EBN.ppt

7/23/2019 EBN.ppt

http://slidepdf.com/reader/full/ebnppt 1/36

Evidence BasedNursing

7/23/2019 EBN.ppt


REVIEW

Essensi Pelayanan Suatu Profesi:Problem identication

Problem solving

7/23/2019 EBN.ppt


History

• Nursing research began to focus on clinical issues in themid 80’s (Stevens & Cassidy !"""#$

• %he National nstitute for Nursing 'esearch (NN'# (htt:))***$nih$gov)ninr)# *as formed in !"8+ greatlyincreasing the visibility and funding oortunities for

nursing research$• ,any ne* -ournals emhasi.e nursing research• n recent years the nternational Society for Nursing

'esearch Sigma %heta %au has greatly increased itscaacity to suort and disseminate nursingscholarshis (htt:))***$nursingsociety$org)#

• ,c,aster niversity in 1ntario Canada has develoede2tensive resources in teaching and imlementingevidence3based ractice in nursing and other discilines(htt:))***$fhs$mcmaster$ca)ceb)acts)ebc$htm#

http://www.nih.gov/ninr/

http://www.nursingsociety.org/

http://www.fhs.mcmaster.ca/ceb/acts/ebcp.htm


http://www.nursingsociety.org/

http://www.nih.gov/ninr/

7/23/2019 EBN.ppt


Evidence Based Nursing

Proses dimana engambilan 4eutusan4eera*atan didasar4an ada hasil3hasilenelitian yang terbai4 4eahlian 4lini4

dan haraan serta nilai3nilai yang adaada asien (niversity of ,inesota500!#$

%u-uan ra4te4 E6N adalah enggunaan

riset3riset 4eera*atan yang valid 4edalam ra4te4 4eera*atan sehari3hari(research utilization#

7/23/2019 EBN.ppt


Evidence Based Nursing (EBN)?

• Evidence 6ased Nursing is the rocess by *hich nursesma4e clinical decisions using the best available researchevidence their clinical e2ertise and atientreferences$

• %hree areas of research cometence are: – interreting and using research – evaluating ractice and – conducting research$

• %hese three cometencies are imortant to E6N$• %o carry out E6N the follo*ing factors must be

considered: – su7cient research must have been ublished on the

secic toic – the nurse must have s4ill in accessing and critically

analy.ing research – the nurses ractice must allo* her)him to imlement

changes based on E6N

7/23/2019 EBN.ppt


Proses praktek EBN

Sama dengan roses ra4te4 EvidenceBased Medicine.mengidenti4asi ermasalahan dalam

bidang 4eera*atan

mela4u4an elaca4an untu4 mencarienelitian yang daat diguna4an untu4men-a*ab ermasalahanmela4u4an evaluasi dan telaah bu4ti

ilmiah

mengidenti4asi intervensi yang alingbai4 berdasar ada hasil enelitian4eahlian 4lini4 dan haraan asien,ela4u4an evaluasi hasil guna eneraan

dalam ra4te4

7/23/2019 EBN.ppt


9ima lang4ah ra4te4 E6N

!$ ,enga-u4an ertanyaan 4lini4 yang daatdi-a*ab (asking answerable question#

5$ ,ela4u4an elaca4an usta4a untu4 men-a*abertanyaan 4lini4

$ ,ela4u4an telaah 4ritis terhada bu4ti ilmiah

;$ ,ela4u4an integrasi antara bu4ti ilmiah yangvalid 4eahlian 4lini4 dan nilai serta haraanyang ada ada asien

<$ ,ela4u4an evaluasi hasil guna eneraan bu4tiilmiah di dalam ra4te4 (Sac4ett 5000#$

7/23/2019 EBN.ppt


Evidence-based NursingPractice

Solves roblems encountered by

nurses by carrying out four stes:

!$ Clearly identify the issue or roblembased on accurate analysis of currentnursing 4no*ledge and ractice

5$ Search the literature for relevantresearch

$ Evaluate the research evidence usingestablished criteria regarding scienticmerit

;$ Choose interventions and -ustify theselection *ith the most valid evidence

7/23/2019 EBN.ppt


S%EP !

