EVIDENCE BASED

PRACTICE
Presented by
Monika Devi
Msc.(N)
HCN, SRHU
 INTRODUCTION
 Evidence based practice is an approach that enables
clinicians to provide the highest quality of care in
meeting the multiphase needs to their parents and
family.
 DEFINITION
 Evidence based practice (EBP) is the process of making
clinical decisions based upon evidence, combined with
clinical experience and patients expectations.

 Evidence based practice is the conscientious explicit and

judicious use of current. Best evidence in making decision
about the care of individual patients. The practice of evidence
based medicine means integrating individual clinical
expertise with the best available external clinical evidence fro
systematic research.
(Sackett. et al 1996)
 PROCESS OF EBP
Clinical
expertise
Best Patient
research values and
evidence preferences

Evidence
based
practice
 AIMS OF EBP
 To provide the high quality and most cast efficient
nursing care possible.
 To advance quality of care provided b health worker.
 To increase satisfaction among patients.
 To focus on nursing practice away from habits and
tradition to evidence and research.
 It results in better patient outcomes.
 It contributes to the science of nursing.
 It keeps practice current and relevant.
 It increases confidence is decision making.
OBJECTIVES AND PURPOSES OF EBP
 Evidence based practice seeks to replace practice as usual
with practice guided by rigorous outcomes oriented research
ideally randomized controlled trials.
 It also seeks to make practice a less subjective enterprise
and to rise it to a higher level of accountability.
 Reduces the variations in nursing care and assist with
efficient and effective decision making.
 Providing practice to the nurse evidence based data to
deliver effective care.
 NEED FOR EBP
 For making sure that each client get the best possible
services.

 Update knowledge and is essential for lifelong learning.

 Provide clinical judgment.

 Improvement care provided and save lives

 To provide framework for understanding the evidence

based practice process.
STEPS OF EVIDENCE BASED PRACTICE

Find evidence Evaluating the

Developing a well based resources strength and
built question to answer the applicability of the
question evidence

Evaluating the Applying the

steps evidence
STEP 1 IS BASED ON PICO :-
• The patient population of interest
P

• Intervention of interest or range of

I intervention.e.g. exposure and risk behavior

• Comparison of intervention e.g. no

C intervention.

• Outcomes of interest e.g. accuracy of

O diagnosis risk of disease
MODELS FOR EVIDENCE BASED PRACTICE

1. The steler model

2. IOWA model

3. Ross worm and lama bee model

 1. STELTER MODEL
 It was developed as practitioner oriented model in 1994.
 It was revised in 2001 without changes in its focus on
critical thinking.
 It raised awareness about the importance of applying
research finding in nursing practice.

Meaning of evidence as per stelter model:-

Evidence is define as information or facts that are obtained
systematically evidence comes from two different sources
1. External evidence

2. Internal evidence
CONT…
• Derived from opinions
External of concepts.
• Comes from the experts
evidence own experiences.

• It comes from
Internal systematically obtain
facts or information at
evidence ground level.
 STELTER MODEL
Phase 1
preparation

Phase 5 Phase 2
evaluation Validation

Phase 3
Phase 4
Comparative
Translation evaluation decision
application making
 2. IOWA MODEL
 Successfully implanted since 1994 intervention ally.
 Infuses research into practice to improve quality of care.
 Planned change principles integrated research and
practice.
 Utilizes a multidisciplinary team approach.

Highlights of the models :-

 it incorporates the use of research and other forms of
evidence.
 Interference to support research use might involve every
level of the organization.
 Evidence based practice is linked to quality assurance.
CONT…
 Staff are given recognition for research work.
 Clinicians are given time and resources for research work.

 This model explains how organizations changes practice

based on research.
 It gives a systemic design.

 It includes both the practitioner and organizational

perceptive.
 It provides guide for regarding implementation of evidence
based practice.
IOWA MODEL BARRIERS TO USING
RESEARCH IN NURSING
Problem Knowledge
Focused Focused
Triggers Triggers

Risk management New research or

data process other literature
improvement data national agencies
internal/external guidelines/standard
bench making data philosophies of care.

Questions from
Financial data and
institutional
identification of
standard
clinical problem
committees
3. ROSS WORM AND LAREE MODEL
 Develop by rossworm and larabee in 1999. it is based
on theoretical and research literature.

 It begins with the assessment of need and integration

of an evidence based protocol.

 Focuses on the use of change theory, principles of

research and standardizations nursing nomenclature.
STAGES OF ROSSWORM AND LARABEE
MODEL

Link problem
Assessment need Synthesis the best
interventions and
for change evidence
outcomes

Implement and
Integrate and
evaluation Design practice
maintain change
change in change
in practice
practice
 BARRIERS TO EBP
 Lack of value for research in practice .

 Difficulty in bringing change.

 Lack of administrative support

 Lack of knowledge.

 Lack of time for research.

 Many nurse have not receive any formal instruction in

research and they lack skill to judge the merits of study.
CONT…
 Unavailability of research reports, which are not easily
gathered.

 Complexity of the research regarding evidence based

practice.

