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nursing fundamentals
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- 1research 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 - 2evidence-based practice [EBP]- broader than research utilization
- basing clinical decisions on best possible evidence, typically high-quality research
- starts with a clinical question - 3types of research utilization- instrumental (direct) utilization
- conceptual (indirect) utilization
- persuasive utilization - 4Instrumental research utilizationA concrete application of the research, which is normally translated into a material and usable form, such as a protocol or set of guidelines.
- 5Conceptual research utilizationResearch findings from one or more studies that may change one’s thinking but not necessarily one’s particular or observable action
- 6Symbolic (persuasive) utilizationInvolves the use of research findings from one or more studies as a persuasive (or political) tool to legitimate a position or practice
- 7key components of EBP [evidence-based practice]- Archie Cochrane
- David sackett - 8Archie Cochrane- efforts led to development of Cochrane center in Oxford and the Cochrane Collaboration
- proposed an evidence hierarchy for weighing evidence - 9Cochrane collaborationits aim is to help providers make good health care decisions by preparing and disseminating systemic reviews of the effects of health care interventions
- 10evidence 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) - 11David Sackett- Evidence-based practice pioneer at McMaster Medical school. This has broadened to the use of best evidence by all health care practitioners
- 12levels 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 studies
VI. individual descriptive studies
VII. opinions of respected authorities and expert committees - 13systematic reviews of RCTsthe highest level of evidence because the strongest evidence comes from careful synthesis of multiple studies
- 14individual RCTsseconds highest level, it depends on the nature of inquires
- 15most barriers in research fall into what three categories?1. quality and nature of the research
2. characteristics of nurses
3. organizational factors - 16research-related barriers- limited availability of strong research evidence for some practice areas
- scarcity of published replications - 17Nurse-related barriers- attitudes and education are a potential barrier
- inadequate skills in locating and appraising evidence - 18organizational barriers- lack of financial support and staff release time for EBP
- 19systematic reviewsis in itself a methodical, scholarly inquiry that follows many of the same steps as those for other studies
- 20different types of systematic reviews- a narrative (qualitative) integration
- meta-analysis
- meta-synthesis - 21Meta-analysisis 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 - 22meta-synthesisis distinct from a quantitative meta-synthesis. its less about reducing information and more about interpreting
- 23clinical practice guidelinesdistill 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 - 24key resources- systematic reviews
- traditional narrative reviews
- meta-syntheses
- meta-analysis
- other pre-appraised evidence
- models
and theories for EBP or RU - 25what is pre-appraised evidencepreprocessed or preappraised evidence is evidence that has been selected from primary studies and evaluated for use by clinicians
- 26steps in individual EBP1. 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 - 27components for quantitative evidence- population
- intervention
- comparison*
- outcome
- time *
* = not always specified - 28populationwhat are the characteristics of the patients or people?
- 29interventionwhat are the interventions r therapies of interest? or, what are the potentially harmful influences/exposures of concern?
- 30outcomewhat are the outcomes or consequences in which we are interested?
- 31components for qualitative evidence- population
- situation - 32components for qualitative evidence: populationwhat are the characteristics of the patients or clients?
- 33components for qualitative evidence: situationwhat, conditions, experiences, or circumstances are we interested in understanding?
- 34templates for clinical questions can ....greatly facilitate wording of questions
- 35appraising 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 - 36evidence quality- is the evidence valid
- what methods were used? - 37evidence magnitude of effectsassess whether findings are clinically important
- how powerful are the effects - 38evidence precision of estimateshow precise the estimate effect is
- 39knowledge-focused triggerbegins with an innovation or research finding
- 40problem-focused triggerbegins with a perplexing or troubling clinical situation
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- Descripción
- 3215 Fichas sobre nursing fundamentals, creado por uconn.huskies.19 el 17/09/2013.
- Creado por
- uconn.huskies.19 · sep 2013
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- 17 ago 2016
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