3215: nursing fundamentals

• the use of study in a practical application unrelated to the original research
• the emphasis is on repeating research findings into real-world applications

• broader than research utilization
• basing clinical decisions on best possible evidence, typically high-quality research
• starts with a clinical question

• instrumental (direct) utilization
• conceptual (indirect) utilization
• persuasive 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.

Research findings from one or more studies that may change one’s thinking but not necessarily one’s particular or observable action

Involves the use of research findings from one or more studies as a persuasive (or political) tool to legitimate a position or 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

• 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

• 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

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

• 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

• a narrative (qualitative) integration
• meta-analysis
• meta-synthesis

• 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

• 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

preprocessed or preappraised evidence is evidence that has been selected from primary studies and evaluated for use by clinicians

• 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

• - 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?

• - population
• - situation

what are the characteristics of the patients or clients?

what, conditions, experiences, or circumstances are we interested in understanding?

greatly facilitate wording of questions

• - 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

how precise the estimate effect is

begins with an innovation or research finding

begins with a perplexing or troubling clinical situation