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Evidence based practice assignment components.

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If you have questions on EBP resources or searching contact Kim O'Neill, koneill@regis.edu

What is a PICO(T) Question?

PATIENT OR PROBLEM
Who is the patient? What is the health issue/problem?

INTERVENTION
What main intervention are you considering? What do you want to do with this patient?

COMPARISON
What is the main alternative being considered, if any?

OUTCOME
What are you trying to accomplish, measure, improve or affect?

TIME (optional)

Length of treatment

PICO Search Strategy

Critical Appraisal

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A Summary of the Steps in the EBP Process for Your EBP Practice Brief/Change Project

1. ASSESS
a Policy and Procedure, Clinical Guideline, Practice Issue

Look at a clinical policy/clinical practice guideline at your workplace or in the D2L course or in DocuCare or perhaps at the National Guideline Clearinghouse website and identify a problem or need in the policy/clinical practice guideline OR review a current nursing practice issue.

 Selected topics posted on the course website for NR 420.

 

2. ASK
a PICOT question

Construct a well built question related to the problem or need you have identified in the policy or practice issue.

3. BACKGROUND

Briefly tell the story of the issue and why it deserves our attention.

4. ACQUIRE
the evidence

Select the appropriate resource(s) and conduct a search. Look for at least 5 scholarly/research articles/reviews that address all three legs of the EBP stool: patient values and preferences, scientific evidence, and clinical experience.

5. APPRAISE
the evidence

Critique the evidence. Use Journal Grid to appraise for its validity (closeness to the truth)and applicability (usefulness in clinical practice). Identify level of evidence.

6. APPLY/INTEGRATE
the evidence

Integrate best scientific evidence, clinical experience, patient values and preferences and apply it To practice. What can nurses do? Make logical, reasonable, feasible recommendations supported by the evidence

7. FEASIBILITY

Briefly discuss the influence of stakeholders /change agents as they might influence the viability of your evidence-based recommendations.
 

Modified from Duke’s Online EBP Tutorial at  http://guides.mclibrary.duke.edu/content.php?pid=431451&sid=3529499

Modified from http://www.sonoma.edu/users/k/kosher/n300/Evidenced-basedpaper/html

Refer to grading rubric for the EBP Practice Brief/Change Project.

Quantitative vs. Qualitative

 
Quanitative
Qualitative
Systematic
Systematic
Objective
Subjective
Deductive
Inductive
Generalisable
Not generalisable
Numbers
Words
Large sample sizes
Smaller sample sizes

http://www.utexas.edu/nursing/norr/html/links/research_qua.html

Types of Quanitative & Qualitative Studies

Quantitative Studies generate numerical data or data that can be converted into numbers. Examples of quantitative studies:

The studies presented here increase in validity, reliability and level of evidence as you go down the list.

Case series and Case reports consist of collections of reports on the treatment of individual patients or a report on a single patient. Because they are reports of cases and use no control groups to compare outcomes, they have little statistical validity.

Case control studies are studies in which patients who already have a specific condition are compared with people who do not have the condition. The researcher looks back to identify factors or exposures that might be associated with the illness.  They often rely on medical records and patient recall for data collection. These types of studies are often less reliable than randomized controlled trials and cohort studies because showing a statistical relationship does not mean than one factor necessarily caused the other. 

Cohort studies identify a group of patients who are already taking a particular treatment or have an exposure, follow them forward over time, and then compare their outcomes with a similar group that has not been affected by the treatment or exposure being studied. Cohort studies are observational and not as reliable as randomized controlled studies, since the two groups may differ in ways other than in the variable under study.  

Randomized controlled clinical trials are carefully planned experiments that introduce a treatment or exposure to study its effect on real patients. They include methodologies that reduce the potential for bias (randomization and blinding) and that allow for comparison between intervention groups and control (no intervention) groups.  A randomized controlled trial is a planned experiment and can provide sound evidence of cause and effect.  

Systematic Reviews  focus on a clinical topic and answer a specific question. An extensive literature search is conducted to identify studies with sound methodology. The studies are reviewed, assessed for quality, and the results summarized according to the predetermined criteria of the review question.

A Meta-analysis will thoroughly examine a number of valid studies on a topic and mathematically combine the results using accepted statistical methodology to report the results as if it were one large study.

Adapted from http://guides.mclibrary.duke.edu/content.php?pid=431451&sid=3530453

Qualitative Studies explore and understand people's beliefs, experiences, attitudes, behavior and interactions. They generate non-numerical data. Examples of qualitative studies:

  • Phenomenological studies investigate the meaning of a phenomenon among those who experienced it.
  • Ethnography is a systematic study of the features and interactions of a particular culture.
  • In Grounded Theory Studies is research where data are collected, analyzed, and used to develop a theoretical explanation and generate hypotheses for further research.
  • Historical method examines social phenomena by studying their historical context or their past.
  • Case Studies use the in-depth description of essential dimensions and processes of the phenomenon being studied.

Adapted from http://www.utexas.edu/nursing/norr/html/links/research_qua.html

Research Pyramid