Evidence-Based Practice

Outlines

 Introduction
 Definition
 Key stones of Evidence Based Nursing Practice
 Importance of evidence based practice
 Implementation and Sustainability of EBP
 Hierarchy in evidence-based practice
 Inclusion Criteria and Exclusion Criteria
 Barriers for implementing evidence-based practice
 Example of evidence based practice
Learning objectives

After Lecture, the students should be able to

• Define evidence-based practice (EBP)

• Differentiate between evidence-based practice and research

• Describe the importance of EBP to nursing practice and high-

quality patient care

• List three components of EBP.

• Describe the nurse’s role in EBP.

• Describe the 5 steps of the EBP process.

Introduction
Evidence based practice is the use of the best clinical

evidence in making patient care decisions and such evidence

typically comes from research conducted by nurses and other

health care professionals. The goal of conducting EBP is to

utilize current knowledge and connect it with patient

preferences and clinical expertise to standardize and improve

care processes and patient outcomes.

 How do we know in nursing?

• Tradition
• Borrowing
• Trial and error
• Personal experience
• Role modeling and mentorship
• Intuition and reasoning
• Nursing research
Definition
Evidence-based practice is integration of the best
research evidence with our clinical expertise and our
patient's unique values and circumstances.

EBP focus on three aspects of quality:

 Services (Interventions)
 Targeted health outcomes
 Consistency with current knowledge (research
evidence).
Importance of evidence based practice

 Resolve problems in the clinical setting

 Achieve excellence in care delivery
 Reduce variations in nursing care
 Assists with efficient and effective decision-making.
 It contributes to the science of nursing
 It keeps practice current and relevant
 It increases confidence in decision-making
 Policies and procedures are current and include the latest
research.
 High-quality of patient care.
 Why is EBP relevant to nursing practice?
⚫There is a gap between what we know and what we do

⚫Nursing practice can and must be changed from

tradition- based to science-based

⚫Improved Patient Outcomes

⚫Decreased unnecessary procedures & complications

⚫Greater provider job satisfaction

⚫Effective nursing practice requires information, judgment,

and skill
Key stones of Evidence Based Nursing Practice

A. Best scientific evidence (research )

Results of experiments and quantitative studies

B. Clinical experience (expertise )

Expert panels, practice groups

C. Patient 's preferences

Satisfaction, quality of life and treatment burden.

Step 1. Formulate the question (PICO):-

• P Population, patient / problem.

• I Intervention or Interest

• C Comparison intervention or status

• O Outcome.
The Purpose of PICO

Form a question that focuses on the most important issue

for a patient or a population

Identify key terms to use in a search for evidence

Select results that directly relate to the situation

Step 2. Search for the best evidence:-

 What resources are available and are they any good?

 What has worked in other places?
 How can you change your practice?
 Plan (develop a plan based on findings)
 Make a plan to change care based on relevant, applicable
information.
 Let others help. Intervene (take action to review process or
change)
 Implement revised caregiving protocol in clinical unit.
3. APPRAISE the literature. Or, in other words, sort, read, and
critique peer-reviewed literature.

4. APPLY the findings to clinical decision-making. Integrate the

evidence with clinical expertise and patient preferences and
values. Then make evidence-based recommendations for day-to-
day practice.
Step 5: Evaluating the impact of the evidence:- When
evaluating the impact, consider:

• The client’s outcomes.

• Cost effectiveness.

• Client satisfaction.

• Therapist satisfaction.
6. DISSEMINATE the information. Share the results of
the project with others. Sharing helps promote best
practices and prevent duplicative work. It also adds to
the existing resources that support or oppose the
practice.
 Hierarchy in evidence-based practice

Level 1 Opinions of respected authorities, based on clinical

evidence, descriptive studies or reports of expert committees

Level 2 Qualitative studies

Level 3 Trials that did not use randomisation or non-

experimental studies

Level 4 A well-designed randomised controlled trial

Level 5 Systematic reviews (such as a Cochrane review) based

on well-designed randomised controlled trials

 Example (1) for evidence based practice

Step 1. Formulate the question (PICO).

Is breastfeeding for infant benefit rather than artificial feeding?

Step 2. Search for the best evidence.

PubMed, books, Journals

Step 3. Critically appraise the evidence.

Breast feeding provides infants with immune substances, vitamins

that not found in artificial feeding as well as infants are liable for
frequent gastroenteritis. A Cochrane review3 encourage for
Step 4. Integrate the evidence.

Physicians were documented that children with breast feeding

are healthier

Step 5. Evaluate its effectiveness

Breast feeding has many advantages for infants rather than

artificial feeding
Inclusion Criteria

1. Has specified disorder.

2. Willing to participate.

3. Has home, phone, & transportation.

4. Fine upstanding citizen.

Exclusion Criteria

1. Coexisting psychopathology (incl. addictions).

2. Multiple prior treatments.

3. Serious medical problems.

4. Lack of housing, transportation.

5. Unmotivated.

6. Taking other medications.

7. History of non-compliance.

8. Serious personality disorder.

Barriers for implementing evidence-based practice

• Lack of value for research in practice.

• Difficulty in changing practice.

• Lack of administrative support.

• Lack of knowledgeable mentors.

• Insufficient time to conduct research.

• Lack of education about the research process.

• Lack of awareness about research or evidence-based

practice.

• Research reports/articles not readily available.

What’s the difference between research and EBP?

one of the fundamental differences lies in their purpose. The

purpose of conducting research is to generate new knowledge

or to validate existing knowledge based on a theory. Research

involves systematic, scientific inquiry to answer specific

questions or test hypotheses using disciplined, rigorous

methods. For research results to be considered reliable and

valid, researchers must use the scientific methods in orderly,

sequential steps.
 Research Evidence based practice

To generate new knowledge To use best available evidence

or validate existing knowledge to make informed patient-care
based on theory. decisions.
Types of Nursing Research

• Describe
Identify and understand phenomena, issues

• Explain
Clarify relationships

• Predict
Estimate the probability of outcome

• Control
Manipulate the situation to get desired outcomes
Much of what is known from research
has not been applied in practice.
This is known as

Research-Practice Gap
 Research-Practice Gap

Steps of the process included:

– Dissemination of knowledge.

– Synthesis of findings.

– Critique of studies.

– Application of findings.

– Development of research-based practice

guidelines
Reference

- Boswell, C., & Cannon, S. (2022). Introduction to nursing research:

Incorporating evidence-based practice. Jones & Bartlett Learning.

- Cullen, L., Hanrahan, K., Farrington, M., Tucker, S., & Edmonds, S. (2022).

Evidence-based Practice in Action: Comprehensive Strategies, Tools, and Tips

from University of Iowa Hospitals & Clinics. Sigma Theta Tau.