پرستاری مبتنی بر شواهد (EBN)
اسلاید 1: به نام خالق بهار13/13/2018EBN dr yekefalah-phd of nursing2012
اسلاید 2: EBN23/13/2018EBN dr yekefalah-phd of nursing2012
اسلاید 3: ObjectivesDescribe evidence based practice from a nursing perspectiveCompare and contrast evidence based nursing and medicineIdentify challenges to using evidence based practice in nursingIdentify resources relevant to nursing3EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 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)4EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 5: What is ‘evidence-based’?Intervention, not descriptionEvaluation, not common senseKnowledge about ‘what works’ must come from …5EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 6: طبابت مبتني بر شواهد: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 Based Medicine حيطه‌هايي چون:Evidence Based NursingEvidence Based ManagementEvidence Based Decision makingEvidence Based PhysiotherapyEvidence Based LibrarianshipEvidence Based teachingEvidence Based PracticeEvidence Based policy making ......پديد آمد.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.6EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 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 مندتخصص و تجربه باليني پزشک ارزشهاي جامعه و بيمار7EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 8: Why EBM?8EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 9: نياز و الزام به افزايش آگاهي و به روز شدنکاهش دانش و آگاهي ارائه دهندگان خدمات سلامت به وجود آمدن دانش و اطلاعات جديدفراموش شدن برخي از دانسته هاي صحيح گذشته رد علمي برخي از اطلاعات ودانسته هاحجم زياد اطلاعات خام و قطعه قطعهانتشار بيش از 3 ميليون مقاله در سالدو برابر شدن کل دانش بيومديکال در 20 ماهدو برابر شدن کل داده هاي اينترنتي در 8 ماه پس از گذشت چند سال تنها در حدود 10 تا 20 درصد از اقدامات يک پزشک مبتني بر شواهد است.ناگزير از روي آوري به طبابت مبتني بر شواهد در قالب کاملترين، علمي ترين و در دسترس ترين شواهد موجود هستيم.
اسلاید 10: Increasing Medical Knowledge/day27Kg of GuidelinesNew papers 3,200Medline New articles 1,000RCT’s 6010
اسلاید 11: Understanding Some Work Processes Inherently DangerousMedication administration 770,000 annually killed or injured from adverse drug events in hospitalsIn two studies, 34-38% of medication errors occurred11EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 12: 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 impossibleOutdated knowledge of practitioners because of:12EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 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.13EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 14: Evidence Based MedicineAvailable evidenceEvidence that gets incorporated into practiceEBM helps shift this balance so that more research gets translated into medical practice14EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 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”15EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 16: DefinitionsEvidence-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, 2005The integration of the best research evidence with clinical expertise and patient values.16EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 17: 17EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 18: EBP in Nursing18EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 19: What is Evidence-based nursing?/? 19EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 20: Evidence-Based Nursing.PatientPreferenceBestEvidenceClinician’sexperienceAsking Answerable QuestionsFinding the Best EvidenceAppraising Validity of EvidenceIntegrating Evidence (clinician/patient)Evaluating Effectiveness Sackett et al (2000)Applied to diagnosis, interventions (treatments), and outcomes20EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 21: What is Evidence-Based Nursing PracticeBuilds on process of research use, but more encompassingMore specific than term ‘best practices’Does not foster rigid adherence to standardized guidelinesRecognizes the role of clinical expertiseEB nursing practice is a state of mind!21EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 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 JudgmentBest available evidenceClient ValuesProfessional JudgmentBest Available EvidenceClient Values22EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 23: Why Practice EBN?Standard of Care: EBNER recommendationsAssures patient receives most up-to-date care possibleAssists practitioner in dealing with increasing volume of medical literatureAllows patient and practitioner to work together to make informed