Page 62 - ACCCN's Critical Care Nursing

Quality and Safety 39

Research evidence
• weaning protocols
• systematic reviews

Nurses’ judgement and Clinical decision Patient preferences and
expertise circumstances
• experience • mechanical ventilation • respiratory history (asthma)
weaning method
• assessment skills • anxiety

Available resources
FIGURE 3.1 Schematic represen-
tation of evidence based nursing • type of ventilator
including an example of weaning • staffing
from mechanical ventilation.

Intervention, Comparison, Outcome format, more often
1. Translate a clinical query into a structured question referred to as PICO. The Population reflects the patient
group or clinical scenario of concern. The Intervention is
one option for the particular nursing practice. The Com-
parison is the current practice, or the second option for
2. Locate the best evidence practice. Finally, the Outcome is the effect that the nurse
is hoping to achieve, which should reflect a patient
outcome. Table 3.1 provides three examples of PICO
questions relevant to critical care nursing.
3. Critically appraise the evidence
Locate the Best Evidence
After well-defined, answerable, structured questions have
been developed, nurses can turn to reviewing the litera-
ture to find the answers. First, the evidence has to be
4. Integrate the evidence into practice
located, which involves searching library databases. Some
of the databases generally searched include Ovid CINAHL,
Medline and Cochrane. Articles that relate to the question
then have to be retrieved. These articles may be reports
5. Evaluate clinical performance about primary research (i.e. written by the person con-
ducting the research); systematic reviews of existing
FIGURE 3.2 Steps in the evidence based nursing process. research; or clinical practice guidelines that have been
developed from primary research and systematic reviews.

Critically Appraise the Evidence
whether this care results in the best possible outcomes Once the various sources of evidence have been retrieved,
for patients. It has been viewed as both an attitude and a they are then assessed for their quality and relevance to
process. As an attitude, it is a way of approaching practice the clinical question. In Australia, the National Health
that is critical and questioning. As a process, a number of and Medical Research Council (NHMRC) has described
5
steps in EBN have been described. Figure 3.2 identifies strategies to assess research evidence on the effectiveness
these steps, with more details about each step being pro- of interventions. It provides a useful framework to con-
vided below.
sider research evidence for improving nursing interven-
Translate a Clinical Query into tions, and identifies three questions to ask regarding
potential interventions:
a Structured Question
In situations where nurses have to make clinical deci- 1. Is there a real effect?
2. Is the size of the effect clinically important?
sions, it is important for them to carefully consider the 3. Is the evidence relevant to practice?
issue or problem they are facing as it influences what
research evidence should be used to make decisions. This first question regarding the real effect relates to the
Thus, the first step in the EBN process is translating a strength of the research that has been conducted. The
clinical query into a well-defined, answerable, structured strength of the research has three dimensions: level of
question. A well recognised approach is the Population, evidence, quality of the individual studies, and their