Taibah University

Applied Medical Science College

Nursing Department

Evidence-Based
Nursing: Translating
Insert Your Image
Research Evidence
into Practice

Dr Hadeel Tayeb
Nursing Leadership & E-Education
Objectives
On completing this lecture, student will be able to:

01
01 define the evidence-based practice

01
02 recognize the evidence-based practice from Islamic perspective

01
03 differentiate between research utilization and Evidence-based practice

01
04 understand the primary and secondary research

01
05 identified the concepts in qualitative & quantitative research

01
06 recognize evidence hierarchies and level of evidence scale

01
07 identified the major steps in evidence-based practice (5As)

01
08 identified the EBNP in Saudi Arabia
 Evidence-based practice (EBP) has
been a major force in health professions
for the past few decades.
In nursing, many organisations and
initiatives has promoted EBP.
Definition of evidence-based practice
‘a paradigm and lifelong problem solving
approach to clinical decision that involves
the conscientious use of the best available
evidence (including systematic search for
and critical appraisal of the most relevant
evidence to answer clinical question) with
one’s clinical expertise and to improve
outcomes for individual, communities, and
system’
(Melnyk and Fineout-Overholt, 2019, in Polit, & Beck, 2021, P.753)
Definition of evidence-based practice

‘Evidence Based Practice (EBP) is a

problem-solving approach to the delivery
of care that incorporates the best
evidence from well-designed studies in co
mbination with a clinician’s expertise and
patients’ preferences within a context of
caring’
(Sackett, et. al., 2000)
Definition of evidence-based practice

‘an integration of the research evidence

with clinical expertise and the values of
patients to assist the health profession in c
linical decision-making’
(Winter & Echeverri, 2017)

(Aljohni, Rawas, Aliilyyani, et al, 2021).

Definition of evidence-based practice

‘integration of the best evidence available,

nursing expertise, and the values and
preferences of the individuals, families
and communities who are served’
(Sigma Theta Tau International, 2005)

Thus, all aspects of patient care should be based on EBP.

(Aljohni, Rawas, Aliilyyani, et al, 2021).

Model of evidence-based practice

(Polit, & Beck, 2021).

Patient values and Clinical expertise &
experiential evidence
Best Evidence
preferences
Encompass several c Decision-making in
oncepts: including clinical practice ultimately
patient preferences for relies on clinicians’
type of treatment; expertise, which is an Identifying and
preferences for being amalgam of academic evaluating the best
involved in decision- knowledge gained during available research
making; patients’ social training , and continuing evidence as a tool
or cultural values; prefer education, experiences for solving problems
ences about involving with patient care, and
family members in interdisciplinary sharing
healthcare decisions, of new knowledge.
patients’ priorities
regarding the quality of Because even very strong
life issues; and their research evidence, may not
spiritual or religious appropriate or applicable for
values individual patients (Polit, & Beck, 2021).
Evidence-based practice from Islamic
perspective
➢ The concept of evidence-based practice is implemented
deeply into the Islamic culture where people are requested to
read and understand the Holy Quran.
➢ The hierarchy of evidence in Islam are the Holy Quran,
Sunnah, and Imams' consensus.

Imams' reach their decisions " Fatwa" based on evidence from the
holy Quran in terms of the following:
1- Monasabah: in what condition or situation did the Quran verse
was delivered to prophet Mohammad (settings);
2- Daleel: the Quran verse (the evidence);
3- Shahid: the word or phrase of the verse indicating the action

(Aljohni, Rawas, Aliilyyani, et al, 2021).

‫‪Evidence-based practice from Islamic‬‬
‫‪perspective‬‬
‫اآليات المتضمنة ألحكام الدين والرهن‬

‫المناسبة‪ :‬هذا إرشاد عظيم كريم من هللا لعباده بحفظ أموالهم وضبطها بالكتابة‬
‫أو اإليثاق بالرهن‬

‫َّ ِ‬
‫س ًّمى فَا ْكتُ بُوهُ ‪ )..‬البقرة ‪282‬‬ ‫آمنُوا إِذَا تَ َدايَنتُم بِ َديْ ٍن إِ َ ىل أ َ‬
‫َج ٍل ُّم َ‬ ‫ين َ‬
‫الدليل‪( :‬اي أَيُّ َها الذ َ‬

‫الشاهد من اآلية‪ :‬لحفظ ما يقع بين المتعاقدين إلى حلول األجل‪ ،‬ألن النسيان يقع‬
‫كثيراً في المدة بين العقد و حلول األجل‪.‬‬

‫‪(Aljohni, Rawas, Aliilyyani, et al, 2021).‬‬

Research utilization (RU) vs. Evidence-based practice (EBP)
Research utilization
(RU)
The use of study findings
in a practical application
unrelated to the original
research.
(applying research findings to
all aspects of nurses’ tasks)
Evidence-based
practice (EBP)
Basing clinical decisions
on best possible evidence
-especially high-quality
research.
(Polit, & Beck, 2021).
 Question

OR
The use of study findings in a practical application
unrelated to the original research is evidence-based
practice.