decisions23EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 24: Why Evidence-Based Practice in NursingPotential to improve quality, reduce variations in careFocus on practices that result in best possible outcomes at possibly lower costProvides a way to keep pace with advances 24EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 25: Why Evidence-Based Practice in NursingPotential 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 issuessupports/improves clinical decision-making skillsBedside nurse as conduit!!25EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 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 methods26EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 27: MisconceptionEBN is not a collection of statistical summaries, ignoring patient preferences and clinical expertise.27EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 28: Goals of EBNProvide practicing nurses with evidence-based dataResolve problems in the clinical settingIntroduce innovationReduce variations in nursing careAssists with efficient and effective decision-making28EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 29: The Ultimate GoalKeeping up with valid information to provide quality patient care and feel good about what we do.Information Mastery29EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 30: Values and Preferences EBN - integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities …30EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 31: EBN Method31EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 32: Evidence-based Steps1. Formulation of a question 2. Literature search3. Critical appraisal4. Clinical decision5. Performance evaluation32EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 33: What EBN originally advocated…33EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 34: مراحل 34EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 35: EBN Steps:Problem IdentificationDiscoveryCritiqueSummaryTranslationEvaluation35EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 36: Step 1: Problem Identification: Converting information needs into an answerable questionPICO Patient or ProblemInterventionComparison InterventionOutcomes36EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 37: P= ParticipantI= InterventionC= Comparison O= Outcome فرمول PICO :37EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 38: شرکت کنندگانبیماری یا شرایطی که مورد نظر و علاقه ماستعوامل بالقوه مضر یا سودمندعوامل جمعیت شناسی38EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 39: مداخلات :درمانها تستهای تشخیصی عوامل ایجاد کننده عوامل پیشگیری کننده 39EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 40: مقایسه نتایج: تمام نتایج مهمی که به افراد کمک می کند با تشخیص میزان موفقیت درمان مورد نظر، تصمیم گیری نمایند. 40EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 41: بازدهنتایج مربوط به سرانجام نهایی بیماری 41EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 42: گام اول: سوالی شفاف و کاملا متمرکز بر مشکل بیمار مربوط به مشکل، قابل پاسخ دادن، شفاف و روشن و ارزشمندسوال دقیق منجر به استفاده موثر از زمان و یافتن مقالات مرتبط 42EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 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 outcomesRisk-taking environment43EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 44: Clinical Nursing QuestionsIn 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? 44EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 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?45EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 46: Key Questions to Ask When Considering EBPWhy 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? 46EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 47: Key Questions to Ask When Considering EBPDo 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? 47EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 48: Once we agree upon the question that poses an opportunity for improvement, then we must find the evidenceWhere should we look?Are all forms of evidence equivalent in quality?48EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 49: Step 2:Discovery: Finding, with maximum efficiency, the best evidence with which to answer the question49EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 50: گام دوم: جستجوی بهترین شواهد در دسترس روشها:1- سوال از همکاران2 چک کردن لیست کتابهای مرجع در کتابهای موجود3- یافتن یک مقاله مربوط در فایل شخصی4- جستجو در بانکهای اطلاعاتی(مهارت پایه و اصلی برای بکارگیری پرستاری مدرن و مبتنی بر شواهد )50EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 51: Step 3: Critique: Determining the merit, feasibility and utility of evidence.The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. (http://www.evidence-based-medicine.co.uk)51EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 52: گام سوم: گام سوم= نقد مقالات و شواهد (پاسخگویی به سه سوال زیر) آیا شواهد یافت شده نتایج معتبر به ما می دهد؟