EVIDENCE - BASED NURSING TO BOOST NURSING IMAGE by BILKIS ADELEYE

A paper presented at the on-going in-house Online Capacity Building/ Intellectual Mentoring section For Inspired Nurses Network Africa In                                      NIGERIA .

DATE: Friday February 26th, 2016.

THEME: USING EVIDENCE-BASED NURSING TO BOOST NURSING IMAGE.
                  BY

            BILKIS ADELEYE
        ALIMOSHO GENERAL HOSPITAL,                 IGANDO, LAGOS STATE, NIGERIA
       RN, RPON, BSN IN VIEW( University                    of Derby,  UK)
                 bilkis.adeleye@gmail.com

Good evening great minds. You are all welcome to todays training module and I do appreciate INNA for this great opportunity.  All protocols duely observed.

Its no news that the public perception of nursing is multifaceted and mostly subjective as it has been based on individual experiences with members of the profession.  Key to personal motivation to a nurse professional is a positive public perception in order to carryout her responsibility with no complexity.

Several attempts have been made to restore this huge concern but it seems the green light is not very close. Despite individual efforts to portray the profession as noble, the public still generalises the activities of the few bad eggs. As we all know bad memories linger longer than pleasant ones.
BUT REALLY ARE WE ( Nurses) THAT BAD?

Can we use evidence based practice/evidence based nursing to boost nursing image?
DEFINITELY YES with no regard to its shortfall.

Hence, WHAT IS EVIDENCE-BASED PRACTICE?

The most acceptable definition of EBP is by Sackett D. (1996). It is the conscientious , explicit and judicious use of current best evidence in making decisions about the care of the individual patient.
This means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

KEY POINTS
1.conscientious , explicit and judicious use of current best evidence
2.making decisions
3. the care of the individual patient.

WHAT IS EVIDENCE-BASED NURSING?
This is an process by which evidence, nursing theory and the practitioner s' clinical expertise are critically evaluated and considered in conjuction with patient involvement,  to provide delivery of optimum nursing care for the individual,. (Scott and Mcsherry, 2009).

KEY POINTS
1. Evidence
2. nursing theory
3 . clinical expertise
4. Critical evaluation and patient involvement
5. delivery of optimum nursing care for the individual.

WHAT IS THE PROCESS OF EBP?(Stillwell, 2010)
Step1
asking an  answerable question: asking a specific and well formed question  that can be answered with the help of available evidence.
Asking questions isnt only d first step, it is d driving force behind the concept of ebp bcos if there were no questions, ebn/ebp wouldn't be necessary.
While working as a nurse, many questions we are asked everyday. Some are from patients( to understand health issues),some from colleagues(to understand how best to deal with the care needs of our patients) and some from ourselves(to reflect on practice and to find ways to improve practice).
The need for EBN stems from questions that arise in a practitioner's mind while providing care to patients.  The questions are about how to improve the quality of care and if there is a more efficient way of completing the same activity.
Asking answerable questions is not only the first step, but it is most challenging  aspect of the process. It gives direction for the rest of the process.

Examples
A. Does aging have an effect on ability to learn.
B. How often should a nurse check the temperature of a normothermic patient.
C. Do early warning scoring systems help identify deteriorating patients quickly.
D. Does the use of nicotine patches in the early days of a smoking cessation programme help smokers, etc

Step 2.
Acquiring evidence: process of identifying and obtaining evidence with the help of appropriate search engines and databases.

Step 3.
Appraising the evidence: process of critically appraising identified literature with the help of appropriate tools and strategies

THE HIERARCHY OF EVIDENCE by Greenhaugh (1997)
7. Personal opinions or anecdotes

6. Case report to narrate a single case of a patient with an unusual presentation
Case series to report an unusual condition or presentation of a condition in more than one patient.

5. Observational or descriptive study which aims to  describe the situation without any attempt of controlling or manipulation.

4. Case control studies require participants to be chosen on the basis of a defined problem or characteristic. In this study,  d prevalence of exposure to a potential risk factors is explored and compare cases and controls.

3. Cohort studies are conducted to determine presence or absence of an etiological factor for a disease. The participants are assigned to groups (study and control) b4 developing disease.

2. Randomised control trials(RCTs) involves manipulation of the variables in order to achieve an explanation of cause and effect.

1. Systematic review are the most credible  evidence.meta analysis is a form of systematic review that results from statistical pooling and summation of results  from more than two principal studies. It requires a lot of effort and skill to conduct

Step 4.
Applying the evidence: implementing the findings identified from the available evidence that was appraised using appropriate tools

Step 5.
Assessing the effect/impact of evidence: assessing the effect of change in practice that resulted from the implementation of evidence in the previous step.

References
Greenhalgh, T (1997). "How to read a paper. Getting your bearings (deciding what the paper is about)". BMJ 315 (7102): 243–6. doi:10.1136/bmj.315.7102.243. PMC 2127173. PMID 9253275.

Sackett, D., et al. (1996). Evidence based medicine: what it is and what it isn’t. Edinburg: Churchill Livingstone 312:71-2.

