M17-18

• Evidence from research studies and opinions of nursing experts provide a basis for nursing care
• Evidence-based care


  • Improves quality, safety, and patient outcomes
  • Increases nurse satisfaction
  • Reduces costs
• Sources of evidence


  • Textbooks
  • Articles from nursing and health care literature
  • Quality Improvement and risk management data
  • Standards of care
  • Infection control data
  • Benchmarking, retrospective, or concurrent chart reviews
  • Clinicians' expertise
• Steps of Evidence-Based Practice


  1. Cultivate a spirit of inquiry

  2. Ask a clinical question in PICOT format

  3. Search for the most relevant evidence

  4. Critically appraise the evidence you gather

  5. Integrate all evidence with your clinical expertise and patient preferences and values

  6. Evaluate the outcomes of practice decisions or changes using evidence

  7. Share the outcomes with others
• Cultivate a spirit of inquiry


  • Question what does not make sense to you and what needs to be clarified
  • Gain evidence-based practice (EBP) knowledge and skills
  • Be committed to providing the best care possible
  • Use problem- and knowledge-focused triggers
  • Consider data gathered from a health care setting to examine clinical trends
• PICOT question


  • P = Patient population of interest
  • I = Intervention of interest
  • C = Comparison of interest
  • O = Outcome
  • T = Time
• Collecting the best evidence


  • Ask experts for help
  • A medical librarian can identify the databases that are available and key words that will provide the best answer to your PICOT question
• Critically appraising the evidence


  • Synthesize or combine the findings
  • Consider the scientific rigor of the evidence and whether it has application in practice
  • Elements of an article: abstract, introduction, literature review or background, purpose statement, methods or design, results or conclusions, clinical implications
• Integrating evidence


  • Teaching, assessment or documentation tools, clinical practice guidelines, policies and procedures
  • Applying evidence: consider setting, staff support, scope of practice, resources
  • A pilot study may be conducted when evidence is not strong enough to apply in practice
• Evaluating the practice decision or change


  • Was the change effective?
  • Are modifications needed?
  • Should the change be discontinued?
  • Unexpected events or results may occur
  • Never implement a practice change without evaluating its effects
• Sharing the outcomes with others


  • Clinical staff on the unit
  • Nursing practice council or the research council
  • Clinicians
  • Professional conferences and meeting
• Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively
• Outcomes research


  • Helps patients, health care providers, and those in health care policy make informed decisions on the basis of current evidence
  • Typically focuses on the benefits, risks, costs, and holistic effects of a treatment on patients
  • Outcomes must be observable or measurable
• Scientific method


  • The foundation of research
  • The most reliable and objective means of acquiring and conducting research and gaining knowledge
  • A step-by-step process to ensure that findings from a study are valid, reliable, and generalizable to a similar group of subjects
• Nursing research approaches


  • Quantitative: experimental research, non-experimental research, surveys, evaluation research
  • Qualitative: ethnography, phenomenology, grounded theory
• Institutional Review Board (IRB)


  Ensures that research involving human subjects is ethical and protects the rights and welfare of participants
• Informed consent


  Participants receive full and complete information, can understand the information, have free choice to participate, and understand how their confidentiality will be kept
• Confidentiality


  Protecting the privacy of research participants
• EBP, research, and QI

  • EBP uses information from research and other sources to determine safe and effective nursing care with the goal of improving patient care and outcomes
  • Research is systematic inquiry that answers questions, solves problems, and contributes to the generalizable knowledge base of nursing
  • QI improves local work processes to improve patient outcomes and health system efficiency, but results are usually not generalizable
• Therapeutic communication promotes personal growth and attainment of patients' health-related goals
• Developing communication skills


  • Critical thinking, perseverance and creativity, self-confidence, humility, integrity
  • Thinking is influenced by perception (five senses, culture, education) and perceptual bias
  • Emotional intelligence
• Levels of communication


  • Intrapersonal
  • Interpersonal
  • Small group
  • Public
  • Electronic
• Elements of the communication process: Circular Transactional Model


  • Referent
  • Sender and receiver
  • Message
  • Channels
  • Feedback
  • Interpersonal variables
  • Environment
• Forms of communication


  • Verbal: vocabulary, denotative & connotative meaning, pacing, intonation, clarity and brevity, timing and relevance
  • Nonverbal: personal appearance, posture and gait, facial expressions, eye contact, gestures, sounds, territoriality and personal space
  • Metacommunication
• Nurse-patient relationship


  • Caring relationships are the foundation of clinical nursing practice
  • Therapeutic relationships promote a psychological climate that facilitates positive change and growth
  • Phases: pre-interaction, orientation, working, termination
• Motivational interviewing


  • A technique that holds promise for encouraging patients to share their thoughts, beliefs, fears, and concerns with the aim of changing their behavior
  • Delivered in a nonjudgmental, guided communication approach
• Professional nursing relationships


  • Nurse-family
  • Nurse-health care team
  • Nurse-community
• Elements of professional communication


  • Appearance, demeanor, and behavior
  • Courtesy
  • Use of names
  • Trustworthiness
  • Autonomy and responsibility
  • Assertiveness
• Nursing process: Assessment


  • Gather information, synthesize, apply critical thinking
  • Physical and emotional factors
  • Developmental factors
  • Sociocultural factors
  • Gender
• Nursing diagnosis for communication


  • Lacking skills in attending, listening, responding, or self-expression
  • Inability to articulate, inappropriate verbalization
  • Difficulty forming words
  • Difficulty with comprehension
• Nursing process: Planning


  • Goals and outcomes: Specific and measurable
  • Setting of priorities
  • Teamwork and collaboration
• Therapeutic communication techniques


  • Sharing observations
  • Sharing empathy
  • Sharing hope
  • Sharing humor
  • Sharing feelings
  • Using touch
  • Using silence
  • Providing information
  • Clarifying
  • Focusing
  • Paraphrasing
  • Validation
  • Asking relevant questions
  • Summarizing
  • Self-disclosure
  • Confrontation
• Nontherapeutic communication techniques


  • Asking personal questions
  • Giving personal opinions
  • Changing the subject
  • Automatic responses
  • False reassurance
  • Sympathy
  • Asking for explanations
  • Approval or disapproval
  • Defensive responses
  • Passive or aggressive responses
  • Arguing
• Adapting communication techniques


  • Patients who cannot speak clearly
  • Cognitive impairment
  • Hearing impairment
  • Visual impairment
  • Unresponsive
  • Patients who do not speak English (or your language)
• Nursing process: Evaluation


  • Through the patient's eyes
  • Patient outcomes
  • Determine whether the plan of care has been successful
  • Evaluate which nursing interventions were effective
  • Modify the plan of care if expected outcomes are not met