اگر شواهد معتبر است، آیا مهم است؟آیا می توان در مراقبت از بیمار آنها را بکار گرفت؟ ارزشیابی منتقدانه شواهد مهارتی است که تنها با آموزش صحیح و ممارست کافی فرا گرفته می شود.52EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 53: Step 4: Summary: Combining findings from all evidence to make a practice recommendation53EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 54: گام چهارم: سوال مطرح آیا نتایج حاصله در بیمار مورد نظر ما کاربرد دارد؟ (لزوم اقدامات زیر)تهیه برگه ای از مضرات و فواید مداخلهتعیین میزان فواید و مضرات با لغات مشخصمشخص کردن فواید و مضرات با توجه به بیمار مورد نظرتعیین ارجحیت فواید بر مضرات54EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 55: Step 5: Translation: Placing evidence into context, incorporating recommendation into a clinical setting or organization55EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 56: گام پنجم :ارزشیابی میزان سودمندی و تاثیر کاربرد و اجرای شواهد حاصل در بیمار مورد نظر ارزشیابی توسط ناظر خارجی 56EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 57: Step 6:Evaluation: Determining and measuring the effectiveness of the practice change over time57EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 58: خدا قوت
اسلاید 59: Most nurses agree that EBP is important… but how do we make it happen? 59EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 60: Factors Contributing to Emphasis on Evidence-Based Nursing PracticeScientific knowledge expansionKnowledge expands exponentially q 2 yrs Knowledge availability -- The InternetHighly educated nurses in clinical settingsAPNs – focusing on evidence-based clinical problem-solvingClinical Nurse ResearchersDNP Movement60EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 61: Factors Contributing to Emphasis on Evidence-Based Nursing PracticeAggressive pursuit of cost-effectivenessFocus on quality of care, Risk & error reductionHighly educated consumers Increased attention to institutional image 61EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 62: What is Evidence?Primary Studies:Clinical TrialsRandomized Controlled TrialsMulticenter studiesSecondary StudiesReviewsMeta-analyses62EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 63: Establishing ValidityWhat are the results of the study?Are the results valid?How do the results affect the patient?63EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 64: Levels of Evidence64EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 65: 65EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 66: AACN Levels of Evidence (Armola, et al. , C C Nurse, 2009)Level ALevel BLevel C Level DLevel ELevel MMeta-analysis or metasynthesis of multiple controlled studies, supporting a specific actionControlled, randomized, or nonrandomized studies, supporting a specific actionQualitative, descriptive or correlational studies or systematic reviews with consistent resultsPeer-reviewed prof. organ. standards with studies to support themTheory-based evidence from expert opinion or case studiesManufacturer’s recommendations only66EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 67: Levels of EvidenceI Evidence - Systematic reviews, meta-analysis RCTs, EB clinical practice guidelines based on RCTsII Evidence - One well designed RCTIII Evidence - CTs without randomizationIV Evidence - Well-designed case control or cohort studiesV Evidence - Systematic reviews of descriptive or qualitative studiesVI Evidence - Single descriptive or qualitative studyVII Evidence – Opinions of authorities, reports of experts67EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 68: Levels of Evidence Hierarchy (Stetler et al.)