HEALTH EDU

• Evidence-based practice (EBP)


  A method of review and assess high-quality research to inform the delivery of care. It involves the integration of evidence in a holistic, patient-centered approach in healthcare.
• Benefits of EBP


  • Leads to high quality care
  • Reduces health costs
  • Decreases denials and increases reimbursement
  • Reduces geographic variations
  • Reduces turnover rate
  • Meets public expectations
• Components of EBP


  • Best external evidence
  • Patient values and expectations
  • Individual clinical experience
• Users of EBP


  • Healthcare providers
  • Researchers
  • Faculty
  • Students
• Hierarchy of Evidence (most to least credible)


  • Randomized controlled trials
  • Evidence from cohort, case-control, or observational studies
  • Expert opinions that are supported by experience, studies, or reports
  • Personal experience
• McMaster's hierarchy of evidence

  • Original research
  • Evidence summaries, systematic reviews, and meta-analyses
  • Clinical decision support
• JBI's Levels of evidence (Joanna Briggs)

  • Level 1 (unequivocal findings, SR, RCT, cost of alternative interventions)
  • Level 2 (credible synthesized findings, Quasi-experimental, cost of alternative interventions)
  • Level 3 (credible synthesized findings, Cohort and observational studies, limited alternatives)
  • Level 4 (Expert opinion with limited critical appraisal, Physiology, Bench research, consensus based on economic theory)
• McMaster's hierarchy of evidence - from most to least credible

  • Randomized controlled trials
  • Evidence from cohort, case-control, or observational studies
  • Expert opinions that are supported by experience, studies, or reports
  • Personal experience
• JBI's Levels of evidence (Joanna Briggs) - takes a broader view on research evidence, and has a more unique level of evidence where in each level, FAME (feasibility, appropriateness, meaningfulness, effectiveness) is reviewed


  • Level 1 - unequivocal findings, SR, RCT, cost of alternative interventions
  • Level 2 - credible synthesized findings, Quasi-experimental, cost of alternative interventions
  • Level 3 - credible synthesized findings, Cohort and observational studies, limited alternatives
  • Level 4 - Expert opinion with limited critical appraisal, Physiology, Bench research, consensus based on economic theory
• Cochrane model (1970) - states that evidence-based practice leads to better healthcare outcomes


  1. Record

  2. Question

  3. Experiment

  4. Analyze
• Cochrane model - sources of evidence

  • External evidence - systematic reviews, randomized control trials, best practice, and clinical practice guidelines
  • Internal evidence - healthcare provider expertise, quality improvement projects outcome management initiatives
  • Patient preferences (what patient want) and values (QoL)
• Advantages of EBP


  • Improving patient outcome
  • Maximizing time, reducing cost
  • Contributing to Nursing science
• EBP Methodologies


  1. Ask - formulate questions about a patient, problem, interventions, etc.

  2. Acquire - search for relevant evidences to answer questions

  3. Appraise - determine the quality of the sought evidence

  4. Apply - make clinical decisions using the evidences

  5. Assess - evaluate the use of evidence to the patient

  6. Disseminate - sharing the research and evidence to colleagues
• Additional EBP Methodologies


  1. Identify - find the aspect that needs improvement. Form PICOT questions about the population, intervention, comparison, outcome, and time.

  2. Research - review relevant research which are peer-reviewed and reliable. Find the review of literature.

  3. Evaluate - looks for high-quality information and sources that support ideas.

  4. Choose interventions - look for the best way to implement the idea and monitor its progress.

  5. Re-evaluate - determine the success of interventions. Review data and include revisions to summarize results.

  6. Disseminate - place the idea on existing literature and share it to other professionals.
• Additional EBP Methodologies


  1. Search and find research or evidence

  2. Appraise the evidence

  3. Implement the evidence

  4. Evaluate practice changes and patient outcomes
• JBI EBP Methodology (J. Briggs) - international, non-profit, and membership-based research and organization
• JBI EBP Methodology


  • Healthcare evidence generation
  • Evidence synthesis
  • Evidence transfers
  • Evidence utilization- evaluate
• Applying Evidence-based Practices


