EVIDENCE BASED

PRACTICE
Ilham, Ners, M. Kep.
 definition
Evidence based practice is a framework for
clinical practice that incorporates the best
available scientific evidence with the expertise
of the clinical staff and the patient’s preferences
and values to make decisions about health care.

Levin, R. Teaching Evidence-Based Practice in Nursing. NY: Springer, 2006.

 EVIDENCE BASED PRACTICE
• Memerlukan :
Kemampuan mengkaji, merangkum menerapkan informasi dr
1
●

literatur

Observasi sistematis, pengalaman, kepercayaan thd literatur

2
●

utk pengambilan keputusan

3 Menyediakan informasi valid ttg situasi klinis bagi praktisi

●

Meningkatkan kemampuan klinisi dlm pengalaman dan training

4
●

data penelitian (mengkaji penelitian, menerapkan di situasi klinis

PROSES EBP
 TAHAP 1
• Membuat pertanyaan terfokus dg mempertimbangkan :
P = Patient problem – can be only one patient, a group of
patients with particular condition or health problem
I = Intervention – represents the intervention of interest,
which can be therapeutic, diagnostic, prognostic, etc
C = Comparison – defined as a standard intervention, the
most used intervention or no intervention
O = Outcome – expected result
 TAHAP 2
• Menemukan Evidence utk menjawab pertanyaan
EBM information can be found in :
a. Cinahl
b. MEDLINE
c. PubMed
d. Other specialized database : ACP Joural Club, Clinical
Evidence, Chochrane Database Systematic Review,
Database of Abstracts of Reviews of Effectiveness (DARE)
All of these database can be accessed from the Health Sciences Library Home Page at
http://library.luhs.org.
 TAHAP 3
• Critical Appraisal Evidence, tentukan validitas tiap artikel
:
• Primary Guides :
a. Was the assignment of patients to treatment
randomized?
b. Were all patients who entered the trial accounted for
and attributed at its conclusion?
c. Was follow-up complete?
d. Were patients analyzed in the groups to which they
were randomized?
 TAHAP 3
• Secondary Guides :
a. Were patients, their clinicians and study
personal kept “blind” to treatment received?
b. Were the groups similar at the start of the
trial?
c. Aside from the experimental intervention,
were the groups treated equally?
 TAHAP 3
d. What are the results ?
1. How large is the treatment effect?
2. How precise is the estimate of the treatment
effect?
e. Will the results help me in my patient care?
3. Can the results be applied to my patients?
4. Were all clinically relevant outcomes considered?
5. Are the benefits worth the harms and costs?
 TAHAP 3
Melakukan Critical Appraisal Terhadap Bukti-bukti
1. Critical Appraisal menyesuaikan dari jenis/level artikel
2. Pertanyaan utama dalam Critical Appraisal adalah
a. Apakah hasil dari penelitian tersebut valid?
 Apakah penelitian tersebut menggunakan metodologi penelitian
yang baik?
b. Apakah hasil dari penelitian tersebut reliable?
 Apakah intervensinya bekerja dengan baik?
 Sebesar apa efek dari intervensi tersebut?
c. Apakah hasil penelitian tersebut akan membantu dalam
melakukan perawatan untuk pasien saya?
 Apakah sample penelitiannya mirip dengan pasien saya?
 Apakah keuntungannya lebih besar dari pada resikonya?
 Apakah intervensi tersebut mudah untuk di implementasikan
• TAHAP 4
Apply the results in clinical practice
• TAHAP 5
Evaluate the clinical application of the evidence
RATING LEVELS FOR EVALUATING EVIDENCE

I. Clinical guidelines based on systematic

reviews of RCTs, meta-analysis
II. One RCT (Randomized Controled Trial)
III. Controlled trials without randomization
IV. Systematic reviews of descriptive or
qualitative studies
V. Single descriptive or qualitative study
VI. Opinion of authorities and committees
 Where to search
• www.ncbi.nlm.nih.gov/pubmed/
• http://highwire.stanford.edu/
• British Medical Journal http://www.bmj.com
• New England Medical Journal
http://content.nejm.org
• Pediatrics Journal
http://pediatrics.aappublications,org/
 example
• Does helmets preventing head and facial
injuries in cyclists?
P = cyclists
I = helmets
C = no helmets
O = head and facial injuries
 Therapy question
“for people living in endemic areas of malaria
(Patient), do insecticide-treated bed nets and
curtains (Intervention) [compared with no bed
nets or curtains (Comparison)] prevent
infection with malaria (Outcome)?”
 JENIS-JENIS PERTANYAAN KLINIS
(Melnyk & Fineout-Overholt, 2011)

Intervention question

●
Meneliti mengenai keefektivan dari suatu treatment/intervensi

Diagnostic question

●
Meneliti mengenai manfaat, keakuratan, seleksi, atau interpretasi dari suatu alat/instrumen

Prognostic question

●
Meneliti mengenai keadaan pasien terkait kondisi tertentu atau mengidentifikasi faktor-faktor yang mungkin mengubah prognosis pasien

Etiology question

●
Meneliti mengenai hubungan sebab akibat dan sesuatu yang mungkin merugikan

Meaning question

●
Meneliti mengenai makna dari sesuatu hal
 CONTOH PERTANYAAN PENELITIAN
JENIS PERTANYAAN CONTOH
PENELITIAN
Intervention Bagaimanakah pencegahan terhadap kejadian pressure ulcers dengan
teknik “X” jika dibandingkan dengan pelayanan standar yaitu diganti
posisi setiap 2 jam terhadap munculnya gejala munculnya pressure
ulcers pada pasien yang dirawat diruang perawatan dalam jangka
panjang dimana pasien mempunyai resiko untuk pressure ulcers?
Prognostic Apakah diet karbohidrat mampu memprediksi pemeliharaan berat
badan yang sehat (BMI< 25) selama lebih dari 6 bulan pada pasien
yang mempunyai riwayat keluarga obesitas (BMI> 30)?
Diagnostic Apakah d-dimer assay lebih akurat dalam mendiagnosa deep vein
thrombosis jika dibandingkan dengan ultrasound pada pasien
suspected deep vein thrombosis?
Etiology Apakah wanita kulit putih yang terpapar sinar UV ray berkepanjangan
dan tidak menggunakan protection (>1 jam) meningkatkan resiko
terkena melanoma jika dibandingkan wanita kulit hitam yang tidak
terpapar UV ray?
Meaning Bagaimanakah wanita paruh baya dengan fibromialgia
mempersepsikan kehilanggan motor functions?