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به نام خالق بهار

به نام خالق بهار. EBN. Objectives. Describe evidence based practice from a nursing perspective Compare and contrast evidence based nursing and medicine Identify challenges to using evidence based practice in nursing Identify resources relevant to nursing. What is - Evidence ?.

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به نام خالق بهار

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  1. به نام خالق بهار EBN dr yekefalah-phd of nursing2012

  2. EBN EBN dr yekefalah-phd of nursing2012

  3. Objectives • Describe evidence based practice from a nursing perspective • Compare and contrast evidence based nursing and medicine • Identify challenges to using evidence based practice in nursing • Identify resources relevant to nursing EBN dr yekefalah-phd of nursing2012

  4. What is - Evidence? Anything that provides material or information on which a conclusion or proof may be based; used to arrive at the truth, used to prove or disprove the point at issue. (Webster) EBN dr yekefalah-phd of nursing2012

  5. What is ‘evidence-based’? Knowledge about ‘what works’ must come from … Intervention, not description Evaluation, not common sense EBN dr yekefalah-phd of nursing2012

  6. طبابت مبتني بر شواهد: در دنياي کنوني شواهد نه تنها براي رد يا اثبات يک فرضيه علمي به کار مي‌روند، بلکه تمامي فعاليتهاي حرفه‌اي افراد نيز بايد بر اساس شواهد باشند. عمل براساس شواهد بهترين راهکارها را در جهت توسعه حرفه‌اي، در اختيار افراد قرار مي‌دهد و فرآيندي است در تضاد با عمل بر اساس آنچه هميشه انجام مي‌شده است. پيشينه: • تفکر استفاده از نتايج حاصل از تحقيقات و پژوهشهاي انجام شده در درمان بيماريها به صدها سال پيش بر مي‌گردد. • واژه «مبتني بر شواهد» براي اولين بار در سال 1990 توسط «ديويد ادي» به کار برده شد و اصطلاح پزشکي مبتني بر شواهد براي اولين بار در سال 1992 در مقاله اي به نوشته « گويات و همکاران» استفاده شد. • تدريجا و پس از آنکه پزشکي مبتني بر شواهد جايگاه خود را پيدا نمود، اين تفکر (مبتني بر شواهد بودن) بتدريج وارد اکثر حيطه‌هاي مراقبت سلامت و سياستگذاري سلامت گرديد. و بدين ترتيب در کنار Evidence BasedMedicineحيطه‌هايي چون: • Evidence Based Nursing • Evidence Based Management • Evidence Based Decision making • Evidence Based Physiotherapy • Evidence Based Librarianship • Evidence Based teaching • Evidence Based Practice • Evidence Based policy making • ...... پديد آمد. EBN dr yekefalah-phd of nursing2012

  7. طبابت مبتني بر شواهد: • تعريف: طبابت مبتني بر شواهد تلاشي است در جهت بکارگيري شواهد بدست آمده از روش هاي علمي، در جنبه هاي مختلف طبابت باليني، به خصوص در ارزيابي شواهد مربوط به مزايا و معايب خدمات سلامت. • در يک تعريف جامع، پزشکي مبتني بر شواهد، حاصل تلفيق سه جز کليدي است: • بهترين و جديد‌ترين شواهدِ مبتني بر مطالعات نظام مند • تخصص و تجربه باليني پزشک • ارزشهاي جامعه و بيمار EBN dr yekefalah-phd of nursing2012

  8. Why EBM? EBN dr yekefalah-phd of nursing2012

  9. پس از گذشت چند سال تنها در حدود 10 تا 20 درصد از اقدامات يک پزشک مبتني بر شواهد است. دو برابر شدن کل داده هاي اينترنتي در 8 ماه به وجود آمدن دانش و اطلاعات جديد دو برابر شدن کل دانش بيومديکال در 20 ماه فراموش شدن برخي از دانسته هاي صحيح گذشته انتشار بيش از 3 ميليون مقاله در سال رد علمي برخي از اطلاعات ودانسته ها نياز و الزام به افزايش آگاهي و به روز شدن حجم زياد اطلاعات خام و قطعه قطعه کاهش دانش و آگاهي ارائه دهندگان خدمات سلامت ناگزير از روي آوري به طبابت مبتني بر شواهد در قالب کاملترين، علمي ترين و در دسترس ترين شواهد موجود هستيم.