,EN=>?@>N PE',>S>9>A>N@9N@

7/23/2019 EBN.ppt


1ld aradigms in learning

• ,uch learning “comlete” at the endof formal training

•

ntuition very o*erful• Bominated by 4no*ledge from

e2erience

•Professionals on to

7/23/2019 EBN.ppt


@ @ Syndrome

• “ @no*” “ @no*”

• %o be certain means to close ourminds to learning

7/23/2019 EBN.ppt


Ne* aradigms in learning

• @no*ing *hat you don’ t 4no* (not feeling badabout it# and 4no*ing how to nd out (or helothers to$$$#

• 9onglife learner

• 9earning by uestioning

• %urning roblems into uestions and to ndaraise store and act on e2erience andevidence to solve them

• Comlementing e2erience *ith 4no*ledgefrom research

• Professionals on ta

7/23/2019 EBN.ppt


Mengajukan permasalaan klinik

!$ Permasalahan 4lini4 daat muncul dariase4 aaran fa4tor risi4o tinda4anrevensi tinda4an diagnosis terai atau

intervensi dan rognosis$5$ Pertanyaan 4lini4 yang dia-u4an

sebai4nya sesi4$

$ Pertanyaan 4lini4 yang bai4 (foregroundquestion# a4an membantu roseselaca4an usta4a yang efe4tif$

7/23/2019 EBN.ppt


@omonen Pertanyaan @lini4

P (oulasi) population patient #

(intervensi) e4sosur) intervention#

C (co!parison#1 (outco!e#$

7/23/2019 EBN.ppt


Contoh

• @asus ana4 dengan demam dan nyeri – Pertanyaan 4lini4 dalam bidang terai

adalah: ”aa4ah iburofen lebih efe4tif

dibanding arasetamol untu4 mengatasinyeri dan demam ada ana43ana4D”$

• Poulasi: ana43ana4

• ntervensi yang ditelaah adalah

iburofen• Pembanding aracetamol or lasebo

• outco!e yang dinilai adalah bebasdemam) nyeri$

7/23/2019 EBN.ppt


Contoh

• %n$ 6 ;8 th sebelumnya tida4 mengeluh4ansesuatu 4eti4a sedang 4er-a ba4ti mengeluhnyeri dada bagian tengah$ Nyeri hilang

setelah istirahat 53 menit$ Setelah 4e-adiantersebut %n$ 6 sering mengeluh nyeri dadabai4 ada *a4tu mela4u4an 4egiatan seertiolah raga mauun ada saat istirahat$ %n$ 6adalah ero4o4 ! bung4us setia hari$ Aasil

emeri4saan E@= normal %B !<0)"+ mmAg$

7/23/2019 EBN.ppt


Pertanyaan Pasien

>a4ah saya sa4itD

6u4ti aa yang menun-u44an bah*asaya sa4itD

@alau sa4it aa enyebabnyaD

>a yang a4an dila4u4an untu4

mengatasi sa4it sayaD

7/23/2019 EBN.ppt


Pertanyaan @linisi

>4ah 4eadaan %n$ 6 berbahayaD

>a4ah erlu engobatan lan-ut atau hanyadengan en-elasan sa-aD

6agaimana dengan hasil E@= yang normalDSe-auhmana E@= bisa memasti4an adanya P?@D

>a4ah berhenti mero4o4 bisa mengurangi'isi4o enya4itD

7/23/2019 EBN.ppt


S%EP 5

,ENC>' B>N ,ENE,@>N 6@%

9,>A %E'6>@

7/23/2019 EBN.ppt


Menemukan Bukti !lmia

%ahaan aling enting dan mendasar

,enemu4an hasil enelitian yang

valid dan reliable$Aasil enelitian yang diilih adalah

enelitian yang memili4i 4ualitas yangbai4 sesuai dengan hirar4i bu4ti

ilmiah

7/23/2019 EBN.ppt


Derajat EvidenceDerajat

IV

Jenis Evidence

Meta-analisis dari RCT

RCT (uji klinis acak terkendali)

Uji klinik dengan pembanding,tanpa randmisasi

!enelitian "uasi-eksperimental

!enelitian deskripti#$ studi kmparasi,studi krelasi, studi kasus

%apran kmisi a&li, pini, pengalaman

klinik a&li 'ang diakui

Ia

Ib

IIa

IIb

III

7/23/2019 EBN.ppt


REKOMENDASIREKOMENDASI

"ingkat

# (Evidence$evels !a% !b)

B (Evidence$evels !!a% !!b%!!!)

