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1 : 18 May 2011 ARUN PIRAVOM 1 Good Morning Welcome
2 : “Quality management- Evidence based practice” By Mr.ARUN II year M.Sc nursing Padmashree College Of nursing Bengaluru 18 May 2011 2 ARUN PIRAVOM
3 : Out Line Introduction Definitions of terms Quality management Historical development Evidence based practice Conclusion 18 May 2011 3 ARUN PIRAVOM
4 : Introduction There is no quality with out “ an evidence ”; Quality and evidence go hand in hand. 18 May 2011 4 ARUN PIRAVOM
5 : “A thing / Things helpful informing a conclusion or judgment” Something that furnishes proof. E V I D E N C E 18 May 2011 5 ARUN PIRAVOM
6 : Nursing is a nurturative , generative, and protective profession. Preventive care is a part of nursing practice of every nurse. Nurses value independence and self respect. They are guided by ethical and humanitarian philosophy in which ; EVERY human being deserve respect regardless of racial ,social, cultural, sexual, economic, and religious or other factors. Nursing 18 May 2011 6 ARUN PIRAVOM
7 : “It is degree of excellence”. It is subjective way of expression according to each ones perception and it is fundamentally relational. ( Webster’s dictionary ) Quality is a measure determining what “the best is” shall be the key to competitiveness. Definitions 18 May 2011 7 ARUN PIRAVOM Quality:
8 : It is also a methodology and a way of promoting peoples active participation based on the involvement and responsibility of each individual working towards common vision. 18 May 2011 8 ARUN PIRAVOM Contd…
9 : In quality management , Quality control is a prime element of the management of nursing service. It is a system for evaluation of the total effort, which include the evaluation of management process and the practice of nursing. Quality Assurance and quality improvement are essential elements . Quality management 18 May 2011 9 ARUN PIRAVOM
10 : Evidence – Based Nursing Is the process by which Nurses make clinical decisions using ; The best available research evidence Their clinical expertise, and Patient preferences in the context of available resources . ( DiCensoA, Cullum N,Ciliska D.) 18 May 2011 10 ARUN PIRAVOM
11 : Is the integration of best research evidence with clinical expertise and patient values. ( Sackett D 2000) Evidence Based Medicine 18 May 2011 11 ARUN PIRAVOM
12 : Involves the use of best evidence to justify particular teaching or curricular interventions considering the needs of individual learners , the professional judgment of nurse educators , and the resource costs of the interventions. Evidence Based Nursing Education 18 May 2011 12 ARUN PIRAVOM
13 : Evidence Based Practice Is a process of finding , appraising , and applying scientific evidence to the treatment and management of health care . 18 May 2011 13 ARUN PIRAVOM
14 : In order to make a start in the quest for evidence based practice nurse managers , educationalists ,researchers and clinical practitioners must all play an active part. Simple strategies can help to prepare nurses such as role modeling and reflection on action.(Walsh & Ham, 1997). 18 May 2011 14 ARUN PIRAVOM
15 : Nurses also tried to adopt an evidence base for clinical practice , although nursing has been talking about a research based profession since 1970s. Quality Management in Nursing 18 May 2011 15 ARUN PIRAVOM
16 : Contemporary nursing has aimed to promote a ‘ critical thinking ‘ scientific culture in an attempt to arm nurses with the requisite of knowledge and skills to utilize evidence in clinical practice. Contd… 18 May 2011 16 ARUN PIRAVOM
17 : Purpose of quality control To detect deviations from desirable standards. To take preventive and corrective actions in order to ensure that the organizations mission and objectives are accomplished as effectively and efficiently as possible. To guide behavior and set into motion plans for the future 18 May 2011 17 ARUN PIRAVOM
18 : Types of control Anticipatory control Concurrent control Feed back control 18 May 2011 18 ARUN PIRAVOM
