Evidence-based practice for the busy nurse practitioner: part four: putting it all together.

PURPOSE: Understanding the critical appraisal process allows nurse practitioners (NPs) to determine a study's reliability, validity, and applicability to their client(s)/families, and to their clinical practice setting. The purpose of this final part of this four-part evidence-based practice (EBP) series is designed to utilize a clinical scenario that will walk the NP through EBP steps 1 through 3 while providing an example of how to critically appraise a randomized control trial. DATA SOURCES: Scientific literature review, gray literature, PubMed and other online literature databases and resources, and online EBP websites. CONCLUSIONS: As healthcare providers, our role is to provide the best possible care we can to our client(s) and their families. One way to do this is through the utilization of the EBP process. When EBP processes are integrated into our clinical practice settings it augments the existing provider-client relationship and shared decision-making process. IMPLICATIONS FOR PRACTICE: It is hoped that this four-part series enhanced NPs' understanding of the EBP processes of developing a clinical inquiry, searching for the best evidence, critically appraising the evidence, and integrating EBP into clinical practice.

Evidence-based practice for the busy nurse practitioner: part three: critical appraisal process.

PURPOSE: Evidence-based practice (EBP) involves integrating research evidence with clinical expertise to answer clinical practice inquiries. The purpose of part 3 of this EBP series is to provide an introductory overview of the critical appraisal process, relevant clinical measurements, and critical thinking skills that can enhance nurse practitioners' (NPs') confidence in the clinical decision-making process. DATA SOURCES: Scientific literature review, gray literature, PubMed and other online literature databases and resources, and online EBP websites. CONCLUSIONS: Critical appraisal skills can assist NPs in interpreting available research, determining its validity reliability, and applicability to their clinical practice. Similarities in the critical appraisal process center around determining a study's reliability, validity, and applicability to the client(s) in question, while the differences exist in the clinical measurements used within specific research designs. IMPLICATIONS FOR PRACTICE: Because medicine is an evolving field, access to knowledge sources that address diagnostic, therapeutic, and prognostic questions is essential for the NP in order to maintain best practice skills. Making EBP user friendly for the practicing NP is paramount for utilization of best evidence.

Evidence-based practice for the busy nurse practitioner: part two: searching for the best evidence to clinical inquiries.

PURPOSE: The purpose of this four-part evidence-based practice (EBP) series is to enhance the nurse practitioner's (NP's) EBP skills by reviewing the process of developing a clinical question, searching for the best evidence, and critically appraising and applying the findings. Part two of the series focuses on how to search the published scientific literature for the most relevant studies that will answer a specific clinical question of importance to the NP. DATA SOURCES: Scientific literature review, gray searching, PubMed and other online literature databases and resources, and online EBP websites. CONCLUSIONS: Technology has allowed multiple healthcare resources to be available at one's fingertips enabling both NPs and their patients to find answers to clinical questions. EBP databases can be categorized as synthesized/filtered, unfiltered, and background information/expert opinion resources. Learning which database can best answer the clinical inquiry can streamline the search process. IMPLICATIONS FOR PRACTICE: For the busy NP, EBP has emerged as an important strategy to maintain valid, accurate, and relevant clinical knowledge. It is expected that this part of the series will enable NPs to identify appropriate databases to answer clinical inquires while refining their search strategy skills, which takes both time and practice.

Evidence-based practice for the busy nurse practitioner: part one: relevance to clinical practice and clinical inquiry process.

PURPOSE: Evidence-based practice (EBP) continues to gain momentum within health care. The purpose of this four-part EBP series is to provide an introductory overview of the EBP process, emphasizing EBP steps one through three, in order to assist nurse practitioners (NPs) in building EBP skills that can be integrated into clinical practice. The relevance of EBP to the NP's clinical practice, an introduction to the EBP process steps, and clinical inquiry process begin the series. DATA SOURCES: Scientific literature review, gray literature, and online evidence-based practice databases and resources. CONCLUSIONS: EBP has become increasingly important to NPs, yet there is evidence suggesting it is not being fully implemented in clinical practice. EBP is one way to keep the busy NP's knowledge up to date, enhance clinical judgment, and augment the existing provider-client decision-making process. IMPLICATIONS FOR PRACTICE: The principles of EBP have become the cornerstone strategy for NPs to translate research findings into clinical practice. Practicing in an ever-changing healthcare environment, NPs have a responsibility to provide their clients with the best available evidence, while incorporating that evidence into the provider-client decision-making process.

A literature review on breathing retraining as a self-management strategy operationalized through Rosswurm and Larrabee's evidence-based practice model.

PURPOSE: The purpose of this article is to critically appraise and synthesize the literature on breathing retraining as a self-management strategy for individuals with chronic obstructive pulmonary disease (COPD) guided by Rosswurm and Larrabee's evidence-based practice model. DATA SOURCES: Scientific literature review, grey literature review, and hand searching. CONCLUSIONS: An exhaustive review of the literature revealed evidence that regularly practiced pursed lip breathing is an effective self-management strategy for individuals with COPD to improve their dyspnea. IMPLICATIONS FOR PRACTICE: It is expected that implementation of this non-pharmacological self-management intervention will improve perception of dyspnea, functional performance, and self-efficacy in individuals with COPD.

Relationship of metabolic syndrome and obstructive sleep apnea.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) and metabolic syndrome represent significant risk factors for the development of cardiovascular disease. The purpose of this study was to see how frequently metabolic syndrome occurred in patients with OSA and whether the presence of metabolic syndrome was correlated with age, sex, or severity of OSA. METHODS: We examined the records of 250 consecutive patients referred to our Sleep Disorders Center to have polysomnography for the evaluation of OSA and extracted clinical data from the patients' medical records. We compared the proportion of patients with OSA and metabolic syndrome, hypertension, diabetes, or dyslipidemia to the group without OSA. We also did subgroup analysis by age and sex. RESULTS: A total of 228 patients were included in the study. Of 146 patients with OSA, 88 (60%) had metabolic syndrome, whereas 33 of 82 patients (40%) without significant OSA had metabolic syndrome (p = .004). The proportion with hypertension was significantly higher in the OSA group (77% vs 51%; p = .001). The proportion of patients with hyperglycemia and dyslipidemia was not significantly different between the 2 groups. In men older than age 50 years, there was a significantly higher than expected proportion of OSA patients with metabolic syndrome and in the proportion with hypertension but not with a diagnosis of diabetes or dyslipidemia. In women (both older and younger than age 50), and in men younger than age 50, there was not an independent relationship between metabolic syndrome and OSA. CONCLUSIONS: Patients with OSA have a high prevalence of metabolic syndrome. The prevalence of metabolic syndrome and hypertension was significantly greater in the OSA group. No significant differences were noted between the 2 groups in the proportion of patients with diabetes and dyslipidemia.