& (Evidence$evel !')

ekomendasi

Memerlukan paling sedikit satu as&" sebagai bagian utama kepusta-kaan

Memerlukan minimal asil uji klinistanpa randomisasi

Memerlukan bukti dari laporansuatukomite ali atau opini ataupengalaman klinik ali yang diakui

7/23/2019 EBN.ppt


"EP *

"elaa +ritis

7/23/2019 EBN.ppt


"E$##H +!"!

%elaah 4ritis dila4u4an dengan menga-u4an ertanyaan utama yaitu:!$ >a4ah enelitian ini validD

5$ >a4ah hasilnya entingD

$ >a4ah enelitian yang valid dan enting ini bergunabagi tatala4sana asien3asien sayaD

Pertanyaan validitas dan a4urasi suatu arti4elbertu-uan untu4 memertimbang4an aa4ah efe4

yang dilaor4an benar3benar menun-u44an arahdan besar efe4 yang sesungguhnya$

7/23/2019 EBN.ppt


S%EP ;

N%E='>S B>9>, PE9>>N>N

7/23/2019 EBN.ppt


!ntegrasi Bukti !lmia ,alamPelayanan

,emung4in4an untu4 ditera4an

6u4ti ilmiah yang ada harus bisa

diintegrasi4an dan menyatu denganelayanan sehari3hari

,isal4an dalam clinical care pathwa"

7/23/2019 EBN.ppt


S%EP <

EF>9>S A>S9 =N>

7/23/2019 EBN.ppt


Evaluasi Hasil una

#elf$evaluation

Baat mengguna4an indi4ator outco!e elayanan

,isal:Be4ubitus

Plebitis

S@ dll

7/23/2019 EBN.ppt


&riticalappraisal

Point critical appraisal .a "idak +eterangan

?udul 3 >a4ah -udul memenuhi 4aidahenulisan -udul3 >a4ah enulisan -udul

mengguna4an tanda tanya (D#3 >a4ah enulisan -udul

mengguna4an tanda seru (G#

Penulis 3 >a4ah nama enulisdicantum4anD

3 >a4ah asal insitusi enulisdicantum4anD

3 >a4ah asal institusi enulissesuai dengan toi4 enelitianD

6idang ilmu 3 >a4ah bidang ilmu yangtercantum dalam -udulenelitianD

3 >a4ah latar bela4ang enulis(institusi temat be4er-a# sesuaidengan bidang ilmu toi4enulisan D

,etodologienelitian

3 >a4ah tu-uan enelitiandisebut4anD

3 >a4ah desain enelitian yangdiguna4anD

3 >a4ah desain enelitian sesuai

dengan tu-uan enelitianD3 6agaimana level of evidence dari

desain enelitianD3 6agaimana emilihan samel

dalam enelitian tersebutD3 Balam bentu4 aa hasil

enelitian disa-i4anD3 >a4ah u-i statisti4 yang

diguna4anD

Aasilenelitian

3 >a4ah hasil enelitian daatdiimlementasi4an di

4eera*atanD3 >a4ah ada re4omendasi 4hususter4ait hasil enelitianD

3

Critical appraisal check list

Judul:...........................................................................................

Penulis:.........................................................................................

7/23/2019 EBN.ppt


&urrent national andinternational projects in EBN

• Centre for Evidence36ased Nursing (@ #

• Evidence36ased Nursing (0nline ?ournal#

• Evidence36ased Nursing and ,id*ifery (%he ?oanna 6riggs nstitute#

•Nurse Prescribing (National Prescribing

http://www.york.ac.uk/healthsciences/centres/evidence/cebn.htm


http://www.bmjpg.com/template.cfm?name=specjou_nu


http://www.joannabriggs.edu.au/about/home.php


http://www.npc.co.uk/









7/23/2019 EBN.ppt


esearc-based nursing journals

• %here are a number of -ournals currently available*hich are secic or very relevant to evidence3based nursing$ %his is a list of such -ournals$ ,ostof them can be found either in rint and)or online

via ,NC>% the niversity of ,innesota catalog$ N%'esearch 6iological 'esearch for Nursing

