Back when we were still 1st year student nurses, the time when we chose nursing as our lifelong

profession, we were already introduced to the concept of EBP or should we say Evidence-based practice,
right? Every time a semester starts, before the introduction of any major topics, we ought to define what
evidence-based practice is. So, once again to refresh our minds about the concepts of EBP, I am asking
everyone to please lend your ears and give your full attention to our report because it concerns Evidence-
based practices connected to NCM 112: Cellular Aberration.
A pleasant afternoon Ma’am Katrine, a pleasant afternoon to my dear classmates. For today’s afternoon,
as we are Group 1 for a reason, we are ought to discuss the 1 st topic all about the Importance of EBP or
Evidence-Based Practices in Cellular Aberration. Sadly, since we have a National Strike, we expected to
discuss our topic Face to face but due to inevitable circumstances, we have no choice but to present it
through online. So, please bear with us.
Healthcare, as we all know, is an ever-evolving field that continues to grow and adapt based on research.
Which means not all nursing interventions na accepted before, may be still practiced pa rin up until now.
Let me give you an example. Diba we always have our clinical duties at hospitals, communities, and
lying-ins, especially when we were in our 2nd year level, so all of us knows what FUNDAL PUSH or
FUNDAL PRESSURE is.
Fundal pressure is a medical term for a very basic technique that medical professionals commonly use to
facilitate vaginal childbirth. Ibig sabihin, we manually apply pressure or push downward at the top of the
mother's uterus para mapaikli natin ang second stage of labor and mabawasan ang paggamit ng mga
instrumental birth tulad ng forceps, vacuum assisted, or caesarean section. Before, ginagawa ito ng mga
health professionals, but now, due to its complications and side effects, hindi na siya accepted at itinuturo
saatin na mga students. Diba wala tayong CI na nagsabi to perform fundal push?
Because nga po according to evidences and researches, the various side effects of applying uterine fundal
pressure include: uterine rupture, postpartum urinary retention, severe perineal trauma and pain, rib
fracture, and even potential neonatal distress or trauma.
Although fundal pressure is commonly used in delivery rooms it is a controversial method. There has
never been any reliable evidence to show that the technique actually works. Moreover, that the use of
fundal pressure in certain situations can actually cause complications and injury to the baby.
As mirrored in other industries, evidence-based practice in health care has become essential, due to the
reason that relying on recent, accurate data helps to provide informative care that promises the greatest
success for patient outcomes, which can be also be applied in oncology or cellular aberration.
Take note po of positive patient outcomes since our patient is always our priority and the focus of our
care, the reason why we base our interventions on accurate and recent researches is for our patient’s
safety.
Before, we proceed to the discussion, may we just introduce ourselves first, I am Lorna Mae P. Montanez,
together with the very dedicated team members of Group 1….
For today’s OBJECTIVES, at the end of the lesson, the students should be able to:
 demonstrate an understanding with regards to Evidence-based Practices applied in the study of
Oncology or Cellular Aberration.
 Understand and enumerate examples of Evidence-based Practices from researches in the care of
patients in Cellular Aberration.
 Apply what the students have learned in real life experiences especially during clinical duties
when taking care of patients.
As we go on with our topic for today, we are expecting to give your full attention, since what you will
learn today can help you save a patient tomorrow. When the time comes when you become Registered
nurses, the examples that my groupmates will discuss may help you deliver the best quality if care that
your patient deserves. I assure you that if you are that kind of nurse, you are the type of nurse that will not
be forgotten by your patients in their hearts and mind.
LET US FIRST HAVE A VERY VERY SHORT ICE BREAKER, don’t worry this is just a 3 question ice
breaker bago tayo mag simula. Handa na ba ang lahat? If yes, let’s start.
TRICK OR TRUTH
Always select the smallest gauge peripheral catheter that will accommodate the prescribed therapy that
the patient needs.
Rationale: Nurses should follow EBP when using intravenous catheters to administer blood for packed
red blood cell transfusions (PRBC). The protocol indicates that nurses should use a smaller-gauge
catheter, which increases patient comfort. Of course, smaller gauge catheters is equal to lesser pain
sensation while larger gauge catheter means greater pain sensation. But, don’t forget to use the catheter
that best suits the patient’s condition.
Smaller catheters cause less damage to the vein wall and allow more space in the vein for blood to flow
around the catheter. This leads to less phlebitis and longer dwell times.
Chemotherapy can suppress the bone marrow's ability to produce red blood cells, leading to anemia.
Anemia is when you have a low level of red blood cells in your body. Blood transfusions replenish the red
blood cell count and can relieve symptoms such as fatigue, weakness, and shortness of breath
Tie a knot in the bottom right sheet for a dying patient to last through the night.
This is more of like a paniniwala or a superstition. Narinig ko na rin to before na for instance, naka duty
ka and may patient ka na terminally ill, if you don’t want that person to die in your shift, then you must tie
a knot in the bottom right sheet for him or her to last through the night. Of course, there is no research
that proves this act is true but sabi nga wala naman daw masama kung sumunod.
For patient’s health and safety, it is essential to give oxygen to patients with COPD.
Despite the belief by some that providing oxygen to these patients can create serious issues such as
hypercarbia or too much carbon dioxide in the body, acidosis or even death, the evidence-based protocol
is to provide oxygen to COPD patients.
Through this practice, maiiwasan natin ang hypoxia and organ failure thus enhancing COPD patients’
quality of life and help them live longer.
That would be all for our ice breaker, and let us now start our discussion.
EVIDENCE
Evidence, what is an evidence, really?
Evidence is anything that can be used to prove something.
Whenever I hear the word evidence, even though this is just a very common word that we hear everyday,
parang ang bigat o kaya ang lalim. This is because, when you say evidence, dapat malaman at may
pinatutunayan. For instance, recently, sabi saakin, wala raw tayong duty bukas. Syempre pag ganon,
maniniwala ka ba agad agad? Sabi ko, pano mo nasabi? Asan ang memo? Asan ang evidence?
Evidence is anything that can be used to prove something. In that example, yung memorandum yung
proof o nagpapatunay na wala talaga tayong duty.
Evidence is factual information used as proof to support a claim or belief. It is information and research
selected from the best available sources to support a decision.
Evidence is factual information, take note of the word factual, that shows a claim is true. It is used to
determine or demonstrate the truth of an assertion. Saan ba natin pwede kunin ang evidence or ano ang
mga sources nito?
Evidence comes from a range of sources:
• journal articles and published literature
• analysis of statistics and data
• conference presentations and papers
• grey literature (publications by government and non-government organisations)
• interviews/surveys
• expert opinion (usually opinions aren’t considered as evidences. But there is an exemption when that
opinion is from an expert of the field.)
• magazine and news articles
Now, let us define what EBP or Evidence-based practice is.
 It is a problem-solving approach that integrates the best available scientific evidence, clinical
expertise, and patients’ values and preferences to achieve the best possible patient outcomes.
Oncology, in particular, is a space that many people devote time and research to, due to the
complexities in treating cancer and the broad variety of cancer treatments. Up until this time, marami
pa ring researches ang cinoconduct in the field of oncology. Why? Estimated numbers of new cancer
cases and deaths in 2022 states that there will be an estimated 1.9 million new cancer cases diagnosed
and 609,360 cancer deaths in the United States. That specific statement is a problem, diba po? Kaya
naman si EBP ay isang problem-solving approach done to achieve the best possible outcomes for our
patients. It is then critical so physicians can look and find the best treatment regimens for their
patients.
With regards to the best available scientific evidence, clinical expertise, and patients’ values and
preference, I will discuss it po on the next slide for much deeper explanation.
Besides keeping health care practices relevant and current, it offers a range of other benefits to both
the nurse and the patients: Promotes positive patient outcomes, reduces health care costs by
preventing complications, and contributes to the growth of the science of nursing.
 It aims to improve healthcare quality, reduce healthcare costs, and optimize patient satisfaction.
Reduce Healthcare Cost
For example, EBP can guide healthcare professionals in choosing the most appropriate diagnostic tests or
even surgical procedures. Like in the field of oncology, Ma’am Katrine taught us several diagnostic tests
to confirm if it is malignant or benign. Likewise, several surgical procedures best suited for the patient’s
condition.
Through the use of evidences, we know that modified radical mastectomy has proved to be effective and
less disfiguring as compared to radical mastectomy. Thus, it reduces the financial burden associated with
over-testing and false-positive results. At the end of the day, it promotes positive patient outcomes.

