The Concept of Evidence-Based Practice: All Rights Reserved Volume Two, Second Edition

The Concept of
Evidence-Based Practice
Nursing: A Concept-Based Approach to Learning Copyright © 2015, 2011 by Pearson Education, Inc.
Volume Two, Second Edition All Rights Reserved
Evidence-Based Practice (EBP)
• Three components of EBP

 Best evidence from most current research
 Nurse's clinical expertise
 Client preferences
• Through integration of components in
decision making
 Client care can be individualized
 Nurses can provide best practice for client-
centered care
Evidence-Based Practice (EBP),
continued
• According to Sigma Theta Tau, evidence-based

nursing is "an integration of the best evidence
available, nursing expertise, and the values and
preferences of the individuals, families and
communities who are served." (2002)
Concepts Related to Evidence-
Based Practice
• Clinical Decision Making
• Advocacy
• Quality Improvement
• Accountability
• Professional Behaviors
Benefits of Evidence-Based
Practice
• Nurses using EBP
 Collaborate with other disciplines
 Assist clients through system in various
roles
 Ensure quality communication, continuity
 Improve client care
Benefits of Evidence-Based
Practice, continued
• Nurses using EBP
 Access variety of sources to guide practice,
improve care
 Ensure credibility of nursing profession
 Provide accountability for nursing care
 Florence Nightingale
Nursing Clinical Research
• Nursing research
 Tests hypotheses about conditions,
processes
• Nursing clinical research
 Seeks answers to improve client care
• Quantitative research
• Qualitative research
Funding
• Examples of sources of awards, grants

 Sigma Theta Tau International Honor
Society of Nursing
 Agency for Healthcare Research and
Quality
 National Institute of Nursing Research
 National Council of State Boards of Nursing
 Robert Wood Johnson Foundation
 American Cancer Society
Participants
• Develop list of criteria

 Age, weight, gender, medical history
 Type, present stage of disease
 Present medications taken
• Research participants
 Volunteers for specific study project
 Meet all inclusion criteria
 Have been informed of all aspects of study
 Have signed informed consent
Ethical and Legal Issues
• Respect for human dignity

• Beneficence
• Justice
• Informed consent
 Right to receive full disclosure, information
regarding study
 Right to withdraw from study at any time
Implications for Nursing Practice
• Benefits of nursing research

 Providing best evidence for EBP
 Supporting nursing as professional
discipline
Implications for Nursing Practice,
continued
• Benefits of nursing research

 Defining current best practice standards of
nursing care
• American Nurses Association (ANA)
• National League for Nursing (NLN)
• Joint Commission
• State nurse practice acts
• Individual healthcare facilities
Barriers to Evidence-Based
Practice
• Work schedule, workload demands
• Client preferences
• Lack of access to technology
• Limited knowledge
• Lack of experience, confidence in
development of strategies
• Lack of support
Barriers to Evidence-Based
Practice, continued
• Lack of access to continuing education
• Attitudes
 Lack of confidence in use of EBP
 Misperceptions regarding EBP
 Lack of motivation in integration of EBP
 Failure to understand value of EBP
• Resistance to change
Developing Evidence-Based
Practice
• Identify information that is relevant,
accurate
• Commit to expanding EBP in nursing
profession
Step 1: Develop a Clinical
Question
• Background, foreground
• Types of research studies
 Meta-analysis
 Case study
 Cohort study
 Case-control study
 Randomized Control Trial (RCT)
Question, continued
• Types of questions
 Diagnosis
 Therapy
 Etiology
 Prognosis
Question, continued
• PICOT
 Population
 Issue of interest
 Comparison of interventions
 Outcomes
 Time frame
Step 2: Retrieve the Evidence
• Numerous databases
 Check for tutorial
 Abstracts or full text of article
 Judge for degree of credibility
 Primary, secondary resources
• Agency for Healthcare Research and
Quality (AHRQ)
 14 Evidence-Based Practice Centers (EPCs)
Step 3: Evaluate the Evidence
• Validity
• Reliability
• Usefulness
• Critique to identify strengths, weaknesses
• Categorize
 Green, yellow, red light (PEP® system)
Step 4: Apply the Evidence
• Evaluate change in practice for impact on

client outcomes
 Part of nursing routine until integrated into
standards of care if beneficial to client
• "Expand the EBP" route by sharing
findings with other colleagues
• Informatics
 Common language
 Track, revise nursing care processes
Strategies to Implement Evidence-
Based Practice
• Self-assessment
• Assess obstacles
 Internal factors
 External factors
• Practice raising questions
• Acquire information
• Focus time on high-yield sources
• www.guideline.gov
Strategies to Implement
Evidence-Based Practice, continued
• Use internet to cut down time
• Learn how to do critical appraisal of
evidence
• Build awareness of how, why things are
done
• Identify others interested
• Volunteer to participate in quality nursing
practice committee
• Participate in research project

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The Concept of Evidence-Based Practice: All Rights Reserved Volume Two, Second Edition

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The Concept of

• Three components of EBP

• According to Sigma Theta Tau, evidence-based

• Examples of sources of awards, grants

• Develop list of criteria

• Respect for human dignity

• Benefits of nursing research

• Benefits of nursing research

• Evaluate change in practice for impact on

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