*Level I: Meta-analysis of multiple RCTs (‘gold standard’)Level II: Individual RCTsLevel III: Quasi-experimentalLevel IV: Non-experimental; qualitativeLevel V: Program evaluation; QI; RU; case reportsLevel VI: Opinion of respected authorities68EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 69: Strength of EvidenceLevel I - meta-analysis of multiple studiesLevel II - experimental studies, RCTsLevel III - quasiexperimental studiesLevel IV - nonexperiemental studiesLevel V - case reports, clinical examples AHCPR/AHRQAt what level is most nursing evidence?69EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 70: Preprocessed Evidence (A. DiCenso, 2009)70EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 71: Types of Research EvidenceExperimentalQuasi-ExperimentalCounterfactualSurveysAdmin DataComparativeQualitativeCost-BenefitCost-EffectivenessCost-UtilityEconometricsExperimentalQuasi-Experimental QualitativeTheories of ChangeSocial EthicsPublic ConsultationSurveysQualitativeImpact EvidenceImplementation EvidenceDescriptive Analytical EvidenceEconomic and Econometric EvidenceEthical EvidenceStatistical ModellingAttitudinal EvidenceLinear and LogisticRegression71EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 72: Critical Appraisal72EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 73: Critical Appraisal Questions Are the results of the study valid?What were the results?Will the results help me in caring for my patients?73EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 74: Critical Appraisal terminologyNull HypothesisP-valueConfidence intervalsRelative vs Absolute Risk Reduction74EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 75: Null hypothesisStates that there is no relationship between the variables being studied. Opposite of what you are trying to find out. Tylenol is better than Advil for headachesExercising 30 minutes a day is good for your healthLefthanders are prone to accidents75EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 76: P-valueProbability that the outcomes are due to chanceAccepted reference point is .05 Less than .05 is statistically significantSmall p-value dismiss chanceLarge p-value means that anything is possible (chance, actual effect, or confounding factors)76EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 77: Confidence intervalsThe ranges of values within which a researcher can be confident that the population value falls. A 95% confidence interval (CI 95) means that one can be 95% confident that the population value falls within a certain rangeExample: A study states that 40% of a sample of 1000 people are smokers with a CI of 95% +/- 3% means the frequency of smoking is between 37% and 43%. 77EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 78: RiskRR (Relative Risk) is the risk for achieving an outcome in the treatment group relative to that in the control group78EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 79: Challenges of EBNNew, UnfamiliarNeed to develop good search strategiesMust identify best databasesNeed to do critical appraisalsMuch of relevant research is qualitative; need more systematic reviews of qualitative research79EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 80: Challenges and MisconceptionsMerely a collection of statistics?Need more qualitative researchNurses need to develop good search strategiesNurses must learn to do critical appraisals Faculty members must embrace and learn EBP80EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 81: Problems with Finding and Using EvidenceSheer amount and flow of information/researchVariable quality of research outputsProblems of publication biasNeed for the balance of evidenceLimitations of single studies81EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 82: BARRIERS TO EVIDENCE-BASED PRACTICEKnowledge… lack of knowledge/awareness .… unfamiliar with guidelines and guideline accessibilityAttitudes …. lack of confidence in the guideline developer, lack of motivation to perform the guideline recommendationsBehaviors …. inability to incorporate patient preferences into the clinical decision making process Melnyk & Fineout-Overholt 200582EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 83: BARRIERS TO EVIDENCE-BASED PRACTICEOverwhelming patient workloadsMisperceptions about EBP and researchLack of time and resources to search for and appraise evidenceOrganizational constraints – lack of supportPeer pressure to continue with practices that are steeped in tradition – “we’ve always done it this way and we are not changing now”Melnyk & Fineout-Overholt 200583EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 84: Overcoming the Barriers Summary of BarriersStrategies for Success Difficult to find the right programFear of changeOrganizational barriers: personnel rules, staff turnoverLimits to the flexibility of the systemCultural competency Administrative supportTeacher/educator/stakeholder supportSecure financial resourcesProvide high-quality training to ensure program fidelityAlign intervention with school/community goals, policies and programsMake program outcomes visibleDevelop strategy for staff turnover84EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 