Scott, K. & McSherry, R.(2009) Evidence Based Nursing: clarifying the concepts for nurses in practice. Journal of clinical Nursing, 18(8): p.1085-95.

Stillwell, S., et al., (2010). Evidence based practice: Step by step; searching for the evidence: Strategies to help you conduct a all welcome to todays training module and I do appreciate INNA 4 dis great opportunity.  All protocols duely observed.

Its no news that the public perception of nursing is multifaceted and mostly subjective as it has been based on individual experiences with members of the profession.  Key to personal motivation to a nurse professional is a positive public perception in order to carryout her responsibility with no complexity.

Several attempts have been made to restore this huge concern but it seems the green light isnt very close. Despite individual efforts to portray the profession as noble, the public still generalises the activities of the few bad eggs. As we all know bad memories linger longer dan pleasant ones.
BUT REALLY ARE WE THAT BAD?

Can we use evidence based practice/evidence based nursing to boost nursing image?
DEFINITELY YES with no regard to its shortfall.

Hence, WHAT IS EVIDENCE-BASED PRACTICE?

The most acceptable definition of EBP is by Sackett D. (1996). It is the conscientious , explicit and judicious use of current best evidence in making decisions about the care of the individual patient.
This means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

KEY POINTS
1.conscientious , explicit and judicious use of current best evidence
2.making decisions
3. the care of the individual patient.

WHAT IS EVIDENCE-BASED NURSING?
This is an process by which evidence, nursing theory and the practitioner s' clinical expertise are critically evaluated and considered in conjuction with patient involvement,  to provide delivery of optimum nursing care for the individual,. (Scott and Mcsherry, 2009).

KEY POINTS
1. Evidence
2. nursing theory
3 . clinical expertise
4. Critical evaluation and patient involvement
5. delivery of optimum nursing care for the individual.

WHAT IS THE PROCESS OF EBP?(Stillwell, 2010)
Step1
asking an  answerable question: asking a specific and well formed question  that can be answered with the help of available evidence.
Asking questions isnt only d first step, it is d driving force behind the concept of ebp bcos if there were no questions, ebn/ebp wouldn't be necessary.
While working as a nurse, many questions we are asked everyday. Some are from patients( to understand health issues),some from colleagues(to understand how best to deal with the care needs of our patients) and some from ourselves(to reflect on practice and to find ways to improve practice).
The need for EBN stems from questions that arise in a practitioner's mind while providing care to patients.  The questions are about how to improve the quality of care and if there is a more efficient way of completing the same activity.
Asking answerable questions is not only the first step, but it is most challenging  aspect of the process. It gives direction for the rest of the process.

Examples
A. Does aging have an effect on ability to learn.
B. How often should a nurse check the temperature of a normothermic patient.
C. Do early warning scoring systems help identify deteriorating patients quickly.
D. Does the use of nicotine patches in the early days of a smoking cessation programme help smokers, etc

Step 2.
Acquiring evidence: process of identifying and obtaining evidence with the help of appropriate search engines and databases.

Step 3.
Appraising the evidence: process of critically appraising identified literature with the help of appropriate tools and strategies

THE HIERARCHY OF EVIDENCE by Greenhaugh (1997)
7. Personal opinions or anecdotes

6. Case report to narrate a single case of a patient with an unusual presentation
Case series to report an unusual condition or presentation of a condition in more than one patient.

5. Observational or descriptive study which aims to  describe the situation without any attempt of controlling or manipulation.

4. Case control studies require participants to be chosen on the basis of a defined problem or characteristic. In this study,  d prevalence of exposure to a potential risk factors is explored and compare cases and controls.

3. Cohort studies are conducted to determine presence or absence of an etiological factor for a disease. The participants are assigned to groups (study and control) b4 developing disease.

2. Randomised control trials(RCTs) involves manipulation of the variables in order to achieve an explanation of cause and effect.

1. Systematic review are the most credible  evidence.meta analysis is a form of systematic review that results from statistical pooling and summation of results  from more than two principal studies. It requires a lot of effort and skill to conduct

Step 4.
Applying the evidence: implementing the findings identified from the available evidence that was appraised using appropriate tools

Step 5.
Assessing the effect/impact of evidence: assessing the effect of change in practice that resulted from the implementation of evidence in the previous step.

References

Greenhalgh, T (1997). "How to read a paper. Getting your bearings (deciding what the paper is about)". BMJ 315 (7102): 243–6. doi:10.1136/bmj.315.7102.243. PMC 2127173. PMID 9253275.

Sackett, D., et al. (1996). Evidence based medicine: what it is and what it isn’t. Edinburg: Churchill Livingstone 312:71-2.

Scott, K. & McSherry, R.(2009) Evidence Based Nursing: clarifying the concepts for nurses in practice. Journal of clinical Nursing, 18(8): p.1085-95.


Stillwell, S., et al., (2010). Evidence based practice: Step by step; searching for the evidence: Strategies to help you conduct a successful search. Vol.110, No. 5

Thank you all.
Thank you Inspired Nurses Network Africa.