19 : Quality Assurance(QA) Quality Assurance(QA) is the process of establishing a target degree of excellence for nursing interventions and taking action to ensure that each patient receives agreed upon care . 18 May 2011 19 ARUN PIRAVOM
20 : Approaches to Quality Assurance 18 May 2011 20 ARUN PIRAVOM
21 : Steps of Quality Assurance Setting standards Assign responsibilities Delineate scope of care Identify important aspects of care Determining criteria 18 May 2011 21 ARUN PIRAVOM
22 : Steps contd…. Data collection Problem identification Problem solution Monitoring and feed back valuation of performance 18 May 2011 22 ARUN PIRAVOM
23 : Quality Assurance Methods Nursing audit Concurrent audit Retrospective audit Peer review Patient care profile analysis Quality circles Patient satisfaction( Client Feedback ) 18 May 2011 23 ARUN PIRAVOM
24 : History of EBP Evidence based practice movement was founded by Dr. Archie Cochrane, a British epidemiologist . In 1972 , Cochrane published a land mark book that criticized the medical profession for not providing rigorous reviews of evidence. Died in 1988. 18 May 2011 24 ARUN PIRAVOM
25 : Hist…… Cochrane Collaboration was launched in England in 1992. 1993 Cochrane collaboration was founded. 18 May 2011 25 ARUN PIRAVOM
26 : Hist…. The term Evidence –Based Medicine ( EBM) describes a clinical learning strategy that was developed by faculty at McMaster medical school in the 1980s Evidence –Based Medicine disseminated to the medical community in the early 1990s 18 May 2011 26 ARUN PIRAVOM
27 : Hist… Applies methods derived from clinical epidemiology to clinical decision making . Over the last decade, other medical professions adopted an evidence –based approach. 18 May 2011 27 ARUN PIRAVOM
28 : Hist….. Nursing research began to focus on clinical issues in the mid 80s. The national institute for nursing research was formed in 1986. Many new journals emphasize nursing research 18 May 2011 28 ARUN PIRAVOM
29 : Hist…. In recent years , the international society for nursing research ,has greatly increased its capacity to support and disseminate nursing scholarships. 18 May 2011 29 ARUN PIRAVOM
30 : Hist…. McMaster University in Ontario, Canada has developed extensive resources in teaching and implementing evidence –based in nursing and other disciplines. In the past few years a number of countries including UK, Canada , New zealand Australia and others , have created centers for evidence based nursing. 18 May 2011 30 ARUN PIRAVOM
31 : What are the driving factors for E B P ? Bridge the gap between knowledge and practice Provide a sound method for making clinical decisions To make education less vulnerable to political ideology ,conventional wisdom , folk lore , and wishful thinking” 18 May 2011 31 ARUN PIRAVOM
32 : Misconceptions Evidence –Based practice is not new, It is what we have been doing for years Evidence –Based nursing lead to “cook book” nursing and a disregard for individualized patient care. 18 May 2011 32 ARUN PIRAVOM
33 : contd…. There is an over emphasis on Randomized Control Trials( RCT) and systematic reviews in Evidence –Based health care. Requires too much time to be routinely employed in real – life practice setting. 18 May 2011 33 ARUN PIRAVOM
34 : contd… Evidence –Based practice is the mindless application of population studies to the treatment of the individual. It takes the results of studies of large groups of people and tries to apply them to individual. There is often great difficulty in getting access to the evidence and in conducting effective searches to identify the best evidence. 18 May 2011 34 ARUN PIRAVOM
35 : Research Models The conduct and utilization of research in nursing (CURN) project. The CURN project was designed to develop and test a model for using Research based knowledge in clinical practice settings. 18 May 2011 35 ARUN PIRAVOM
36 : The Stetler Model Research The stetler model of research utilization applies research findings at the individual practitioner level. 18 May 2011 36 ARUN PIRAVOM
37 : Lowa Model For Research in Practice. The Lowa model of research in practice infuses research into practice to improve the quality of care ,and is an out growth of Quality Assurance Model Using Research(QAMUR) 18 May 2011 37 ARUN PIRAVOM
