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Evidence Based Practice: Models and EBP implementation. Questions and answers. 2022/2023. Organizational obstacles to implementing EBP in the workforce - ✔✔- inadequate research skills - lacking confidence to implement change - misperceptions that EBP takes time internal evidence - ✔✔evidence generated internally from QI or outcomes management Evidence based decision making model - ✔✔clinical state and circumstances-> research evidence------------------> clinical expertise patient preferences and actions---> healthcare resources ---------------> internal validity - ✔✔The extent to which it can be said that the independent variable causes a change in the dependent variable, and the results are not due to confounding variables external validity - ✔✔generalizability; the ability to generalize findings to a larger sample evidence based practice - ✔✔The integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making Steps of Evidence-based practice - ✔✔0: cultivate a spirit of inquiry 1: Ask the burning clinical question in PICOT format 2: Search for and collect the most relevant best evidence 3: Critically appraise the evidence 4: integrate the evidence with one's clinical expertise and patient preferences and values in making a decision for change 5: evaluate outcomes of the practice decision or change based on evidence 6: disseminate the outcomes of the EBP decision or change Research utilization (RU) vs EBP - ✔✔Research utilization: research knowledge used in practice. Not as BIG as EBP. EBP takes into consideration clinical experience and patient values The Stetler Model (280-282) - ✔✔Practitioner-oriented model focused on critical thinking and use of research findings. -Considers internal and external evidence. -Facilitates safe and effective practice -Guided problem solving process Five phases of Stetler model - ✔✔1. Peparation: get question and start research 2. Validation: assess studies for applicability and validity 3. Comparative Evaluation/Decision Making: Make decision about what research to use 4. Translation/Application: Converting findings into the type of change to be made/recommended. Plan application. 5. Evaluation: evaluate the plan in terms of the degree to which it was implemented and whether the goals were met PARIHS - ✔✔developed to reflect complexities of EBP implementation SI= f (E,C,F) SI: successful implementation E: evidence C: context F: facilitation Evidence (in PARIHS) - ✔✔- knowledge from research, experience, and local information Context (in PARIHS) - ✔✔- culture, leadership, and evaluation - The environment or setting in which the change is going to be implemented Facilitation (in PARIHS) - ✔✔- process of enabling implementation of evidence into practice - Can be task-oreinted or process-oriented Elements of PICOT - ✔✔Population Intervention Comparison Outcome Timeframe Interventions - ✔✔Can be provided by a nurse/doc/etc or can be environmental Healthy People 2020 - ✔✔Mission: >ID nationwide health improvement priorities >Increase public awareness >Provide goals that are applicable at fed, state, and local levels >engage multiple sectors in achieving goals > ID critical research and data collection methods clinical expertise - ✔✔Involves ability to recognize numerous family and environmental variables around our patients

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