  10. Increasing Medical Knowledge/day • 27Kg of Guidelines • New papers 3,200 • Medline New articles 1,000 • RCT’s 60

  11. Understanding Some Work Processes Inherently Dangerous Medication administration • 770,000 annually killed or injured from adverse drug events in hospitals • In two studies, 34-38% of medication errors occurred EBN dr yekefalah-phd of nursing2012

  12. Outdated knowledge of practitioners because of: Time spent to publish new findings as books (considering the half-life & doubling time of knowledge) Coverage of knowledge included in books Large volume of a book cause never be fully seen Carrying books in hand or in mind are impossible EBN dr yekefalah-phd of nursing2012

  13. به خاطر داشته باشيم که پزشکي مبتني بر شواهد اهميت تجربه باليني پزشکان را انکار نمي‌کند، ارزشها و ترجيحات بيماران را ناديده نمي‌گيرد، و مانند يک کتاب آشپزي نيست که تمام مراحل ارائه يک مراقبت يا انجام يک درمان را يک به يک ديکته کند و توان تصميم گيري را از پزشک سلب نمايد. EBN dr yekefalah-phd of nursing2012

  14. Evidence Based Medicine EBM helps shift this balance so that more research gets translated into medical practice Evidence that gets incorporated into practice Available evidence EBN dr yekefalah-phd of nursing2012

  15. Definition Evidence-based nursing “Process by which nurses make clinical decisions using best available evidence, clinical expertise, & patient preferences in the context of available resources” EBN dr yekefalah-phd of nursing2012

  16. Definitions Evidence-based nursing is an approach to health care practice that enables nurses to provide the highest quality care based on the best evidence available to meet the needs of their patients. Melnyk & Fineout-Overholt, 2005 The integration of the best research evidence with clinical expertise and patient values. EBN dr yekefalah-phd of nursing2012

  17. EBN dr yekefalah-phd of nursing2012

  18. EBP in Nursing EBN dr yekefalah-phd of nursing2012

  19. What is Evidence-based nursing?/? EBN dr yekefalah-phd of nursing2012

  20. Evidence-Based Nursing • Asking Answerable Questions • Finding the Best Evidence • Appraising Validity of Evidence • Integrating Evidence (clinician/patient) • Evaluating Effectiveness Sackett et al (2000) Applied to diagnosis, interventions (treatments), and outcomes EBN dr yekefalah-phd of nursing2012

  21. What is Evidence-Based Nursing Practice • Builds on process of research use, but more encompassing • More specific than term ‘best practices’ • Does not foster rigid adherence to standardized guidelines • Recognizes the role of clinical expertise • EB nursing practice is a state of mind! EBN dr yekefalah-phd of nursing2012

  22. What Is Evidence-based Practice? • EBP is a decision-making approach that places emphasis on evidence to: • guide decisions about which interventions to use; • evaluate the effects of an intervention. Professional Judgment Best available evidence Client Values Client Values Best Available Evidence Professional Judgment EBN dr yekefalah-phd of nursing2012

  23. Why Practice EBN? Standard of Care: EBNER recommendations Assures patient receives most up-to-date care possible Assists practitioner in dealing with increasing volume of medical literature Allows patient and practitioner to work together to make informed decisions EBN dr yekefalah-phd of nursing2012

  24. Why Evidence-Based Practice in Nursing • Potential to improve quality, reduce variations in care • Focus on practices that result in best possible outcomes at possibly lower cost • Provides a way to keep pace with advances EBN dr yekefalah-phd of nursing2012

  25. Why Evidence-Based Practice in Nursing • Potential to narrow the ‘research-practice gap’: adoption of research findings into practice can take as long as 17 years (Balas & Boren) • Provides a means to answer problematic clinical • practice issues • supports/improves clinical decision-making skills • Bedside nurse as conduit!! EBN dr yekefalah-phd of nursing2012

  26. Closing the Gap… EBN leads to: • improved patient outcomes • avoidance of unnecessary procedures • reduction of complications Nurses should feel empowered to change practice using proven methods EBN dr yekefalah-phd of nursing2012

  27. Misconception EBN is not a collection of statistical summaries, ignoring patient preferences and clinical expertise. EBN dr yekefalah-phd of nursing2012

  28. Goals of EBN • Provide practicing nurses with evidence-based data • Resolve problems in the clinical setting • Introduce innovation • Reduce variations in nursing care • Assists with efficient and effective decision-making EBN dr yekefalah-phd of nursing2012