3 components of EBP
Let’s proceed to the 3 key components of evidence-based practice which includes the 1 st key
component, best specific evidence, followed by clinical experience, and patient values.
Let us focus first on best specific evidence. This just simply means that Staying up-to-date on the latest
medical research by reading journals, reviewing data, and talking to peers is key. What I am referring to
as peers here are professionals. However, the most recent data alone does not make up evidence-based
practice. This is because, we proceed to the 2nd key component which is Clinical Experience.
The clinician must ow analyze the large body of data and use their clinical expertise in conjunction with
the knowledge of the patient (Here comes the 3 rd component which are patient’s values) and their
individual preference on a case-by-case basis to make the recommendation they believe will lead to the
best outcome and maximum comfort for the patient.
If one key component is absent, then EBP will not be that effective when applied in real life scenarios.
The best specific evidence, followed by clinical experience is not enough since patient’s values and
preferences are required for they are the main focus of our care. Parang domino effect lang, the presence
of these 3 make up Evidence-based practices. I hope we are clear on that.
Now, we have here Johns Hopkins Evidence-based practice (JHEBP) Model. I have chosen this model to
explain how the process of EBP works. According to Center for Evidence-based Practice, the Johns
Hopkins Evidence-Based Practice model for Nurses and Healthcare Professionals is a powerful problem-
solving approach to clinical decision-making and is accompanied by user-friendly tools to guide
individuals or groups through the EBP process.
STEPS OF EBP

