Research Application in Nursing Practice Hana Rizmadewi Agustina, S.Kp, MN Department of Fundamental of Nursing Universitas Padjadjaran Nursing Research Methodology

Why need to use research? Tenaga kesehatan kadang dipenuhi oleh rasa ketidakpastian tindakan apa yang paling efektif untuk mendapatkan hasil yg terbaik untuk pasien  Evidence base practice (EBP) EBP  pendekatan yg dpt membantu praktisi untuk memberikan kualitas pelayanan yang terbaik dalam memenuhi kenutuhan pasien dan keluarganya

What is EBP? Penggunaan secara sungguh-sungguh dari evidence terbaik dengan menggabungkan keahlian klinik dan nilai/lingk untuk perawatan bagi pasien (Straus, et al., 2005) Membantu praktisi untuk memberikan kualitas pelayanan yang tinggi dlm rangka memenuhi kebutuhan pasien dan klg yang multifacet (Melnyk & Fineout-Overholt, 2005) Meningkatkan kualitas intervensi keperawatan dari yang berbasis tradisi atau kebiasaan menjadi intervensi berbasis fakta dan hasil riset

The importance of evidence

The importance of evidence

EBP & Evidence EBP menggunakan “Best Evidence” yang didapat melalui : Scientific knowledge from randomized clinical trials, observational studies Expert opinion Expert consensus Other

The cognitive continuum. This diagram is an analysis of something called the cognitive continuum, in this instance based on research among nurses in the UK. It shows 6 steps of information used in decision making, from using intuition on the left, to the most highly analytic and structured information: the scientific experiment, on the right. In this study they followed nurses around and kept track of their decision making processes. What determines whether a nurse uses intuitive decision-making (or NOT evidence based practice) or a more rational decision making (EBP) depends on where the decision task lies on this chart. So, the more structured the decision is, such as through forming a PICO question, by learning how to search in a structured way, the more likely the nurse will use rational decision making. Short time frames for decision turn around encourage intuitive decision making, so learning how to search databases efficiently reduces that time and makes nurses more likely to use EBP. Other factors that increase the likelihood that a nurse will use EBP: whether the information has been broken down into components The need to demonstrate decision making reasoning to others, such as developing a policy or budget rationale to administrators. Thompson, C. et al. Evid Based Nurs 2004;7:68-72

Research utilization & EBP Menggunakan hasil penelitian Diambil secara Random Mendukung tindakan keperawatan Kurang systematic Evidence-Based Practice Mempertimbangkan semua riset Menggunakan hasil riset berdasarkan review yg terintegrasi Dikaitkan dengan keahlian klinik dan sistem nilai dari pasien Lebih sistematik systematic

Goals of EBP Memecahkan masalah di klinik Mencapai pelayanan yang terbaik Mengenalkan inovasi Mengurangi variasi dalam pelayanan keperawatan Membantu dengan efektif dan efisien dlm membuat keputusan Memecahkan masalah dlm sistem regulasi Mencapai sistem pengaturan yang terbaik

Who are the Users of Evidence-Based Practice Nurses (RN, LVN, NP) Nursing assistants Physicians Physical Therapists Pharmacists Nutritionist Others

Steps in EBP Menentukan masalah pasien Identifikasi informasi yg diperlukan untuk memecahkan masalah Mencari literature Penilaian secara kritis terhadap evidence yg ada Melakukan extraksi sbg jawaban klinik Membuat protokol Evaluasi

The Iowa Model of Evidence Based Practice to Promote Quality Care Problem Focused Triggers 1. Risk Management Data 2. Process Improvement Data 3. Internal/External Benchmarking Data 4. Financial Data 5. Identification of Clinical Problem Knowledge Focused Triggers 1. New Research or Other Literature 2. National Agencies or Organizational Standards & Guidelines 3. Philosophies of Care 4. Questions from Institutional Standards Committee Consider Other Triggers Is this Topic a Priority For the Organization? Form a Team Yes No = a decision Point

The Iowa Model of Evidence Based Practice to Promote Quality Care Assemble Relevant Research & Related Literature Critique & Synthesize Research for Use in Practice Is There a Sufficient Research Base? Yes No Pilot the Change in Practice 1. Select Outcomes to be Achieved 2. Collect Baseline Data 3. Design Evidence-Based Practice (EBP) Guideline(s) 4. Implement EBP on Pilot Units 5. Evaluate Process & Outcomes 6. Modify the Practice Guideline Base Practice on Other Types of Evidence 1. Case Reports 2. Expert Opinion 3. Scientific Principles 4. Theory Conduct Research

Questions example Apakah air kran (tap water) bisa dipakai untuk membersihkan luka? Apakah semua luka harus dibersihkan dengan cairan yang steril?

Source of literatures CINAHL OVID/MEDLINE www.joannabriggs.edu.au

OVID

Cinahl

EBP Sample EBP kateter.pdf EBP Skin care.pdf EBP Surgical.pdf water for wound cleansing.pdf

Barriers in EBP utilization Health care organizations  culture, policy, multi professional team, working load Lack of skills and knowledge Lack of support, motivation, and incentives

Steven’s ACE Star Model Discovery Summary Translation Implementation Evaluation

Discover Summary Riset asli Melakukan pencarian literatur Melakukan sintesa semua riset kedalam satu makna yg mencakup keseluruhan  Ini yg membedakan dg “research utilization” dari Evidence-based practice  Dpt disebut sintesa evidence Meningkatkan kekuatan dan efek data Mengurangi bias Mengkaji konsistensi Memelihara generalizability

Translation Implementation Evaluation Evidence yg ada dipertimbangkan dg keahlian klinik dan nilai-nilai Menghasilkan panduan praktek, praktik yg terbaik, protokol, standar, klinikal atau pathway Implementation Translation diwujudkan kedalam praktik Dimana perubahan akan dilakukan Evaluation Dampak dari perubahan terukur Kaji variabel (hasil kesehatan, efisiensi, biaya atau kepuasan)

SUMBER EBP ? Journal Organisasi khusus Publikasi pemerintah Organisasi komersial Database Medline National Guidelines Clearinghouse (NCG) Cinahl HAPI (Health and Pyschosocial Instruments) Cochrane Reviews PsychInfo Sport Discus Message services

SUMBER EBP(LANJUT) Background InformationUptoDate Harrison’s Online E-books Filtered ResourcesACP Pier Cochrane Natural Standard InfoPOEMS MDConsult (First Consult) Natural Medicines Comprehensive Database OTseeker Physiotherapy Evidence Database (PEDro) National Guideline Clearinghouse Unfiltered ResourcesOVID MEDLINE PubMed CINAHL PsycINFO BIOSIS