Ch. 6 4205 Evidence-Based Practice, Advocacy, & Bill of Rights Presented by Pamela Roberts, MSN RN EBP Defined The process of providing clinically competent care, supported by the
best scientific evidence available, such as outcomes research and expert advisers. EBP Characteristics Framework for clinical practice Considers internal and external influences on practice
Encourages critical thinking Judicious use of evidence for broad-based thinking Numerous studies cited Critical Thinking and EBP
Translating theory to practice Posing answerable questions Broad-based critical thinking Analysis, synthesis, interpreting, and drawing conclusions Using Evidence-Based Practice Asking the right questions Why was the research done, what setting was used?
Applying innovation to practice Innovation is originality Evaluating the effect of predetermined outcome Was success achieved? How were the results disseminated? Disseminated dispersed, distributed Why are we using
Evidence-Based Practice? Increased rate of information distribution You can google anything you want on the internet Nontraditional EBP moves away from tradition. This is the way weve always done it. Well, maybe that way has been wrong all these years
Decision making based on comprehensive body of knowledge Patient care improvement Implementing the Fallen Star program has decreased the rate of falls Conscientious use of current best evidence in making decisions about nursing care By educating clients based on whats current
Why use EBP? Efficacy The ability to reach the desired result Efficiency Desired result timely with minimal effort Effectiveness The ability to produce the desired result The Nurses Role in EBP
Active in the evolution of EBP in the organization Promote ways to systemize evidence at the bedside Remained enlightened about the use of EBP We do CEUs, take classes, read articles and what not How do we use EBP? Translating evidence into practice
PET P Practice question PICO E - Evidence T Translation Are the changes in practice feasible? If so, actions are taken to put the change into practice, this is when a plan is developed PICO for practice question
Patient, population, or problem Intervention Comparison with other treatments Outcomes Searching for Evidence
PubMed (MEDLINE) CINAHL (The Cumulative Index to Nursing and Allied Health Literature) The Cochrane Library CINAHL EBSCO 2700 nursing, allied health, biomedical, and consumer health journals ANA and NLN journals
Various depths of coverage References dissertations, books, standards of practice, legal cases, critical pathsetc. MEDLINE (PubMed) Produced by the National Library of Medicine Premier source for biomedical literature 5000 journal with 300 nursing specific
Evidence-based filters in clinical queries The Cochrane Library A collection of seven databases Contains evidence summaries and synthesizes reviews Reviews are based on the best available information in health-care interventions Structured to minimize bias
Good evidence-based source Search tips Use controlled vocabulary for keywords and phrases Use AND, OR, and NOT Ex: Clinical competence AND Intravenous therapy More search tips Think of alternative spellings such as
tumour, behaviour, gynaecology American vs. British) Use limits such as age, date of publication, and language Reviewing the search Who wrote it? Who sponsored the research? When was it
published? Has it been reviewed? If so by whom? Why was it published? Has it been cited? Advocacy
Advocacy Advocacy is the foundation and essence of nursing and nurses have a responsibility to promote human advocacy Advocacy is helping people grow and self actualize Nurses must advocate for themselves, clients, family members, subordinates, and their profession
Goals of the Advocate 1. Inform 2. Autonomy (enhance this) 3. Respect 1. To respect the decisions of others, even if you dont agree with it. How Nurses Can Act as Advocates Helping others make informed
decisions Cultural and ethnic diversity and sensitivity Directly intervening on behalf of others Continuing care of DNR client Advocating for Clients Clients needs and goals are paramount Advocate the distribution of resources Leadership must be willing to take risks
Time out procedures (right pt, right site, right surgery) DNRs Ethics Committee for Staff Must be willing to accept conflict Bills of Rights Passed by the National League for Nurses and American Hospital Association in the 1960s
Privacy law primarily protects the rights of the patient Guide professional practice Subordinate Advocacy What is it? The manager helps subordinates resolve ethical problems and live with the solutions at the unit level Like if you have a problem on E5, you should try to solve the problem and
live with the consequences on E5 Promoting Subordinate Advocacy 1. 2. 3. 4. Staff needs, (listen to) Empower staff
Promote autonomy (for the nurses) Face challenges (and solve problems together) 5. Go to bat for the staff (when needed) Workplace Advocacy Manager insures safe, growth oriented environment Occupational health and safety must be assured
Internal vs. External Whistle-Blowing Internal whistle-blowing Within the organization, reporting up the chain of command External whistle-blowing Reporting outside the organization, such as the media or an elected official Public awareness has increased
People are more likely to complain when they feel wronged Nurses must act individually or collectively Professional Advocacy Leader-managers also must be advocates for the nursing profession Professional duty is assumed by entering the profession of nursing Speak out on consumer issues,
continuing and expanding attempts to influence legislation, and increasing membership on governmental health policy-making boards and councils Speak out on staffing issues
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