85: 85به طور خلاصه موانع موجود: شامل:عدم توانایی در دسترسی به نتایج تحقیقاتزمان و هزینه مورد نیاز جهت به کارگیری نتایج تحقیقاتوجود مقاومت در مقابل تغییر در سازمان بهداشتیعدم وجود ارتباط بین یافته های حاصل از جستجوعدم درک و یا موافقت با نتایج تحقیقاتعدم ارزش گذاری در به کارگیری نتایج حاصل از تحقیقات در بالینعدم وجود همکاری در سازمان از نظر مدیریتی(خصوصا از طرف پزشکان)عدم فراهم سازی امکانات لازم جهت به اجرا گذاشتن نتایج حاصل از تحقیقاتعدم اختصاص وقت کافی برای مطالعه نتایج تحقیقات (کورتنی،2005 )و(ملنیک،2005)EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 86: لزوم ارائه مراقبت مبتني بر شواهد در پرستاری:در بیانیه انجمن بین المللی پرستاران تاکید شده است که عملکرد مبتنی بر تحقیق نشانه خاص حرفه پرستاری است و آن را چالشی قوی و چشمگیر برای پرستاران می داند و حتی طبق بیانیه فوق عملکردی که در حرفه پرستاری بر مبنای تحقیق نباشد غیر اخلاقی است. ارائه مراقبت بهداشتي ودرماني مبتني بر شواهد نوعي يادگيري در طول زندگي است و پرستاران به عنوان جزيي از سيستم مراقبت بهداشتي ودرماني بطور جدي بايد بدان بپردازند تا پرستاري به عنوان يك حرفه مبتني بر علم مطرح شود. پرستاران نيز خود معتقدند كه امر مراقبت بايستي بر اساس بهترين شواهد در دسترس باشد. 86EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 87: 87کاربرد در پرستاری:پرستاری مبتنی بر شواهد فرایندی سیستماتیک و منظم است.پرستاران را به اخذ تصمیمات بالینی با استفاده از بهترین شواهد موجود، تجارب بالینی و اولویت های بیمار تشویق می کند.با توجه به تمرکز آن بر مشکل بیمار، پرستاران بایستی در موارد زیر آگاهی و مهارت داشته باشند: کاربرد نتایج پژوهش های بالینی حساسیت نسبت به نیازهای عاطفی و فیزیکی بیمار درک رنج بیمار دانستن بیماری با تاکید بر پاتوفیزیولوژی آن دانستن مراقبت مربوطهEBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 88: 88فواید پرستاری مبتنی بر شواهد:فواید حاصل برای بیمار شامل احترام گذاشتن به ارزشهای وی و دادن اجازه تصمیم گیری به وی بین پیشنهادات دریافت کرده از متخصص بهداشتی می باشد.EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 89: 89فواید حاصل برای پرستار شامل: برقراری امکان استفاده از آخرین یافته های حاصل از پژوهش های انجام شده با توجه به ساختاری نظامدار جهت یافتن، مورد ارزشیابی قرار دادن، انتخاب و به کارگیری بهترین شواهد برای مددجوی مورد نظر ایجاد چنین امکانی خطر سر ریز شدن اطلاعات را به دنبال دارد در حالی که اگر چنین جستجویی بر اساس پرستاری مبتنی بر شواهد باشد، این خطر به حداقل خواهد رسیدامکان برقراری ارتباط با مددجو و تیم ارائه دهنده مراقبت در رابطه با علل و تصمیمات و طرح مراقبتی مددجوی مورد نظر ولی این امر نیازمند تربیت پرستاران متخصص عملکرد پرستاری مبتنی بر شواهد است که اطمینان از ارائه مراقبت هایی بر اساس حقایق موجود به جای عادات دارند و دارای توانایی جوابگویی قانونی نسبت به عملکرد خویش می باشند.EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 90: 90فواید حاصل برای سازمان بهداشتی شامل حضور در عرصه رقابت فعلی بر اساس ارائه مراقبت با کیفیت بالا می باشد همچنین احساس مفید بودن، صرفه جویی در هزینه ها و جلوگیری از مخارج اضافی نیز برای سازمان به ارمغان دارد.EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 91: 91فواید حاصل برای جامعه شامل جلوگیری از بیهودگی نتایج تحقیقات، کاهش عوارض درمان ها و ارائه بهترین و موثرترین نوع مراقبت ها برای مددجویان می باشد. (کورتنی،2005)EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 92: 92محدودیت های پرستاری مبتنی بر شواهد: تنها نوعی تجربه بوده و برای هر بیمار مناسب نیست.از مداخلاتی پشتیبانی می کند که از حمایت مالی برخوردار باشدقابل دسترسی نیست (حجم زیاد اطلاعات برای افراد مبتدی)نمی تواند به بعضی از سوالات پاسخ دهدبرای خریداران و مشتریان خدمات بهداشتی ارزش محدودی دارد دچار سو استفاده و سو تعبیر است.دارای تورش است.EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 93: چالش های پرستاری مبتنی بر شواهد:چالش های موجود در پژوهش پرستاری:وجود فاصله عمیق بین آموزش و خدمات افزایش کیفیت مراقبت های ارائه شده با توجه به نتایج حاصل از پژوهش های انجام شده چالش های موجود در آموزش پرستاری:تغییر نظام آموزش پرستاری برای آموزش پرستاری مبتنی بر شواهدآماده سازی پرستاران برای به کار گیری این علم در بالینچالش موجود برای دانشکده های پرستاری نحوه تدریس ،عملکرد پرستاری مبتنی بر شواهد است . 93EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 94: Creating an EBP cultureInternal ExpertiseIdentified leaders for EBPCollaboration with outside expertsEducating Frontline staffEnhancing staff awareness and understandingGrooming staff to become leaders in EBP94EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 95: StrategiesStrong supportive leadershipMentorshipStaff education regarding research and evidence based practice.Time to conduct or use researchRoutine performance expectations in research use (Fink, et al, 2005)
اسلاید 96: 96Key MessageRECOMMENDATION NO. 13/13/2018EBN dr yekefalah-phd of nursing2012