RU is the use of study findings in a practical application

unrelated to the original research.
EBP is clinical decision on best possible evidence.
Primary and secondary research
Primary
Research
Studies in which original data
are collected to answer a
specific research question.
Randomised controlled trials,
cohort studies, case-control
studies and surveys.
(Polit, & Beck, 2021).
Secondary
Research
Uses information from existing
studies. Publications, or expert
opinion to answer a specific
research question.
Systematic reviews, meta-
analysis (quantitative data),
meta-synthesis (qualitative or
narrative data) and guidelines.
 Key concepts in qualitative
& quantitative research

Quantitative Research

Qualitative Research

Qualitative and Quantitative Research Methods

(Polit, & Beck, 2021).

 Key concepts in quantitative research
Experimental/ controlled trial
or clinical trial
➢ Researchers actively introduce an
intervention or treatment to address therapy
questions.
➢ E.g., if a researcher gave bran flakes to one
group of subjects and prune juice to another
to evaluate which method facilitated
elimination more effectively, the study would
be experimental because the researcher
intervened in the normal course of things.
➢ Experimental studies are explicitly designed
to test causal relationships—to test whether
the intervention caused changes in the
dependent variable
Non-experimental research/
observational study
➢Researchers are by standers—they collect
data without introducing intervening to addr
ess Etiology, prognosis, or discerption
questions.
➢E.g., if a researcher compared elimination
patterns of two groups whose regular eating
patterns differed, some normally took foods
that stimulated bowel elimination and others
did not—there is no intervention.
➢Sometimes nonexperimental studies seek to
elucidate causal relationships, but doing so
is tricky and usually is less conclusive
because experimental studies offer the
possibility of greater control over
confounding influences. (Polit, & Beck, 2021).
 Key concepts in qualitative research:
disciplinary traditions

Many qualitative studies are rooted in research traditions that originated in

the disciplines of:

➢ Grounded theory: seeks to describe and understand the key social,

psychological, and structural processes that occur in a social setting.
Most of grounded theory studies focus on a developing social experience.
➢ Phenomenology: is concerned with the lived experiences of humans.
➢ Anthropology: providing a framework for studying the patterns,
lifeways, & experiences of a defined cultural group in a holistic manner.

(Polit, & Beck, 2021).

Evidence hierarchies and level of evidence
scale
Intended to show a ranking of evidence source in terms of their risk of bias.
Evidence hierarchies are often presented as pyramids, with highest
ranking sources-those presumed to have the least bias for making
inferences about the effects of an intervention-at the top.

Level I evidence source is a systematic review

of a type of study called a randomized controll
ed trial (RCT).
“gold standard” type of study

Level II evidence for an individual RCT.

(Polit, & Beck, 2021).

 Evidence hierarchies and level of evidence
scale
Going down the “rungs” of the evidence hierarchy results in evidence with a higher
risk of bias in answering questions about “what works.”

Level III evidence comes from a type of study called quasi-experiments. (Cohort Study)

Steps in conducting a
systematic review

(Polit, & Beck, 2021).

 Group Activity
Ingham-Broomfield, (2016). A nurses' guide to the
hierarchy of research designs and evidence. Australian
Journal of Advanced Nursing, The, 33(3), 38-43.

➢ Select one level of the Evidence-Based

pyramid.
➢ Discuss with your group the involved study
designs that you find and why the level is
important as a supporting evidence in daily
nursing practice.
➢ Present your outcomes to the whole class
for discussion and critique

(Aljohni, Rawas, Aliilyyani, et al, 2021).

Individual and organisational evidence-based
practice
Individual nurses make many decisions and convey important healthcare information and
advice to patients, and so they have ample opportunity to put research into practice.

Clinical Scenario 1 Clinical Scenario 2 Clinical Scenario 3

You are an Advance Practice

You are working on a
haemodialysis unit and one of
your patients with type 2
diabetes develops severe foot
ulceration that ultimately leads
to amputation of several toes.
You want to know if there is a
reliable assessment tool for the
earlier detection of foot
complications so that the risk of
amputation for patients with end-
stage renal disease would be
reduced.
You are working in an allergy
clinic and notice how difficult
it is for many children to
undergo allergy scratch tests.
You wonder if there is an
effective intervention to help
allay children’s fears about the
skin test.
(Polit, & Beck, 2021).
Registered Nurse working in a
rehabilitation hospital and one of your
elderly patients, who had total hip
replacement, tells you that she is
planning a long airplane trip to visit
her daughter after her rehabilitation
treatments are completed.
You know that a long plane ride will
increase the patient’s risk of deep vein
thrombosis and wonder if compression
stockings are really an effective in-flight
treatment and should be recommended.
You decide to look for the best possible
evidence to answer this question.
Individual and organisational evidence-based
practice
In these and thousands of other clinical situations,
research evidence can be put to good use
to improve the quality of nursing care.
Thus, individual nurse need to have the skills to
personally search for, appraise, and apply evidence
in their practice.

