Use of EBP for Advocacy: patients, units and nurses

Report
Sally Decker, PhD, RN, CNE
Saginaw Valley State University
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Explain Evidence-Based Practice as a form of
patient advocacy
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Explore how Evidence-Based practice can be
used to advocate for the nursing profession
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Thinking of evidence broadly, nurses are
“summoned” to use the best evidence in the
care of the individual and the care of groups
of individuals and the care of the nursing
profession.
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Guardian of Patients’ rights (legal)
Preservation of Patient values
Champion of social justice in the provision of
health care (social advocacy – use of best
practice for groups)
Conservator of Patients’ best interests
(respect for persons- use of best practice for
individuals)
EBP is "the conscientious, explicit and judicious use of
current best evidence in making decisions about the care
of the individual patient. It means integrating individual
clinical expertise with the best available external clinical
evidence from systematic research." (Sackett D, 1996)
 EBP is the integration of clinical expertise, patient values,
and the best research evidence into the decision making
process for patient care. Clinical expertise refers to the
clinician's cumulated experience, education and clinical
skills. The patient brings to the encounter his or her own
personal and unique concerns, expectations, and values.
The best evidence is usually found in clinically relevant
research that has been conducted using sound
methodology. (Sackett D, 2002)
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definitions of EBP suggest practice based on
the best available evidence that also
incorporates patient values and preferences
and clinician judgment and expertise
Sackett, et al. (2000); Cronenwett et al. (2009)
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Advocacy has been thought of as protecting
legal and moral “rights” of individuals but
individuals also have the “right” to the best
possible care and advocacy can be for groups
and not just individuals.
Evidence is generated from groups and
therefore the use in a specific case can’t be
assumed.
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Saitz (2010) writing in the Annals of Internal
Medicine, questioned if the candidate
performance measures for screening for
unhealthy substance use in hospitals was
advocacy or evidence-based practice –
suggesting they were two different things.
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So evidence collected in one setting and for
one purpose may not be the evidence needed
in another setting and for another purpose
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Develop the question:
P= population
I = intervention
C=comparison
O=outcome
t = time (Fineout-Overholt, et al.)
Search for best evidence
Critically analyze and synthesize
Develop recommendations
Evaluate the outcome of EBP changes
RCTs create the highest evidence in
terms of generalizability and
reproducability – but are not the
only evidence for use in clinical
practice
Polit and Beck 2008
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Agency for Healthcare Research and Quality
www.ahrq.gov/clinic/epcix.htm
Cochrane Library www.cochrane.org
Joanna Briggs Institute for Evidence-Based
Nursing and Midwifery
www.joannabriggs.edu.au
National Guideline Clearinghouse
www.guidelines.gov
CINAHL/Medline
Use of social
statistics in the care
of individuals and
group – policy
change
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Kendall-Gallagher, Aiken, Sloane, & Cimiotti (2011). Nurse
specialty certification, inpatient mortality and
failure to rescue.
Mchugh et al. (2011). Impact of nurse staffing on
safety-net hospitals.
Flynn, Liang, Dickson, & Aiken (2010) Effects of nursing
practice environments on quality outcomes in
nursing homes.
AHRQ. Hospital Nurse Staffing and Quality of
Care
Tapping the potential for research-based
advocacy King (2011) –
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Policy-relevant research and evidence-informed policy in
public health and now policy-directed advocacy –especially
in obesity, environmental factors, food labeling.
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Global issues such as tobacco use have been addressed by
WHO with expert synthesis of research
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Mmatli (2009). Translating
disability-related
research into evidence-based advocacy
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Anderson (2011). Behavioral
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Vaartio, Leino-Kilpi, Suominen & Puukka (2009).
research in pediatric
diabetes: Putting the evidence to work for
advocacy and education
Nursing
advocacy in procedural pain care
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Rosenberg & Allard (2008) Women
and statin use: A
women’s health advocacy perspective.
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Ford-Gilboe, Wuest, Varcoe & Mettirr-Gray (2006).
Developing
an evidence-based health advocacy
intervention for women who have left an
abusive partner.

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