اسلاید 97: The many faces of advanced practice registered nurses in 2011High quality, safe, affordable health careprovided by teams of health care professionals973/13/2018EBN dr yekefalah-phd of nursing2012
اسلاید 98: “Messaging” Barriers to practice reduce access to careMain issue is access to care and this should define our focus98EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 99: 99Key MessageRECOMMENDATION NO. 2New graduates and nurses in transition3/13/2018EBN dr yekefalah-phd of nursing2012
اسلاید 100: 100Key MessageRECOMMENDATION NO3EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 101: 101Key Message RECOMMENDATION NO. 4EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 102: Institute of Medicine October 2010 Report: The Future of Nursing Leading Change, Advancing HealthRemove scope-of-practice barriersExpand opportunities for nurses to lead and diffuse collaborative improvement effortsImplement nurse residency programsIncrease the proportion of nurses with a baccalaureate degree to 80% in 2020Double the number of nurses with a doctorate by 2020Ensure that nurses engage in lifelong learningPrepare and enable nurses to lead change to advance healthBuild an infrastructure for the collection and analysis of interprofessional health care workforce data1023/13/2018EBN dr yekefalah-phd of nursing2012
اسلاید 103: Key point:EBN should be considered as: A part of educational curriculum 103EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 104: Literature Searching104EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 105: Resources to Support Evidence-Based PracticeGovernment agenciesCochrane CollaborationProfessional OrganizationsBenchmark Institutions105EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 106: AHRQ – Agency for Healthcare Research and Quality
اسلاید 107: 107EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 108: 108EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 109: Cochrane Collaboration “an international, independent, not-for-profit organization of over 27,000 contributors from more than 100 countries, dedicated to making up-to-date, accurate information about the effects of health care readily available worldwide.Contributors produce systematic assessments of healthcare interventions, known as Cochrane Reviews, which are published online in The Cochrane Library. Rely heavily on RCTsPrimarily focused on effectiveness of interventions, more medical and pharmaceutical than nursing109EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 110: Cochrane Collaboration http://www.cochrane.org 110EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 111: 111EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 112: Professional Nursing Organizations Supporting Evidence-Based PracticeAACNAWHONNAORNONSSigma Theta Tau112EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 113: Am. Assoc. of Critical Care Nurses Succinct dynamic directives…supported by evidence to ensure excellence in practice and a safe and humane work environment. Venous Thromboembolism PreventionOral Care in the Critically IllNoninvasive BP MonitoringVerification of Feeding Tube PlacementVentilator Associated PneumoniaDysrthymia MonitoringPublished since 2005 Available free on AACN websiteInclude ppt presentations and audit tools1133/13/2018EBN dr yekefalah-phd of nursing2012
اسلاید 114: Oncology Nursing SocietyEBP Resource Center http://onsopcontent.ons.org/toolkits/evidence/Also provides topical toolkits, on specific topics, plus: How To Find The Evidence How To Critique EvidenceHow To Develop An Evidence Based PresentationEvidence Based Practice Education GuidelinesEvidence on Clinical TopicsHow to Change PracticeLevels of Evidence Table114EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 115: Sigma Theta Tau EBP Initiatives Strategic PlanOnline ResourcesNKI http://www.nursingknowledge.org > 200 resources for EBP – some free, some for purchaseNew Award for EBP (formerly Clin Scholarship)Conferences International EBP and Research CongressJuly, 2010 – OrlandoJuly, 2011 – CancunJuly, 2012 – Australia 115EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 116: Journals Supporting EBPEvidence-Based NursingOnline Journal of Clinical InnovationsWorldViews on Evidence-Based NursingThe Online Journal of Knowledge Synthesis for Nursing – (archived, no longer being published)Reflections on Nursing Leadership (Vol 28, 2)116EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 117: Resources PubMed/MedlineCitations and Abstracts Includes over 4600 journals worldwideMore than 17 million citationsApproximately 1/3 full text articles availableUses MeSH controlled vocabularyUpdated dailyAvailable anywhere, anytimeSearching help availableMust do one’s own quality filteringMust learn how to search the database117EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 118: Medline:The National Library of Medicine in Maryland, USA produces Medline (Index Medicus). It contains over 73,000 citations indexed as medical education and over 300,000 additional citations that are considered educationally relevant. 118EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 119: CINAHL:The Cumulative Index to Nursing and Allied Health Literature is the world’s largest database for nursing and the professions allied to medicineAlthough there are less than 1,500 citations indexed as medical education there are over 100,000 educationally relevant ones that could inform a medical education query119EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 120: Resources CINAHLDates back to 1981Contains more than a million recordsIndexes almost 3,000 journalsSearchable cited references for more than 1,200 journalsFull text for 71 journalsCovers nursing, biomedicine, health science librarianship, alternative/complementary medicine, consumer health and 17 allied health disciplinesNow features Clinical Query Functionality120EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 121: 121EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 122: Evidence-Based Policies and Indicator Systems Conference, 2003http://cem.dur.ac.uk/EB2003122EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 123: Embase:This is the second largest medical database and is owned by Elsevier Science, Netherlands.Embase contains over 43,000 citations indexed as medical education and more than 100,000 that are related to education in a health environment.123EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 124: ERIC: The Education Resource Information Centre is the world’s largest education database (1,000,000 + records)Although the emphasis on primary and secondary education, there are over 17,000 citations related to medical educationMany more will be relevant in a supporting context, providing evidence in education that could be applied to medical education124EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 125: British Education IndexThe British Education Index is much smaller than ERIC but contains citations that are relevant to answering queries in medical education125EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 126: PsycINFO:While PsycINFO obviously concentrates on psychiatric and psychological content, there are over 4,000 records indexed as medical education with well over 100,000 concerning education in a broader context, as well as teaching and learning.126EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 127: Additional Indexed DatabasesAllied and Complementary Medicine Database (AMED)Applied Social Sciences Index and Abstracts (ASSIA)British Nursing Index (BNI)Health Management Information Consortium (HMIC)SOCIOFILE127EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 128: Models of EBPJohn Hopkins ModelStetler ModelCURNIowa Model of Evidence Based Practice128EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 129: 129EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 130: Steven’s ACE Star Model SummarySynthesize all research into a single meaningful wholeThis step differentiates research utilization from Evidence-based practiceCan be called evidence synthesisIncrease power and effect of dataReduce biasAssess consistenciesEstablish generalizabilityReduce data into an manageable form 130EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 131: Steven’s ACE Star ModelDiscoverySummaryTranslationImplementationEvaluation131EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 132: Steven’s ACE Star Model DiscoveryOriginal researchConduct a literature search utilizing recognized techniques132EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 133: Steven’s ACE Star Model TranslationScientific evidence is considered in the context of clinical expertise and valuesResults in clinical practice guidelines, best practices, protocols, standards or clinical pathways133EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 134: Steven’s ACE Star Model ImplementationTranslation of research into practiceWhere changes take place134EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 135: Steven’s ACE Star Model EvaluationImpact of the change is measuredAssess variables (health outcomes, efficiency, cost or