Some of the activities may include in assessing

whether the question is an organisational priorities,
forming a team, and conducting the a formal evaluation
as shown in Iowa Model.

(Polit, & Beck, 2021).

Major steps in evidence-based practice (5As)
This steps will show you exactly how the research evidence can be put to use in clinical setting.

search for and after integrating the 5

retrieve the best evidence with clinical
Cultivating evidence to expertise, patient
answer the clinical preferences, and local
a spirit of
context
inquiry question
0 1 Ask 2 Acquire 3 Appraise 4 Apply 5 Assess 6 Dissemination

clinical question critically apprai evaluate the out

that can be se the evidence come of the pra
answered with for validity and ctice change
research applicability to
evidence. the problem
and situation

(Polit, & Beck, 2021).

Major steps in evidence-based practice (5As)

Step 0: Cultivating. a spirit of inquiry

➢ It is tagged as step Zero because it is the foundation and the trigger
for asking questions, which enables knowledge development and
evidence-based utilization
➢ Nurses start to think, inquire, compare and question daily nursing
practices and their effect towards patients' outcomes.
➢ For example, nurses may start to think about their chronic diseases'
self-care teaching methods and how they improve patients’
outcome.
(Polit, & Beck, 2021). (Aljohni, Rawas, Aliilyyani, et al, 2021).
Major steps in evidence-based practice (5As)

Step 1: Ask a well-worded

. clinical question
A crucial first step in EBP involves converting information needs into well-
worded clinical questions that can be answered with research evidence

Most guidance for EBP uses the acronyms PICO to help practitioners
develop well-worded questions.
•Population: What are key characteristics of the patients or people?
•Intervention: (influence, or exposure) What is the intervention or therapy
of interest? or, What are the potentially harmful or beneficial influence?
•Comparison: an explicit Comparison to the ‘I’ component, with what is
the intervention or influenced being compared?
•Outcome: What are the outcomes or consequences in which we are
interested?
(Polit, & Beck, 2021).
Major steps in evidence-based practice (5As)
Step 1: Ask a well-worded
. clinical question
Is a fish oil–enhanced nutritional supplement effective in stabilizing
weight in patients with advanced cancer?

•Population: cancer patients with cachexia

•Intervention: fish-oil enhanced nutritional supplements

•Comparison: is not formally stated, but the implied ‘C’ is the absence of
fish oil.

•Outcome: weight stabilization

However if we want to understand whether fish-oil enhanced supplement ‘I’ are better than
melatonin ‘C’ in stabilizing weight ‘O in patient with cancer ‘P’. (Polit, & Beck, 2021).
Major steps in evidence-based practice (5As)

Step 1: Ask a well-worded

. clinical question

For questions that can best be answered with qualitative information (e.g.,
about the meaning of an experience or health problem), uses the acronyms PS

•Population: What are key characteristics of the patients or people?

•Situation: What conditions, experiences, or circumstances are we inter

ested in understanding?

(Polit, & Beck, 2021).

Major steps in evidence-based practice (5As)
Step 1: Ask a well-worded
. clinical question

‘What is it like to suffer from cachexia?’

•Population: patients with advanced cancer

•Situation: the experience of cachexia

(Polit, & Beck, 2021).

(Polit, & Beck, 2021).
Major steps in evidence-based practice (5As)

Step 2: Acquire research

. voidance
Nurses start to enter the PICO question keywords into search databases.
Search a process should combine all keywords.

For example,
• MEDLINE
• PubMed
• GOOGLE SCHOLAR
• EMBASE
• CENTRAL – The Cochrane Central Register of Controlled Trials
• CINAHL – Nursing and allied health literature

(Polit, & Beck, 2021).

