Table of Contents

 

 

 

Foreword

xvii

 

Introduction

xix

PART 1

EVIDENCE-BASED PRACTICE BACKGROUND

1

1

Evidence-Based Practice: Context, Concerns, and Challenges

3

 

EBP: A Definition

4

 

Differentiating Quality Improvement, Research, and EBP

5

 

The History

6

 

Research Utilization

6

 

EBP and Outcomes

9

 

EBP and Accountability

10

 

Translation of Evidence

11

 

Knowing and Using Evidence

11

 

Nursing’s Role in EBP

12

 

Summary

13

2

Critical Thinking and Evidence-Based Practice

15

 

Evidence-Based Practice and the Nursing Process

16

 

Critical Thinking, Reasoning, Reflection, and Judgment

18

 

Nursing Expertise, Intellectual Competence, and

 

 

Evidence-Based Practice

20

 

Educating for Critical Thinking Skills

22

 

Critical Thinking and the PET Process

23

 

Critical Thinking in Posing the Practice Question

23

 

Critical Thinking and Appraising Evidence

25

 

Critical Thinkingand Translation

27

 

Recommendations for Nurse Leaders

27

 

Summary

28

PART 2

THE JOHNS HOPKINS NURSING EVIDENCE-BASED PRACTICE MODEL AND GUIDELINES

31

3

The Johns Hopkins Nursing Evidence-Based Practice Model and Process Overview

33

 

The Johns Hopkins Nursing Evidence-Based Practice Model 34

 

 

Nursing Practice

35

 

Nursing Education

38

 

Nursing Research

39

 

The JHNEBP ModelThe Core

40

 

Internal and External Factors

40

 

The JHNEBP Process: Practice Question, Evidence, and Translation

42

 

Practice Question

43

 

Evidence

46

 

Translation

49

 

Summary

52

PART 3

PRACTICE QUESTION, EVIDENCE, TRANSLATION (PET)

55

4

The Practice Question

57

 

The Interprofessional EBP Team

58

 

Practice Problems

59

 

Practice Questions

63

 

Background and Foreground Question

64

 

Developing an Answerable EBP Question

64

 

Summary

66

5

Searching for Evidence

69

 

Key Information Formats

70

 

The Answerable Question

71

 

EBP Search Examples

72

 

Selecting Information and Evidence Resources

74

 

CINAHL

74

 

MEDLINE and PubMed

74

 

The Cochrane Library

75

 

Creating Search Strategies and Utilizing Free Resources

76

 

Key Components to Creating Search Strategies

76

 

Free Resources

77

 

Evaluating, Revising, and Storing Search Results

80

 

Summary

81

6

Evidence Appraisal: Research

83

 

Publications That Report Scientific Evidence

84

 

Summaries of Multiple Studies

84

 

Systematic Reviews

85

 

Meta-Analysis

87

 

Meta-Synthesis

88

 

Individual Research Studies

89

 

Experimental Studies

90

 

Quasi-Experimental Studies

91

 

Non-Experimental Studies

93

 

Descriptive Designs

93

 

Predictive Designs

96

 

Explanatory Designs

96

 

Time-Dimensional Designs

97

 

Qualitative Designs

100

 

Interpreting Primary Research Evidence

102

 

Measures of Validity

103

 

Measures of Reliability

105

 

Measures of Precision

105

 

Appraising the Strength and Quality of Research Evidence.

107

 

Qrading Quality of Research Evidence

108

 

Tips for Reading Research

115

 

The Title

116

 

The Abstract

116

 

The Introduction

117

 

The Conclusion

117

 

The Method

117

 

The Results

118

 

The Discussion

118

 

The Overall Report

118

 

A Practical Tool for Appraising Research Evidence

119

 

Recommendation for Nurse Leaders

119

 

Summary

120

7

Evidence Appraisal: Non-Research

125

 

Summaries of Research Evidence

126

 

Clinical Practice Guidelines and Consensus/Position Statements

126

 

Literature Reviews

129

 

Interpreting Evidence from Summaries of Research Evidence

129

 

Organizational Experience

132

 

Quality Improvement Reports

132

 

Financial Evaluation

133

 

Expert Opinion

135

 

Case Report

136

 

Community Standard

136

 

Clinician Experience

137

 

Patient/Consumer Preferences

139

 

Recommendations for Nurse Leaders

140

 

Summary

141

8

Translation

145

 

Implementing Practice Recommendations

146

 

Additional Models for Translation

146

 

Requirements for Successful Translation

148

 

Pathways to Translation

148

 

Criteria for Successful Translation

149

 

Evidence-Based Practice, Research, and Quality Improvement

151

 

Creating an Action Plan for Translation

152

 

Steps in Implementing Change

153

 

Secure Support and Resources

154

 

Implement the Action Plan

154

 

Evaluate Outcomes

154

 

Report Outcomes to Stakeholders

155

 

Identify Next Steps

156

 

Disseminate Findings

156

 

Summary

158

PART 4

INFRASTRUCTURE

161

9

Creating a Supportive Evidence-Based Practice Environment

163

 

Choosing an EBP Model

166

 

Creating and Facilitating a Supportive EBP Environment

167

 

Establishing the Organizational Culture

167

 

Reviewing the Nursing Philosophy

168

 

Developing a Strategic Plan

170

 

Ensuring Committed Organizational Leadership

171

 

Identifying and De veloping Mentors and Informal Leaders

172

 

The Johns Hopkins Nursing Experience

174

 

Overcoming Barriers

177

 

Leading Change and Managing Transition

179

 

Strategies for Managing Transitions

180

 

Building Capacity

182

 

Developing EBP Skills and Knowledge

182

 

Interprofessional Collaboration

184

 

The Johns Hopkins University School of Nursing

184

 

Sustaining the Change

185

 

Setting Expectations for EBP

186

 

Committee Structure

188

 

Communication Plan

189

 

Summary

191

PART 5

EXEMPLARS

195

10

Exemplars

197

 

Support Surfaces and Pressure Ulcers

198

 

Use of Evidence-Based Practice Model by a

 

 

Professional Nursing Association

202

 

Placing Patients Taking Oral Antiplatelet Medications on

 

 

Bleeding Precautions

206

 

Fall Injury Risk Assessment

209

 

Preventing Pediatric Infiltrates

213

 

The Frequency of Manufactured Intravenous Fluid Bag Replacement

216

 

Ankyloglossia, Frenotomy, and Breast Feeding

219

 

APPENDIXES

 

A

Project Management Guide

225

B

Question Development Tool

227

C

Evidence Level and Quality Guide

231

D

Practice Question, Evidence, and Translation Process (PET)

235

E

Research Evidence Appraisal Tool

237

F

Non-Research Evidence Appraisal Tool

241

G

Individual Evidence Summary Tool

245

H

Synthesis and Recommendations Tool

249

 

Index

255