Integrating Evidence-Informed Decision Making in the School of Nursing, McMaster. University

Transcription

1 Integrating Evidence-Informed Decision Making in the School of Nursing, McMaster University Bergen, Norway June 17, 2015 Jennifer Yost RN, PhD

2 School of Nursing Within the Faculty of Health Sciences Undergraduate and graduate programs Undergraduate program Collaborative program across three different sites ~ 1300 students Three streams (BScN, Accelerated, RPN-BScN) Graduate program MSc in nursing; course-based, thesis, and nurse practitioner PhD in nursing

3 Evidence-Informed Decision Making (EIDM) (McKibbon et al., 2010) EIDM Evidence-Informed Decision Making (EIDM) EIP, EIHC EBP, EBHC EBM, EBN Evidence-Informed Practice (EIP) Evidence-Based Health Care (EIHC) Evidence-Based Practice (EBP) Evidence-Based Health Care (EHBC Evidence-Based Medicine (EBM), Evidence-Based Nursing (EBN)

4 What we teach Framework for EIDM (DiCenso, Guyatt, & Ciliska, 2005) Clinical state, setting, and circumstances Patient preferences and actions Research evidence Clinical Expertise Clinical Expertise Health care resources

5 Evaluate the effectiveness of implementation strategies Decide if & how to implement the adapted evidence into practice Adapt the information to a local context Steps to EIDM (NCCMT, 2014) Clearly define the question or problem Efficiently search for research evidence Critically & efficiently appraise research sources Interpret/form practice recommendations informed by the evidence

6 How did we teach EIDM? Some EIDM taught in Year 1 Required course 3C04: Introduction to Research Methods and Critical Appraisal Taken in the 3 rd year (or stream equivalent) EIDM EIDM

7 Year 1 & EIDM Year 1, 1 st term Library orientation Information literacy [evaluation component] Developing learning questions (background, foreground/clinical) Evaluation of resources Year 1, 2 nd term Foreground/clinical questions [in-class] Quantitative (PICO) Qualitative (PS) Information Literacy [evaluation component] Evaluation of resources

8 Year 3, Required Course & EIDM

9 EIDM Integration EIDM is now integrated through all levels of the curriculum i.e. traditional 4 year student EIDM EIDM EIDM EIDM

10 EIDM Integration - Why? Opportunity for change BScN curriculum was being revised Resources Development of teaching-learning strategies Student feedback Why didn t we learn about EBP sooner Expected competency Regulatory body (College of Nurses of Ontario) Clinical agencies

11 EIDM Integration How? Step 1: Faculty members with expertise in EIDM met to discuss the leveling of the integration of EIDM throughout the curriculum

12 Leveling of EIDM Outcomes Level 1 Level 2 Level 3 Level 4 EIDM Framework EIDM Steps Clinical Questions (PICO/PECO/ PS) Quantitative vs Qualitative paradigms 6S Pyramid/ Searching Appraisal: Practice Guidelines Searching Research designs Appraisal: Intervention Studies Appraisal: Qualitative Studies Appraisal: Intervention Studies Appraisal: Systematic Reviews Appraisal: Studies about Prognosis & Causation/ Harm Appraisal: Practice Guidelines Knowledge Translation Reinforcement of Appraisal Skills Knowledge Translation

13 EIDM Integration How? Step 2: Faculty member appointed to oversee the integration of EIDM. Step 3: Faculty member then requests current course materials

14 EIDM Integration How? Step 4: Faculty member reviews the current PBL/PBL course material to identify recommendations for how to integrate EIDM into the course materials. This includes: Revision of existing course activities and/or evaluation measures New course activities and/or evaluation measures

15 EIDM Integration How? Step 5: Faculty member meets with the faculty responsible for the courses Recommendations for integration of EIDM are made Discussion occurs, and decisions are made based on consensus about how to integrate EIDM into the courses.

16 EIDM Integration How? Step 6: Faculty member either revises and/or creates new course activities and/or evaluation measures. Including Tutor Guides for faculty Step 7: The revised and/or new course activities and/or evaluation measures are implemented into the courses

17 Course Activities Various activities used throughout all levels: Required textbook Library sessions (multiple) Online learning modules Embedded exercises Worksheets

18 Health Science Library Page

19 Online Learning Modules

20 Evaluation Measures Various methods throughout the curriculum: Assignments Short papers Scholarly papers Exam Now 2 quizzes

21 EIDM Integration How? Step 8: Prior to implementation, faculty member conducted ½ to full day faculty development workshops before the next term began provided exposure to the EIDM content and teaching strategies for the faculty

22 EIDM Integration How? Step 9: Faculty member meets with the faculty responsible for the courses on an ongoing basis to review formal and anecdotal feedback from students and faculty on the integration of EIDM and, as necessary, further revisions are implemented.

23 Successes Significant improvement in Exam marks with integrated curriculum vs stand-alone course Mean difference 8.53, 95% CI (7.52, 9.54), P < 0.001, N = 2255 Informal and formal feedback that the redesign is working Students Faculty

24 Keys to Success Faculty buy-in Responsibility of one faculty member Resources Staggered implementation Faculty development sessions Library support

25 Challenges Faculty development EIDM knowledge Knowledge and skills for teaching EIDM Time Lack of student preparation Change in class size Continued resources for teaching-learning activities

26 Inspire. Questions

27 For Further Information Contact: Jennifer Yost PhD, RN Assistant Professor School of Nursing, McMaster University (t) x 21927

28 References College of Nurses of Ontario (2014). Competencies for entry-level registered nurse practice. Retrieved from pslanguage=en DiCenso, A., Guyatt, G., & Ciliska, D. (2005). Evidence-based nursing: A guide to clinical practice (pp ). St. Louis: Elsevier. National Collaborating Centre for Methods and Tools (2014). Evidence informed public health. Retrieved from