EVIDENCE BASED

PRACTICE
 INTRODUCTIO
• During 1980s the N
term “evidence-based medicine” emerged to
describe the approach that used scientific evidence to
determine the best practice. Evidence based practice
movement started in England in the early 1990s

• Evidence-based medicine (EBM) or evidence based practice

(EBP), is the judicious use of the best current evidence in
making decisions about the care of the individual patient.

• Evidence-based practice represents both an ideology and a

method. The ideology springs from the ethical principle that
clients deserve to be provided with the most effective
interventions possible. The method of EBP is the way we go
about finding and then implementing those interventions.
 DEFINITIONS

Evidence: It is something that furnishes proof or

testimony or something legally submitted to
ascertain in the truth of matter.

Evidence based practice: It is systemic inter

connecting of scientifically generated evidence
with the tacit knowledge of the expert practitioner
to achieve a change in a particular practice for the
benefit of a well- defined client / patient group.
(French 1999).
 CONTD
…nursing- it is a process by
• Evidence based
which nurses make clinical decisions using the
best available research evidence, their clinical
expertise and patient preferences (mulhall,
1998).

• EBP as using best evidence available to guide

clinical decision making.
 CONTD….
• EBP in nursing a way of providing
is nursingcare that is guided by the
integration of the best available scientific
knowledge with expertise. This
nursing approach
requires nurses to critically
assess relevant scientific data or research
evidence and to implement high quality
interventions for their nursing practice.
(NLM PubMed)
 NEED FOR
EBP
• For making sure that each client get
the best possible services.

• Update knowledge and is essential

for lifelong learning.

• Provide clinical judgement.

• Improvement care provided and save lives.

 GOAL OF
EBP
• Provide practicing nurse the evidence based
data to deliver effective care.

• Resolve problem in clinical setting.

• Achieve excellence in care delivery.

• Reduces the variations in nursing care and

assist with efficient and effective decision
making.
STEPS FOR PROCESS OF EBP
Formulating a clear question based on a
clinical problem

Literature review to search best available

evidence

Analysis of strength and weakness of evidence

Use of best evidence in clinical practices

Evaluating the efficacy of empirical evidences

Formulating a clear question based on a
clinical problem
The first steps is to formulate a clear
question based on a clinical problems. The
sources for formulating a question generally
categorized in two broader classes:

1. Problem based sources

2. Knowledge based sources
 The selection of final question for EBP
require:

• Brainstorming about idea

• Obtaining consensus among the team
• Willingness of stakeholder
While finalizing the question, the priority of
topic must be considered based on the
severity of problem, support from people in
organization and willingness of staff to
implement the evidence in practices.
 While formulating a clinical question for EBP, the
following should be include:
• The disorder or disease of patient,
• The intervention or finding being reviewed
• Possibly a comparison intervention
• The outcome
The term used to remember this is called PICO
model.
P – who is the patient population?
I - what is the potential intervention and area of
interest?
C – is there a comparison intervention or control
group?
O - what is the desire outcome?
Literature review to search best available
evidence
This is the second step of EBP process, where
essential and relevant literature related to the topic
is extensively reviewed.
The literature review for EBP must start with
theoretical and clinical articles to have overview
about the topic of concern, which should be
followed by well known existing EBP guideline, if
any available then should go for reading and
critiquing the original research article.
 It is better to include high level of evidences for
review, such a meta-analysis and systemic reviews
of randomized control trials, original randomized
clinical trial etc.
It must be ensured that an extensive literature
review is carried out including electronically as well
as not electronically available literature.
However, the reviewer must be very careful about
the facts given in literature because sometimes
article appears to be precise and factual on the
surface but with further and much closer
examination, flaws can be found.
Analysis of strength and weakness of
evidence
Use of rating system to determine the quality of
the research is crucial to the development of EBP.
There are several rating scales proposed to
determine the validity, strengths and weaknesses
of available evidence.
Implementing useful finding in clinical
practice based on valid evidence
Once study findings are analysed for strength
and weaknesses, internal and external validity, a
decision is made about appropriateness of
evidence for particular question initiated for EBP.
The final evidences must be extensively
discussed among the users with risk benefit ratio
of evidence and extent and level of harms are
involved with particular evidence.
Evaluate efficacy and performance of
evidence
Finally after implementation of the useful
findings for the clinical practices, efficacy and
performance is evaluated through processes of
self reflection, internal and external audit or peer
assessment.
 Barriers in
EBP
• Lack of value for research in practice
• Difficulty in bringing change
• Lack of administrative support
• Lack of knowledge mentors
• Lack of time for research
• Lack of knowledge about research
• Research reports not easily available
• Complexity of research reports
• Lack of knowledge about EBP
 Advantages of
EBP
• Provide better information to practitioner
• Enable consistency of care
• Better patient outcome
• Provide client focused care
• Structured process
• Increases confidence in decision-making
• Generalize information
• Contribute to science of nursing
• Provide guidelines for further research
• Helps nurses to provide high quality patient care
 Disadvantages of
EBP
• Not enough evidence for EBP
• Time consuming
• Reduced client choice
• Reduced professional
judgement/ autonomy
• Supress creativity
• Influence legal proceedings
• Publication bias
 CONCLUSION

Evidence-based nursing care is a lifelong

approach to clinical decision making and
excellence in practice. Evidence-based
nursing care is informed by research
findings, clinical expertise, and patients'
values, and its use can improve patients'
outcomes.
Use of research evidence in clinical practice is an
expected standard of practice for nurses and health
care organizations, but numerous barriers exist that
create a gap between new knowledge and
implementation of that knowledge to improve patient
care. Using the levels of evidence, nurses can
determine the strength of research studies, assess
the findings, and evaluate the evidence for potential
implementation into best practice.