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EVIDENCE BASED PRACTICE IN

NURSING

CHRISNAWATI, BSN, MSN


Faculty Member of STIKES Suaka Insan
Banjarmasin
Dasar EBM/ EPB
Sejarah D Sackett dkk (1990) istilah
EBM
epidemiologi Klinik
Archie Cohrane The Cohrane
Collaboration
Unsur Penting Pendekatan EBM/
EPB
1. Ketidak pastian dalam pengetahuan
klinis
2. Informasi penelitian untuk
menguranginya
penelitian akademik dan Terapan

Diambil dari penyajian RPL Bandung


Hierarchy of Evidence (Evidence Pyramid)
Source:
Source: Med
Med Research
Research Library
Library Brooklyn
Brooklyn

PRODI SARJANA KEPERAWATAN


STIKES SUAKA INSAN
Hierarchy of Evidence
Most Powerful Results

Combined (meta-) analysis of


Randomized Control Trials
(RCTs)
Systematic Review of RCT
studies
Single RCT
Observational or Cohort
studies
patient-important outcomes
Basic research
test tube, animal, human
physiology
physiological rationale
Least Powerful Results
Clinical experience
Levels of Evidence
Level 1: Randomized Clinical Trials
Level 2: Head to Head Trial or
Systematic Review of Cohort
Studies
Level 3: Case-Control Studies
Level 4: Case-series
Level 5: Expert Opinion

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Evidence Pyramid

Meta-Analysis

Systematic Review

Randomized Controlled Trial

Cohort studies

Case Control studies

Case Series/Case Reports

Animal research
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The evolution of information resources
for evidence-based decisions Examples
Systems
Computerized
decision support

Summaries Evidence-based
textbooks

Evidence-based
Synopses journal abstracts

Systematic reviews
Syntheses

Original journal
Studies articles

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Evidence-Based Practice
The process of systematically finding,
appraising, and using contemporaneous
research findings as the basis for clinical
decision.
Formulate a clinical question
Literature search
Evaluate the evidence
Implement findings in clinical practice

(Rosenberg, William and Anna Donald. Evidence based


medicine: an approach to clinical problem-solving. BMJ
1995; 310:1122-1126.)
The EBM Process
The patient 1. Start with the patient / a clinical problem / question
arises out of the care of the patient
The question 2. Construct a well built clinical question derived from
the case
The resource 3. Select the appropriate resource(s) and conduct a
search
The evaluation 4. Appraise that evidence for its validity (closeness to
the truth) and applicability (usefulness in clinical
practice)
The patient 5. Return to the patient -- integrate that evidence with
clinical expertise, patient preferences and apply it to
practice
Self-evaluation 6. Evaluate your performance with this patient
EBM Resources -6 nov 09
Pertanyaan Klinis / problem pasen

Pertanyaan Jenis keterangan

1. Apa yang harus saya lakukan intervensi Biasanya rutinisme


terhadap kondisi atau masalah ini

2. Apa penyebab masalah ini Etiologi dan faktor risiko Sudah tahu namun
kemungkinan ada
temuan baru

3. Apakah orang ini memiliki Diagnosis Deteksi tidak pernah


kondisi atau masalah tsb atau akurat 100%
mana yang lebih akurat
antara ...........
dibanding........

4. Seberapa umum / sering masalah Frekuensi dan angka Misal Kejadian


tsb kejadian kecacatan karena
kecelakaan lalin
Question Template

THERAPY/PREVENTION
In _________________, what is the effect of ________________ on
___________________ compared with ________________________?

DIAGNOSIS or DIAGNOSTIC TEST


Are (Is) ____________________________________ more accurate in diagnosing
___________________ compared with ______________________________?

ETIOLOGY/HARM
Are _____________________ who have __________________________ at
__________________ risk for/or _____________________________________
compared with ______________________ with/without _____________________?

PROGNOSIS
Does ____________________ influence _________________________ in patients
who have __________?

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KEYWORDS
Patient or Problem (or disease of interest)
Age
Gender
Ethnicity
With a certain disorder
Invervention (or range of interventions of interest)
exposure to disease
prognostic factor A
risk behavior (e.g. smoking)
Comparison (what you want to compare the interventions against)
no disease
placebo or no intervention/therapy
prognostic factor B
absence of risk factor (e.g. non-smoking)
Outcome
risk of disease
accuracy of diagnosis
rate of occurrence of adverse outcome (e.g. death)

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Mencari sumber informasi/
Databases

PubMed
CoChrane Library
PEDro
TRIP (Turing Research into Practice)
CINAHL
Hooked on Evidence (APTA)
BMC
Highwire
dll
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1. Start with the patient -- a clinical problem
The Patient or question arises out of the care of the
patient.