  29. The Ultimate Goal • Keeping up with valid information to provide quality patient care and feel good about what we do. Information Mastery EBN dr yekefalah-phd of nursing2012

  30. Values and Preferences EBN - integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities … EBN dr yekefalah-phd of nursing2012

  31. EBN Method EBN dr yekefalah-phd of nursing2012

  32. Evidence-based Steps 1. Formulation of a question 2. Literature search 3. Critical appraisal 4. Clinical decision 5. Performance evaluation EBN dr yekefalah-phd of nursing2012

  33. What EBN originally advocated… EBN dr yekefalah-phd of nursing2012

  34. مراحل EBN dr yekefalah-phd of nursing2012

  35. EBN Steps: Problem Identification Discovery Critique Summary Translation Evaluation EBN dr yekefalah-phd of nursing2012

  36. Step 1: • Problem Identification: Converting information needs into an answerable question • PICO • Patient or Problem • Intervention • Comparison Intervention • Outcomes EBN dr yekefalah-phd of nursing2012

  37. فرمول PICO : • P= Participant • I= Intervention • C= Comparison • O= Outcome EBN dr yekefalah-phd of nursing2012

  38. شرکت کنندگان بیماری یا شرایطی که مورد نظر و علاقه ماست عوامل بالقوه مضر یا سودمند عوامل جمعیت شناسی EBN dr yekefalah-phd of nursing2012

  39. مداخلات: • درمانها • تستهای تشخیصی • عوامل ایجاد کننده • عوامل پیشگیری کننده EBN dr yekefalah-phd of nursing2012

  40. مقایسه نتایج: تمام نتایج مهمی که به افراد کمک می کند با تشخیص میزان موفقیت درمان مورد نظر، تصمیم گیری نمایند. EBN dr yekefalah-phd of nursing2012

  41. بازده نتایج مربوط به سرانجام نهایی بیماری EBN dr yekefalah-phd of nursing2012

  42. گام اول: • سوالی شفاف و کاملا متمرکز بر مشکل بیمار • مربوط به مشکل، قابل پاسخ دادن، شفاف و روشن و ارزشمند • سوال دقیق منجر به استفاده موثر از زمان و یافتن مقالات مرتبط EBN dr yekefalah-phd of nursing2012

  43. What is the 1st step toward EBP for the practicing nurse? • Asking good clinical questions • Nurses must be empowered to ask critical questions in the spirit of looking for opportunities to improve nursing care and patient outcomes • Risk-taking environment EBN dr yekefalah-phd of nursing2012

  44. Clinical Nursing Questions • In postoperative patients, does prn or ATC analgesic administration yield better pain relief? • Among critically ill patients, is controlled or open visitation more effective in reducing patient anxiety? EBN dr yekefalah-phd of nursing2012

  45. What kind of questions might the Nurse Manager ask? • On medical-surgical units, do 12 hour or 8 hour shifts result in more medication errors? EBN dr yekefalah-phd of nursing2012

  46. Key Questions to Ask When Considering EBP • Why have we always done “it” this way? • Do we have evidence-based rationale? • Or, is this practice merely based on tradition? • Is there a better (more effective, faster, safer, less expensive, more comfortable) method? • What approach does the patient (or the target group) prefer? • What do experts in this specialty recommend? EBN dr yekefalah-phd of nursing2012

  47. Key Questions to Ask When Considering EBP • Do the findings of recent research suggest an alternative method? • Are organizational barriers inhibiting the application of best practices in this situation? • Is there a review of the research on this topic? • Are there nationally recognized standards of care, practice guidelines, or protocols that apply? EBN dr yekefalah-phd of nursing2012

  48. Once we agree upon the question that poses an opportunity for improvement, then we must find the evidence • Where should we look? • Are all forms of evidence equivalent in quality? EBN dr yekefalah-phd of nursing2012

  49. Step 2: Discovery: Finding, with maximum efficiency, the best evidence with which to answer the question EBN dr yekefalah-phd of nursing2012

  50. گام دوم: جستجوی بهترین شواهددر دسترس روشها: 1- سوال از همکاران 2 چک کردن لیست کتابهای مرجع در کتابهای موجود 3- یافتن یک مقاله مربوط در فایل شخصی 4- جستجو در بانکهای اطلاعاتی(مهارت پایه و اصلی برای بکارگیری پرستاری مدرن و مبتنی بر شواهد) EBN dr yekefalah-phd of nursing2012

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