B71P02 - Foundations in

Evidence Based Practice

Session Outcomes
At the end of this session you will be able to:
 Identify a range of perspectives that influence
evidence based nursing practice
 Consider the extent to which these
perspectives facilitate or complicate evidence
based nursing practice
 Appreciate how user involvement influences
the delivery of care
Different Forms of Evidence

Evidence based practice is ‘the process by

which nurses make clinical decisions
using the best available research
evidence, their clinical expertise and
patient preferences, in the context of
available resources’ (DiCenso et al,
1998)
Perspectives on Evidence

Research
Evidence

Nursing action

Clinical Patient /
expertise User
perspectives

Nursing outcomes
Practice context
 Research Evidence

 Arising from well conducted and reviewed research

studies, ideally conducted in clinical areas.
 Published in peer reviewed journals and other sources
(Cochrane library) and thus exposed to external/expert
scrutiny
 Clinical expertise and the user voice may be present in
published research e.g. through action research or
qualitative studies of user experience
 ‘..there has been anxiety that the emphasis on evidence
ignores practitioner’s skills and individual patient
preferences…’ (Closs and Cheater (1999)
Clinical expertise
 Gates and Atherton (2001) note that in a study conducted by Tsafrir and
Grinberg (1998) ‘…physicians considered review articles and meta-
analysis extremely reliable for information purposes but for practical
patient care they tended to rely upon the judgement of peers and
experts…’ (p.518)
 There is a potential gap between national agendas and what nursing
staff consider to be local priorities (Brooks & Barrett, 2003)
 Colbrook (2002) writes that the Medical Defence Union advise that
healthcare staff are not obliged to follow national clinical guidelines
when they can justify that they were not in the patient’s best interests
or applicable to the patient’s particular circumstances.
 User/patient perspectives

‘… practitioners do not necessarily

know what is in the best, personal
interests of an individual patient..’
(Closs & Cheater, 1999)
User/patient perspectives

‘…there is abundant evidence

demonstrating wide
discrepancies between patient’s
and professional’s judgements
about what constitute desirable
or successful outcomes…’ (Closs
& Cheater, 1999)
User/patient perspectives

‘…past experience, individual

beliefs, family/peer pressure
or greater access to
information may lead patients
to request a particular
intervention…’ (Closs &
Cheater, 1999)
 User/patient perspectives

 ‘It is not only practitioners who need to know about the latest
evidence of the effectiveness of treatments and services.
Service users need this information in order to make their own
choices based on the research evidence and a whole range of
other complex factors, some of which will be unique to them’
(Needham, 2000, p.144)
 A well informed patient may change the practice of the
health professional and information can change the
patient-practitioner relationship from one in which the
patient passively accepts advice to one in which the patient
becomes a partner in shared decision-making (Needham,
2000)
Implementing EBP: A Conceptual
Framework

Kitson et al (1998) have argued that

implementing research into practice may be
expressed in this equation:

SI=f (E,C,F)

Where SI=successful implementation;

E=evidence; C=context; F=facilitation;
and f=function of.
Session summary
‘...Evidence based practice is not simply a pragmatic,
logical process, involving access to, and the
subsequent use of best research evidence. There is an
interplay of multiple factors that influence decisions
about patient care; an amalgam of evidence, context,
expert practice/experience and patients’ preferences
and wishes…’ (Closs & Cheater, 1999)
References
 Barnett (1997) in Brechin, A. (2000) ‘Introducing critical practice’ in Brechin, A., Brown, H. and Eby,
M. (eds) (2000) Critical Practice in Health and Social Care, London, Sage Publications/Open
University.
 Brookes, N. and Barrett, A. (2003) ‘Identifying nurse and health visitor priorities in a PCT using the
Delphi technique’, British Journal of Community Nursing, Vol.8, No.8, pp. 376-380.
 Closs, S.J. and Cheater, F.M. (1999) ‘Evidence for nursing practice: a clarification of the issues’,
Journal of Advanced Nursing, Vol.30, No.1, pp. 10-17.
 Colbrook, P. (2002) The Legal Status of NICE Guidelines, The Medical Defence Unit, London.
 DiCenso, A., Cullum, N. and Ciliska, D. (1998) ‘Implementing evidence-based nursing: some
misconceptions’, Evidence Based Nursing, Vol.1, pp. 39-39.
 Gates, B. and Atherton, H. (2001) ‘The challenge of evidence-based practice for learning
disabilities’ British Journal of Nursing, Vol.10, No.8, pp. 517-522
 Gomm, R. (2000) ‘Would it work here’ in Gomm, R. and Davies, C. (eds) (2000) Using Evidence in
Health and Social Care, London, Sage Publications/Open University.
 Kitson, A., Harvey, G. and McCormack, B. (1998) ‘Enabling the implementation of evidence based
practice: a conceptual framework’, Quality in Health Care, 7, pp. 149-158.
 Needham, G. (2000) ‘Research and practice: making a difference’ in Gomm, R. and Davies, C. (eds)
(2000) Using Evidence in Health and Social Care, London, Sage Publications/Open University.