• Canadian ?ournal of Nursing 'esearch

• ?ournal of Nursing ,easurement

• Hestern ?ournal of Nursing 'esearch

• Scholarly nuiry for Nursing Practice• >dvances in Nursing Science

• 1ncology Nursing Iorum

http://mncat.lib.umn.edu/

http://mncat.lib.umn.edu/

7/23/2019 EBN.ppt


• Nursing 'esearch• Evidence 6ased Nursing• 1nline ?ournal of @no*ledge Synthesis• Clinical Nursing 'esearch• Nurse 'esearcher• >lied Nursing 'esearch• 'esearch in Nursing and Aealth Nursing Science

Juarterly•

?ournal of Nursing Scholarshi• >nnual 'evie* of Nursing 'esearch

7/23/2019 EBN.ppt


EBN internet resources

• Evidence3based Clinical Practice Hor4ing =rouBeartment of Clinical Eidemiology and6iostatistics niversity of ,c,aster Canada$htt:))***$fhs$mcmaster$ca)ceb)acts)ebc$htm

•

6oo4s related to E6N:htt:))***$astu4$com)roducts3by34ey*ords)evidence3based3nursing$html

• niversity of Aertfordshire @ has a informative*eb age to e2lain evidence3based medicine$htt:))***$herts$ac$u4)lis)sub-ects)health)ebm$htm

•> *onderful E6, *ebsite from niversity of %orontoCanada aims to develo disseminate andevaluate resources that can be used to ractise andteach E6, for undergraduate ostgraduate andcontinuing education for health care rofessionalsfrom a variety of clinical discilines$htt:))***$library$utoronto$ca)medicine)ebm)


http://www.astuk.com/products-by-keywords/evidence-based-nursing.html


http://www.herts.ac.uk/lis/subjects/health/ebm.htm

http://www.herts.ac.uk/lis/subjects/health/ebm.htm




7/23/2019 EBN.ppt


• %his is a Nursing 'esource Collection from niversity of,assachusetts K >mhersthtt:))***$library$umass$edu)sub-ect)business)ebn$html

• %he unit for Evidence 6ased Nursing at ,almL niversitythe Beartment of Nursing and Public Aealth School of

Aealth and Society recently formed a unit for Evidence6ased Nursing$htt:))***$hs$mah$se)'esearch)Evidenseng$htm

• Beveloing Evidence 6ased Nursing Practice AealthCare Practice 'esearch and Beveloment nit (ACP'B#niversity of Salford @$

htt:))***$salford$ac$u4)ihr)hcrdu)comlete)ebn$htm

7/23/2019 EBN.ppt


• NAS research and develoment: center for evidence basedmedicine$ %he Center *as established in 12ford niversity @$ts broad aim is to romote evidence3based health care and

rovide suort and resources to anyone *ho *ants to ma4euse of them$ htt:))cebm$-r5$o2$ac$u4)

• %he Hestern >ustralian Centre for Evidence 6ased Nursing and,id*ifery School of Nursing Curtin niversity of %echnology>$ htt:))***$curtin$edu$au)curtin)det)lanstats)*acebnm)

• Evidence 6ased Aealth Care Saint 9ouis niversity Saint 9ouis

,1$ htt:))***$slu$edu)libraries)hsc)*rMebhc$html• Evidence3based Practice *ebsites for nurse researchers by,ary E$ Buy the Birector of the Center for Nursing 'esearch at6oston College School of Nursinghtt:))***$nursing$uc$edu)nrm)duy!!O""$htm

7/23/2019 EBN.ppt


• %echniues for 9ocating Evidence36ased Practice'esources niversity of Hashington Aealth Sciences9ibraries htt:))healthlin4s$*ashington$edu)eb)

• Evidence3based ,edicine resource and information Bu4eniversity medical center library$

htt:))***$mclibrary$du4e$edu)resub)guides)ebm)inde2$html

• Nursing nformatics and Evidence36ased Nursingniversity of Hisconsin Aealth Science libraries

• htt:))***$medsch$*isc$edu)chslib)ad)docs)nurfmatc$ht

m

EBN.ppt

Documents

Transcript of EBN.ppt