aim is to help providers make good health care decisions by preparing and disseminating systemic reviews of the effects of health care interventions
evidence of hierarchy
- involves ranking evidence sources according to the strength of evidence they provide
- typically, hierarchies rank evidence relating to the effectiveness of health care interventions
- evidence hierarchies are not meaningful for certain types of questions (e.g., about meaning and process)
Evidence-based practice pioneer at McMaster Medical school. This has broadened to the use of best evidence by all health care practitioners
levels of evidence (from strongest to weakest)
- I. systemic reviews of RCTs
- II. individual RCTs
- III. systematic reviews of non-RCTs (correlational)
- IV. individual correlational studies
- V. systematic reviews of descriptive studiesVI. individual descriptive studiesVII. opinions of respected authorities and expert committees
systematic reviews of RCTs
the highest level of evidence because the strongest evidence comes from careful synthesis of multiple studies
seconds highest level, it depends on the nature of inquires
most barriers in research fall into what three categories?
- 1. quality and nature of the research
- 2. characteristics of nurses
- 3. organizational factors
- limited availability of strong research evidence for some practice areas
- scarcity of published replications
- attitudes and education are a potential barrier
- inadequate skills in locating and appraising evidence
lack of financial support and staff release time for EBP
is in itself a methodical, scholarly inquiry that follows many of the same steps as those for other studies
different types of systematic reviews
- a narrative (qualitative) integration
- is a technique for integrating quantitative research findings statistically - it treats the findings from a study as one piece of information
- - individual studies are the unit of analysis
- - it provides an objective method of integrating a body of finding and of observing patterns that might not been detected
is distinct from a quantitative meta-synthesis. its less about reducing information and more about interpreting
clinical practice guidelines
- distill a body of evidence into a usable form. it gives recommendations for evidence-based decision making
- - typ involves the consensus of a group of researchers, experts, and clinicians
- - systematic reviews
- - traditional narrative reviews
- - meta-syntheses
- - meta-analysis
- - other pre-appraised evidence
- - models and theories for EBP or RU
what is pre-appraised evidence
preprocessed or preappraised evidence is evidence that has been selected from primary studies and evaluated for use by clinicians
steps in individual EBP
- 1. ask questions that are answerable with research evidence
- 2. search for and assemble evidence
- 3. appraise and synthesize evidence
- 4. integrate evidence with other sources
- 5. assess effectiveness of decision or advice
components for quantitative evidence
- - population
- - intervention
- - comparison*
- - outcome- time
** = not always specified
what are the characteristics of the patients or people?
what are the interventions r therapies of interest? or, what are the potentially harmful influences/exposures of concern?
what are the outcomes or consequences in which we are interested?
components for qualitative evidence
components for qualitative evidence: population
what are the characteristics of the patients or clients?
components for qualitative evidence: situation
what, conditions, experiences, or circumstances are we interested in understanding?
templates for clinical questions can ....
greatly facilitate wording of questions
appraising the evidence
- - what is the quality of the evidence?
- - what is the magnitude of effects?
- - how precise are estimated of effects?
- - is there evidence of side effects?
- - what are the costs?
- - is there relevance to my clinical situation
- - is the evidence valid
- - what methods were used?
evidence magnitude of effects
evidence magnitude of effects
evidence precision of estimates
how precise the estimate effect is
begins with an innovation or research finding
begins with a perplexing or troubling clinical situation