38 : Steps of EBP Ask the burning clinical question Collect the most relevant and best evidence 18 May 2011 38 ARUN PIRAVOM
39 : Contd… Integrate all evidence with one’s clinical expertise ,patient preferences, and values in making a practice decisions or change . Evaluate the practice decision or change. 18 May 2011 39 ARUN PIRAVOM
40 : 1.Ask the burning clinical questions Clinical question should be asked in PICO format P – Population I - Intervention/s C- Comparison O – Out come/s Example: In teenagers (p), how effective Depo –Provera ( Intervention) versus oral contraceptives ( Comparison) in the prevention of pregnancy ( Out come) 18 May 2011 40 ARUN PIRAVOM
41 : 2.Collect the most relevant and best evidence. Begin with systematic reviews or meta analyses Evidence based clinical guide lines Eg: Dove soap, Washing powders, Face creams, Medications etc which means everything needs proof 18 May 2011 41 ARUN PIRAVOM
42 : 3.Critical appraisal General critical appraisal questions What were the results of the study? Are the results Valid? Will the results help in caring for my patients? 18 May 2011 42 ARUN PIRAVOM
43 : 18 May 2011 ARUN PIRAVOM 43 4.Integrate the Evidence
44 : Applying E B P to Nursing education: Issues to be answered. Are nursing educators are walking the walk in terms of Evidence Based practice? Are nursing education strategies and curricula based on the best evidence? Does nursing education have a specific body of knowledge that is used as Evidence Based practice? 18 May 2011 44 ARUN PIRAVOM
45 : Do nurse educators use clinical judgment in adopting recommended practices to their particular situations , curriculum or students? In which way are student values considered in the development of curricula and teaching strategies? What are the implications of implementing evidence based practice in nursing education? Contd….. 18 May 2011 45 ARUN PIRAVOM
46 : Will this method benefit the students? Increased interest in Evidence Based nursing practice and participating in the generation of research. Enhanced critical thinking skills through the development of knowledge , experience , and competencies. 18 May 2011 46 ARUN PIRAVOM
47 : Increased motivation to continue professional growth and development by participating in life long learning. The desire to become better consumers of research findings. Increased desire to pursue graduate studies in nursing. Contd….. 18 May 2011 47 ARUN PIRAVOM
48 : Strategies to stimulate students Sensitizing the students to research related issues. Stimulating collaborative learning about research. Enhancing analytical skills related to the research process 18 May 2011 48 ARUN PIRAVOM
49 : Fostering communication skills specific to nursing research. Creating mentored opportunities to practice research process. Promoting enduring pattern of research use. 18 May 2011 49 ARUN PIRAVOM
50 : Accessibility of research findings. Anticipated outcomes of using research . Organizational support to use research. Support from others to use research. Barriers to EBN 18 May 2011 50 ARUN PIRAVOM
51 : According to Capez and Morehouse (2004) Total Quality Management refers to “A management process and set of disciplines that are coordinated to ensure that the organization consistently meets and exceeds customers requirements .” What is TQM? 18 May 2011 51 ARUN PIRAVOM
52 : TQM contd… TQM engages all divisions , departments , And levels of the organizations. Top management organizes all of its strategy and operations around customer needs and; Develops a culture with high employee participation. 18 May 2011 52 ARUN PIRAVOM
53 : To assure high quality nursing care, or education ; Information about structure , Nursing process, And patient/Student out comes Must be continuously fed back to the Nurses /Teachers at all levels of organizational hierarchy.   Conclusion 18 May 2011 53 ARUN PIRAVOM
54 : Quality is not only that which is “shaped“ but also that which “does shaping.” There can be no quality without An environment of quality it demands of the ‘TEAM’ So, 18 May 2011 54 ARUN PIRAVOM
55 : Thank you 18 May 2011 55 ARUN PIRAVOM


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