Evidence Based

Practice
Strategies to Nursing Practice

L Anand,
Lecturer,
College of Nursing,NEIGRIHMS,
Shillong
“ARE YOU SURE NEW BATH TECHNIQUE WAS ON
THE EVIDENCED BASED PRACTICE LIST?”
 EVIDENCE-BASED PRACTICE ?
 Evidence-based practice is the integration
of best research evidence with clinical
expertise and patient values to facilitate
clinical decision making.
 Evidence-based clinical decision making
should incorporate consideration of the
patient’s clinical state, the clinical setting,
and clinical circumstances.
The concept of EBP
 EBP is a problem-solving approach to
clinical decision making

 EBP encourages critical thinking

 EBP uses the latest research evidence to

produce high quality health care.
The value of EBP
 EBP ensures efficacy , efficiency and
effectiveness.

 EBP weighs risk, benefit, and cost

against a backdrop of patient
preferences.

 promote patient satisfaction and higher

health-related quality of life.
 Models of EBP
 The Johns Hopkins Nursing Evidence-
Based Practice Model
 The Ace Star Model (Stevens, 2005)
 Lowa Model
 Rosswurm and Larrabee Model.
 Stetler Model.
Models of EBP
 Models of EBP
 Discovery
 Summary

 Translation

 Integration

 Evaluation
Process of EBP
 STEP 1: Identify an EBP question
The process of forming an EBP question often
begins when one of the following questions
arises:
 1. What evidence is the basis for this
treatment?
 2. Is there a scientific basis for this treatment?
 3. What was the rationale for making that
decision?
 4. What are the clinical implications of this
practice?
N. MacIntyre, 2005
 STEP 1: Identify an EBP question

 P Patient, population, or problem.

 I Intervention or Interest

 C Comparison intervention or status

 O Outcome
N. MacIntyre, 2005
 PICO
 A clinical question should incorporate at least three
elements

 Patient
 Age, sex, ethnicity, etc.
 Condition, diseases, general health status

 Intervention
 Education, diagnostics, treatment plan, self-care, etc.
 PICO

 Comparison Intervention
 Placebo, etc.

 Outcome
 Expected and actual effects on patient
 PICO

 Do nurse led tobacco cessation interventions result

in decreased smoking rates after hospital admission
for coronary heart disease?
 PICO

 PATIENT
 (Adult) coronary heart patients
 Smokers
 Discharged from hospital

 INTERVENTION
 Nurse led tobacco cessation programmes
 PICO

 COMPARISON
 (Non-nurse led tobacco cessation programmes
 Self-administered, non-nurse administered, etc.)
 No comparison

 OUTCOME
 Lower rates of tobacco use among Patient group
 PICO

 Not all questions are of a clinical nature

 Intervention can be interpreted very broadly

Sources of Evidence-Based Practice
Problems

N. MacIntyre, 2005
 Step 2: Define the scope of the
practice question
The problem or question may relate to the
care of
 an individual patient,

 a specific population of patients, or

 the general patient population in the

organization.
N. MacIntyre, 2005
Step 3: Assign responsibility for leadership

Step 4: Recruit an interdisciplinary team

Step 5: Schedule a team conference

N. MacIntyre, 2005
 STEP 6: Conduct an internal and
external search for evidence
 Preprocessed resources - materials that have
been reviewed and chosen based on
methodological standards for inclusion.

 Primary evidence - usually data collected at

the point of patient contact. This evidence can
come from hospital-wide data, clinical trials,
peer-reviewed research journals, conference
reports, monographs, or summaries.

N. MacIntyre, 2005
STEP 6: Conduct an internal and external
search for evidence
 Evidence summaries - synthesized
literature and provide broader foci on
topics. (systematic reviews, integrative
reviews, book chapters, and meta-
analyses).
 Translation literature - quality-filtered
Internet and Intranet sources(practice
guidelines, critical pathways, care plans,
clinical innovations, protocols, standards).
N. MacIntyre, 2005
STEP 6: Conduct an internal and external
search for evidence
 Evidence summaries - synthesized
literature and provide broader foci on
topics. (systematic reviews, integrative
reviews, book chapters, and meta-
analyses).
 Translation literature - quality-filtered
Internet and Intranet sources(practice
guidelines, critical pathways, care plans,
clinical innovations, protocols, standards).
N. MacIntyre, 2005
STEP 7: Appraise all types of evidence


N. MacIntyre, 2005
Evidence Based Resources Models

Claude Moore Health Sciences Library, 2003

Evidence Pyramid

SUNY Downstate Medical Center, 2003

Evidence Based Resources Models

Claude Moore Health Sciences Library, 2003

 STEP 8 – 10 : EBP
STEP 8: Summarize the evidence

STEP 9: Rate the strength of the evidence

STEP 10: Develop recommendations for

change in systems or processes
of care based on the strength
of the evidence
N. MacIntyre, 2005
STEP 11: Determine the appropriateness and feasibility
of translating recommendations into the
specific practice setting

The practice guidelines development cycle

 STEP 12 – 15 : EBP
 STEP 12: Create an action plan

 STEP 13: Implement the change

 STEP 14: Evaluate outcomes

 STEP 15: Report the results of the

preliminary evaluation to decision makers
N. MacIntyre, 2005
 STEP 12 – 18 : EBP
STEP 16: Secure support from decision
makers to implement the
recommended change
internally
 STEP 17: Identify the next steps

 STEP 18: Communicate the findings

N. MacIntyre, 2005
Questions?