George is an active 83 year old male. He used to


swim three times a week for 45 minutes, garden,
and walk to church. But for the last several
months, he has had trouble walking and bending
his knees. It has made gardening difficult and
caused some discomfort.

His family physician made the diagnosis of osteoarthritis and suggested that a
course of physical therapy would be beneficial. George has had physical therapy
before for his back and is very skeptical of this suggestion. He wants to know if
there is any proof that physical therapy does any good for this problem.
EBM Resources -6 nov 09 18
The
The Question
Question
2.
2. Construct
Construct a
a well-built
well-built clinical
clinical question
question derived
derived from
from the
the case.
case.

Based on this scenario, choose the best,


well-built clinical question:
A. Can physical therapy help an elderly 83
year-old male?
B. In elderly patients with osteoarthritis of
the knee, can physical therapy improve
mobility and reduce pain?
C. Is physical therapy helpful for a painful
knee?
The
The Resource
Resource
Searc
3.
3. Select
Select the
the appropriate
appropriate resource(s)
resource(s) and
and conduct
conduct a
a search
search
Most Recent Queries Result
h
#1 Search physical therapy techniques 92828
#2 Search osteoarthritis knee 1519
#3 Search #1 AND #2 107
#4 Search #1 AND #2 Field: All Fields, 28
Limits: Aged: 65+ years, Randomized
Controlled Trial
Setelah dapat artikel
Pilih artikel yang yang relevan
Pilih kualitas artikel ( dapat menggunakan
Pedro Scale )
Analisis/ penilian kritis ( Journal Appraisal )

EBM Resources -6 nov 09 21


EBM Resources -6 nov 09
EBM Resources -6 nov 09 23
Penilaian Kritis artikel
primer
Rekrutmen mewakili populasi ?
Allocotion atau adjusment
pengacakan dan atau kelompok
sebanding pada awal penelitian
Maintenance kelompok
penelitian di jaga melalui
perlakukan ( lanjut dan tidak)
Measurement Blinded /
penyamaran dan atau objective
outcome 24
Penilaian Kritis artikel
primer
Analisis statistik yang sesuai
Diskusi dan cara penarikan
kesimpulan

Tingkat evidence based (dasar


bukti)

Implementasi dalam praktek


(memperhatikan NNT ) 25
Summary
Type of Question Suggested best type of Study

Therapy RCT>cohort > case control > case series


Diagnosis Prospective, blind comparison to a gold standard
Etiology/Harm RCT > cohort > case control > case series
Prognosis Cohort study > case control > case series
Prevention RCT>cohort study > case control > case series
Clinical Exam Prospective, blind comparison to gold standard
Cost Economic analysis

EBM Resources -6 nov 09 26


Free Journal
www.pubmed.com
www.bmj.com
http://advan.physiology.org/
http://www.annfammed.org/
http://archfami.ama-assn.org/
http://asheducationbook.hematologylibrary.org/
http://biohorizons.oxfordjournals.org/current.dtl
http://caonline.amcancersoc.org/
http://www.cfp.ca/
http://www.cmaj.ca/
http://www.lifescied.org/
http://clinical.diabetesjournals.org/
http://www.clinmedres.org/
http://err.ersjournals.com/
http://www.haematologica.org/
http://www.bonekey-ibms.org/
http://icvts.ctsnetjournals.org/
http://proceedings.jbjs.org.uk/ abstract
http://www.jabfm.org/
http://mmcts.ctsnetjournals.org/
http://theoncologist.alphamedpress.org/
http://nar.oxfordjournals.org/
http://firstwatch.jwatch.org/ semi /populer
http://pats.atsjournals.org/
http://pn.psychiatryonline.org/ semi ilmiah
http://rphr.endojournals.org/
http://jnm.snmjournals.org/
http://www.studiesinmycology.org/
http://journals.cambridge.org/action/displ
ayJournal?jid=ASO
http://ionchannels.tradepub.com/?pt=ca
t&page=Biop&flt=down
http://ijahsp.nova.edu
TUGAS INDIVIDU
Carilah jurnal melalui website yang
diberikan 3 jurnal mengenai
keperawatan yang disukai
diberbagai area dan setting.
Jurnal harus dalam bentuk asli
format html atau pdf.
Dikumpulkan ke email
yudhachris16@gmail.com
Pengumpulan paling lambat tanggal
31 oktober 2015
Tidak diperkenankan ada jurnal yang
sama, jika terjadi maka nilai tugas
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