Now, let’s define evidence-based practice for oncology with a few key steps:

 Step one: cultivate a spirit of inquiry.

- When we refer po to inquiry, it is the act of asking for information or merely asking a
question such as (What is the problem, and why is it important to fix it?)
- everything starts with a problem, you need first to have a problem which is something to
solve before we think of solutions and appropriate practices.
- If we have an identified problem, thus, here is where problem-solving approach occurs.
Diba, yung diniscuss ko kanina?
- Again, cultivate a spirit of inquiry and converting the need for information (about
prevention, diagnosis, prognosis, therapy, causation, etc) into an answerable question.

 Step two: formulate an answerable question.

- Kung saan papasok na dito ang PET Process which are practice question, evidence, and
translation. Through practice questions, we find information/evidence to answer question.
We track down the best evidence with which to answer that question.
- So, himay himayin natin siya. In the first phase, PRACTICE QUESTIONS. The team
develops a practice question by identifying the following: patient population,
interventions, and outcomes (PICO). In our research, pinag aralan natin ang PICO. Kung
 saan, bago tayo makabuo ng isang research, it is important to have a well-built question.
One way to construct a well-built question is to use the PICO model.
- In the second phase, EVIDENCE. A literature search is performed, and the evidence is
appraised for strength and quality. A while ago I mentioned different sources on how we
can be able to find evidence and one of which is through literature reviews.
 journal articles and published literature
 analysis of statistics and data
 conference presentations and papers
 grey literature (publications by government and non-government organisations)
 interviews/surveys
 expert opinion (usually opinions aren’t considered as evidences. But there is an exemption when
that opinion is from an expert of the field.)
 magazine and news articles

- In the third phase, the findings are synthesized to develop recommendations for practice.
KNOWN TO BE AS TRANSLATION.
- These processes should be applied to practice, and must be critically appraised through
reflection, which can then lead to learnings, which we say is the most effective in terms
of patient care. Sana po nakakasunod ang lahat.

 Again po, we systematically conduct research using the latest tools and technology for clinically
proven treatment options.

 Appraise the validity, relevance, and applicability of that research. If we find that research valid,
relevant, and applicable, these can lead to having the BEST PRACTICES na maaapply natin
when dealing with our patients. It is needed for us to have a strong healthcare team.

 KAHIT WAG NA BASAHIN. Step five: integrate the research evidence with the physician’s
clinical expertise.

 Step six: implement the EBP decision-making framework from the analysis of results, clinical
expertise, and patient preference to have PRACTICE IMPROVEMENTS, and these process
continues and is considered as a never ending cycle. Because, everyday we learn something new.
Due to the vast and rapid developments of technology, no doubt that many EBP can be applied in
our practices in the health or nursing field.

QUOTE

Are we morally responsible for what we believe? Is it wrong for people who are morally responsible to
believe something on insufficient evidence?
It is expected for us, who work in the nursing field to have the Duty to Believe According to the
Evidence
Extraordinary claims require extraordinary evidence. According to Socrates, To believe without evidence
and demonstration is an act of ignorance and folly.

It is wrong always, everywhere and for anyone, to believe anything upon insufficient evidence. It is
wrong for a man to say that he is certain of the objective truth of any proposition unless he can produce
evidence which logically justifies that certainty.
To end my part in our report, Evidence-based practice (EBP) is a guide for nurses to structure how to
make accurate, timely, and appropriate clinical decisions. Rather than providing one-size-fits-all care,
nurses can create a care plan that works for each patient.