Major steps in evidence-based practice (5As)

Step 2: Acquire research voidance

Database Brief description Website
Cochrane Database of It is the gold standard https://www.cochran eli
Systematic Reviews. of systematic reviews brary.com/
Joanna Briggs Institute It has systematic https://joannabriggs.o r
EBP Database reviews, evidence g/
summaries, and best
practice information
sheets
The Cumulative Index It has broad content https://www.ebscoho st
to Nursing and Allied coverage including all .com/nursing/produ cts/
Health Literature nursing specialties. cinahl-databases/cinah
(CINHAL) l-complete
Major steps in evidence-based practice (5As)

Step 2: Acquire research

. voidance

Taibah University

‫دليل التسجيل في بوابة عمادة شؤون المكتبات‬

https://www.taibahu.edu.sa/Pages/AR/DownloadCenter.aspx?SiteId=50a13fdf-fc2d-43ef-a1d5-50bd4a749c
1b&FileId=43901828-8896-4c69-adb0-3e02e165752c

‫أدلة البحث في قواعد المعلومات‬

https://www.taibahu.edu.sa/Pages/AR/Sector/SectorPage.aspx?ID=47&PageId=623

(Polit, & Beck, 2021).

Major steps in evidence-based practice (5As)

Step 2: Acquire research

. voidance

RLO: Using databases RLO: Advanced

to find journal articles What are Journals?
Literature Searching

(nottingham.ac.uk)
(Polit, & Beck, 2021).
Major steps in evidence-based practice (5As)
Step 3: Appraise
. the Evidence

Critical appraisal is an assessment of the benefits and strengths of research

against its flaws and weaknesses.
Various criteria have been proposed for EBP appraisals, including the following:
1- Quality: to what extent is the evidence valid- that is how serious is the risk of
bias?
2- Magnitude: how large is the effect of the intervention or influence ‘I’ on the
outcome ‘O’ in population of interest ‘P’? Are the effects clinically significant?
3- Quantity: how much evidence is there? How many studies have been
conducted, and did those studies involve a large number of participants?
4- Consistency: how consistent are the findings across various studies?
5- Applicability: to what extent is evidence relevant to my clinical situation and
patients?
(Polit, & Beck, 2021).
Major steps in evidence-based practice (5As)

Step 4: Apply . the evidence

As the definition for EBP implies, research evidence needs to be integrated

with other types of information, including nurses own clinical expertise and
knowledge of their clinical setting and patient preferences.

Nurses need to present their evidence and negotiate with other nurses and
healthcare team members and patients to apply the new practice or the
new evidence.

(Polit, & Beck, 2021).

Major steps in evidence-based practice (5As)
Step 5: Assess the Outcomes
. of the Practice Change

One last step in many EBP efforts concerns evaluating the outcomes of the
practice change.
Did you achieve the desired outcomes?
Were patients satisfied with the results?

(Polit, & Beck, 2021).

Major steps in evidence-based practice (5As)

Step 6: Disseminate EBP results

Sharing the outcome with other parties including nursing colleagues,

healthcare teams, hospital administration decreases the impact of the new
evidence as a new approach of improving patients' outcomes.
 EBNP in Saudi Arabia
The development of EBP in Saudi Arabia is not well documented in the literature and
it may indicate an infancy stage of adopting EBP.

Barriers and facilitators of integrating evidence-based nursing are at different levels

(e.g. individual and organization) that contribute to the blocking of the integration of
evidence into clinical practice:

➢ Individual barriers:
• Consist of a lack of nurses’ knowledge, skills and awareness regarding the use of
EBP
• Lack of professional characteristics
• Nurses’ attitude and experience in using EBP
• Language barriers in using EBP
 EBNP in Saudi Arabia
➢Organizational factors:
Organizational culture; leadership; networks and communication; resources;
evaluation, monitoring and feedback; and champions.

➢Additional factors recognized by nurses:

Lack of time, lack of authority, lack of physician cooperation, and lack of EBP-related
education and training

Therefore, current nursing practices may not relay on scientific evidence.

Nurses used alternative sources of information including social networks, personal
experiences.

(Aljohni, Rawas, Aliilyyani, et al, 2021).

 Textbook references:
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing
evidence for nursing practice. Lippincott Williams & Wilkins.
Aljohni, K., Rawas, H., Aliilyyani, B., ALNajjar, H., Tayyib, N., Aldossary, R., Almadin
in, N., Alsharari, A., Althobaity, A. (2021). Nursing Research for the Bachelor of
Nursing Students. King Fahad Library

Online references:
• Qualitative and Quantitative Research Methods (https://www.nottingham.ac.uk/nursing/sonet/rlos/ebp/qvq/
index.html)
• Steps in conducting a systematic review (https://www.nottingham.ac.uk/nmp/sonet/rlos/ebp/systematic_re
views/)
• RLO: Using databases to find journal articles (https://www.nottingham.ac.uk/nursing/sonet/rlos/ebp/journal
s/databases/3.html)
• RLO: Advanced Literature Searching (https://www.nottingham.ac.uk/nursing/sonet/rlos/studyskills/lit_sear
ch_advanced/index.html)
• What are Journals? (https://www.nottingham.ac.uk/nursing/sonet/rlos/studyskills/lit_search_advanced/inde
x.html)
Thank you