  • Giving oxygen to patients with COPD - use of research-based procedures to properly administer oxygen to patients with COPD
  • Measuring BP of children - comparing the results of auscultatory method with data from oscillometric method
  • Catheterization - using the correct size of intravenous catheter to improve patient comfort
  • Recognizing family objectives - valuing the role of family members, and recognizing their influence on how the patient presents symptoms
  • Improving infection control - understanding the importance of wearing personal protective equipment and practicing handwashing
  • Recognizing alarm fatigue - creating protocols to ensure that nurses desensitized to sounds due to alarm fatigue are monitoring patients correctly
• Types of Research


  • Quantative - intervention or outcome research based on science method
  • Qualitative - involves understanding human behavior, and observation of culture, beliefs, actions, and adaptations
• Quantative Research


  • Clinical trials - exposure status is assigned
  • Randomized controlled trials - randomized assignment to exposure
  • Cohort study - observational study in which people are followed forward
  • Case-control study -

  
  

  
  

  
  

  • Case report (case series) - descriptive study without comparisons
  • Meta-analysis - analyzes studies related to the hypothesis
  • Clinical practice guidelines - identifies and summarize evidence on prevention, diagnosis, prognosis, and treatment
• Qualitative Research


  • Phenomenology (philosophy) - focuses on individual meanings
  • Ethnography (anthropology) - focuses on culture, and social meanings
  • Grounded theory (social sciences) - generates explanations and theories
  • Action research (social sciences) - interacting with members for change
• Systematic reviews (meta-analysis) - highest level of research which examines quantative and qualitative evidence separately or together. It brings the same level of rigor to reviewing research evidences.
• Systematic reviews are based on peer-reviewed protocols with minimum of 2 people. It examines FAME: feasibility, appropriateness, meaningful, and effectiveness.
• Outcome-based education (OBE)


  Learning with clear objectives, and focusing on the results rather than the process of learning
• Types of Outcome-based education

  • Traditional
  • Transitional
  • Transformational
• Grounded theory (social sciences)


  Generates explanations and theories
• Action research (social sciences)


  Interacting with members or change
• Systematic reviews (meta-analysis)


  Highest level of research which examines quantitative and qualitative evidence separately or together. It brings the same level of rigor to reviewing research evidences.
• Systematic reviews


  • It's based on peer-reviewed protocols with minimum of 2 people. It examines FAME: feasibility, appropriateness, meaningful, and effectiveness.
• Outcome-based education (OBE)


  Learning with clear objectives, and focusing on the results rather than the process of learning.
• Outcome-based education


  • It's practical - involves understanding things, and making decisions
  • It's fundamental - involves apprehending what you are doing and why
  • It's reflective - involves learning through self-consideration
• Types of OBE


  • Traditional
  • Transitional
  • Transformational
• Components of OBE


  • Curriculum design
  • Teaching and learning methods
  • Assessment
  • Continual quality improvement
  • Monitoring
• In outcome-based education


  Learners engage with the subject matter, instead of memorizing theory
• In outcome-based education


  Assessment is performance-based, testing if the learners can apply their skills and knowledge unlike in traditional exams
• Differences between Outcome-based and Traditional Education

  • Practical skills, competencies, and real-world applications vs Transfer of content knowledge to learners
  • Active learning vs Passive learning
  • Critical thinking and problem-solving vs Theoretical understanding and practical application
  • Flexible and adaptable in changing industry and society vs Established knowledge rather than current trends
• Principles of OBE


  • Clarity of focus - educators and learners understand a shared objective, which is explicit and measurable
  • Designing back - educators begin with identifying desired outcomes and design the curriculum to achieve them
  • High expectations - learners are believed to have greater competence with provided with right support and encouragement
  • Expanded opportunities - OBE is inclusive and ensures that all learners thrive given appropriate opportunities
• Objectives of OBE


  • Course outcomes (CO) - OBE aids instructors design effective teaching strategies, assessments, and learning activities that align with objectives
  • Program outcomes (PO) - OBE includes cumulative learnings from multiple courses within a program
  • Program educational objectives (PEO) - OBE reflects an institution's mission and commitment to prepare graduates for the workforce
  • Global opportunities - OBE encourages educational institutions to provide opportunities for cross-cultural experiences, international collaborations
• Ethics (ethos: character)


  A systematic mode of inquiry in understanding morality, the rightness and wrongness of action
• Ethics


  Defines the expected standards for moral behavior. It's the critical reflection and rational analysis about morality.