 Organization have failed to motivate or rewards.

 There is a shortage of role models nurse who can be

evaluated for their success in using or promoting the use
of research in clinical practice.
 ADVANTAGES OF EBP
 Information explores

 Provide better patient outcomes.

 Ebp increases the efficiency of nurses.

 Making decision based on knowledge that is backed by

research.

 It keeps nursing practice current to the new trends and

updated guidelines of care.
CONT…
 It provides variations in practice because it can help
determine high quality cast effective intervention that
actually work.

 It promotes high quality and cast effective

intervention and treatment.

 Using EBP to provide care to patients increases the

nurses confidence.
SUMMARY
 The State of Evidence-Based Practice in US
Nurses: Critical Implications for Nurse Leaders
and Educators
 Melnyk, Bernadette Mazurek PhD, RN, CPNP/PMHNP,
FNAP, FAAN; Fineout-Overholt, Ellen PhD, RN, FNAP,
FAAN; Gallagher-Ford, Lynn PhD, RN; Kaplan, Louise
PhD, RN, ARNP, FNP-BC, FAANP
 This descriptive survey assessed the perception of evidence-based
practice (EBP) among nurses in the United States. Although
evidence-based healthcare results in improved patient outcomes
and reduced costs, nurses do not consistently implement evidence-
based best practices. A descriptive survey was conducted with a
random sample of 1015 RNs who are members of the American
Nurses Association. Although nurses believe in evidence-based
care, barriers remain prevalent, including resistance from
colleagues, nurse leaders, and managers. Differences existed in
responses of nurses from Magnet® versus non-Magnet institutions
as well as nurses with master’s versus nonmaster’s degrees. Nurse
leaders and educators must provide learning opportunities
regarding EBP and facilitate supportive cultures to achieve the
Institute of Medicine’s 2020 goal that 90% of clinical decisions be
evidence-based.
 Evidence-Based Practice and the Role of Nursing
Leadership
 Stetler, Cheryl B. PhD, RN, FAAN; Brunell, Mary MS,
RN; Giuliano, Karen K. MSN, RN, CCRN; Morsi,
Deborah MS, RN; Prince, Lorna MS, RN; Newell-
Stokes, Virginia MS, RN
 A new term, evidence-based practice, is beginning to
appear both in the healthcare literature and at
professional conferences. Its meaning, however, is not
always clear, nor is its full implication for nurse
administrators explained. This article provides a
pragmatic definition of evidence-based practice
developed in the nursing division at Baystate Medical
Center, Springfield, Massachusetts. It outlines steps
required to institutionalize evidence as a routine part
of nursing practice and provides examples of its use.
Nurses' Perceived Knowledge, Beliefs, Skills, and Needs
Regarding Evidence‐Based Practice: Implications for
Accelerating the Paradigm Shift
 Bernadette Mazurek Melnyk RN, PhD, CPNP/NPP, FAAN,
FNAP
 Ellen Fineout‐Overholt RN, PhD

 Nancy Fischbeck Feinstein RN‐C, PhD

 Hong Li RN, PhD

 Background:-The paradigm shift to evidence‐based nursing practice in
the United States has been slow. Although multiple barriers to
evidence‐based practice (EBP) have been identified through prior studies,
there is a gap in the literature specifically identifying key variables (e.g.,
belief that EBP produces quality outcomes) that are correlated with the
extent to which nurses engage in EBP.
 Aim: The primary aims of this study were to (1) describe nurses'
knowledge, beliefs, skills, and needs regarding EBP; (2) determine
whether relationships exist among these variables; and (3) describe major
barriers and facilitators to EBP.
 Methods: A descriptive survey was conducted with a convenience sample
of 160 nurses who were attending EBP conferences or workshops in four
states located within the Eastern Region of the United States.
 Results: Although participant beliefs about the benefit of EBP
were high, knowledge of EBP was relatively low. Significant
relationships were found between the extent to which the nurses'
practice is evidence‐based and (1) nurses' knowledge of EBP, (2)
nurses' beliefs about the benefits of EBP, (3) having an EBP mentor,
and (4) using the Cochrane Database of Systematic Reviews and
the National Guideline Clearinghouse.
 Conclusion and Implications: Health care systems need to
implement interventions that not only increase nurses' EBP
knowledge and skills, but also strengthen their beliefs about the
benefit of evidence‐based care. EBP mentors may be key in
accelerating a more rapid shift toward evidence‐based nursing
practice. Theoretically driven randomized controlled trials are
urgently needed to test the effectiveness of interventions on
advancing evidence‐based care.
CONCLUSION
 REFERENCES
 Brae Kour Navdeep ; HC Rawat, textbook of advance
nursing practice first edition . Jaypee publisher ; page
no 533-541.
 Basheer. P, shabeerkhan . Yasmeen S. A concise
textbook of advanced nursing practice first edition;
EM-ESS medical publisher; page no . 751-757.
 Polit. F. Denise ; back tatano cheryl nursing research ;
generating and assessing evidence for nursing
practice ; tenth edition, wolters kumars publisher
page no 30-41.