satisfaction)135EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 136: Iowa ModelSuccessfully implemented since 1994 internationallyInfuses research into practice to improve quality of carePlanned change principles integrate research and practiceUtilizes a multidisciplinary team approachUtilizes feed-back loops136EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 137: Why the Iowa Model?Multiple resources available to aid in implementationAlgorithm that can easily be applied to practiceApplicable to quality improvement projects as well as nursing research137EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 138: Problem Focused TriggersKnowledge Focused TriggersPriority forOrganizationConsider other triggersNOForm a teamThe Iowa Model ofEvidence-Based Practice to Promote Quality CareYES138EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 139: Assemble Relevant Research & Related LiteratureCritique and Synthesize Research for Use in PracticeSufficientResearch?Pilot Change inPracticeBase Practice on otherTypes of EvidenceConductResearch139EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 140: Should weAdopt this change into practice?NoYesInstituteChangeContinue toEvaluate qualityCare and New KnowledgeMonitor and AnalyzeStructure, Process, andOutcome DataDisseminateResults140EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 141: ResourcesYale University Nursing Library and Information Resourceshttp://www.med.yale.edu/library/nursing/education/ebhc2.html Oncology Nursing Societyhttp://onsopcontent.ons.org/toolkits/evidence/ United States Department of Health and Human Services – Agency for Healthcare Research and Qualityhttp://www.ahrq.gov/clinic/epcix.htm University of Iowa Hospitals and Clinics Nursing Services and Patient Care http://www.uihealthcare.com/depts/nursing/rqom/evidencebasedpractice/index.html 1413/13/2018EBN dr yekefalah-phd of nursing2012
اسلاید 142: Resources (con’t)University of Texas Health Science Center at San Antonio – Acedemic Center for Evidence-Based Practicehttp://www.acestar.uthscsa.edu/About.htm Medical Library Association – Nursing and Allied Health Resources Sectionhttp://nahrs.library.kent.edu/resource/symposium/ University of Minnesota – Evidence-based Health Care Projecthttp://evidence.ahc.umn.edu/ebn.htm 1423/13/2018EBN dr yekefalah-phd of nursing2012
اسلاید 143: ResourcesAddressing Barriers to Learning. (2007). Evidence-based practices in schools: Concerns about fit and implementation. UCLA Center, 12(3).Dunifon, R., Duttweiler, M., Pillemer, K., Tobias, D., & Trochim, W.M.K. (2004). Evidence-based extension. Journal of Extension, 42(2).Forman, S.F., Olin, S.S., Hoagwood, K.E., Crowe, M., & Saka, N. (2008). Evidence-based interventions in schools: Developers’ Views of implementation barriers and facilitators. School Mental Health, 1. Henderson, M.L., Mathias-Humphrey, A., & McDermott, M.J. (2008). Barriers to effective program implementation: Rural school-based probation. Federal Probation, 72(1).Identifying barriers to evidence-based uptake. (2006). National Institute of Clinical Studies, Melbourne VIC. Research Development Associates. Evidence-based Practices. Power Point retrieved from http://www.resourcedevelopment.net/projects/workshops.html 143EBN dr yekefalah-phd of nursing20123/13/2018
اسلاید 144: ReferencesChitty, K.K. (2005). Professional nursing: Concepts and challenges. 4th ed. Philadelphia: Saunders.Spector, N. (n.d.). Evidence-Based Health Care in Nursing Regulation. Retrieved on October 8, 2006 from Nation Council of State Boards of Nursing web site on World Wide Web: http://www.ncsbn.org/pdfs/Evidencebased_NSpector.pdf#search=%22evidence%20based%20practice%20in%20nursing%22 Yale University. (2005). Evidence-Based Practice. Nursing Library and Information Resources. Retrieved on October 8, 2006 from World Wide Web: http://www.med.yale.edu/library/nursing/education/ebhc2.html 1443/13/2018EBN dr yekefalah-phd of nursing2012
اسلاید 145: Burns & Grove (2005). The Practice of Nursing Research (5th ed).St. Louis: Elsevier Saunders Polit & Beck (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice. Philadelphia : Lippincott Williams & WilkinsMelnyk & Fine-Overholt (2005). Evidence-Based Practice in Nursing & Health Care. Philadelphia: Lippincott Williams & WilkinsACE Star Model: http://www.acestar.uthscsa.edu/Learn_model.htmREFERENCES1453/13/2018EBN dr yekefalah-phd of nursing2012
اسلاید 146: اگه مبتني بر شواهد عمل کنیدبه اینجا می رسید!!!!1463/13/2018EBN dr yekefalah-phd of nursing2012
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