EVIDENCE- BASED

PRACTICE IN PUBLIC
HEALTH

Maria Katrina L. Costiniano, RN, MAN

  The term evidence-based was first
attributed to Gordon Guyatt, a
Definition of Canadian physician at McMaster
Evidence- Based University in 1992.
Practice  The term was first applied in
medicine to begin the development of
new ways of guiding professional
decision making by using the best
available evidence.
 “the conscientious, explicit, and
judicious use of current best evidence in
Evidence-based making decisions about the care of
medicine individual clients”
Sackett et al. 1996 (p. 71)
 “a public health endeavor in which there is an
informed, explicit, and judicious use of evidence that
has been derived from any of variety of science and
social science research and evaluation methods”
Rychetnik et al. 2004 (p. 538)
Evidence-based
public health “making decisions on the basis of the best available
evidence, using data and information systems,
applying program planning frameworks, engaging the
community in decision making, conducting
evaluations, and disseminating what has been learned”
Brownson et al. 2009 (p. 175)
 Evidence- based nursing

“an integration of the best evidence

available, nursing expertise, and the
values and preferences of the individuals,
families and communities who are
served”
Honor Society of Nursing, Sigma Theta
Tau International, 2005
Evidence- Based Nursing
Continues to be broadened in scope and now includes a lifelong problem solving
approach to clinical practice, integrating both external and internal evidence to answer
clinical questions and to achieve desired client outcomes (Melynk et al., 2017).

External evidence includes research and other evidence such as reports and professional
guidelines.

Internal evidence includes the nurse’s clinical experiences and the client’s preferences.
  During the mid- to late 1970s there was
growing consensus among nursing
History of leaders that scientific knowledge should
Evidence-Based be used as a basis for nursing practice.
 The Division of Nursing in the U.S.
Practice Public Health Service began funding
research utilization projects.
 Research utilization has been defined as
“the process of transforming research
knowledge into practice” and “the use of
research to guide clinical practice”.
  Three projects funded by the Division of
Nursing received the most attention and
were the most influential in shaping
nursing’s view of using research to guide
History of practice using very different approaches
and methods, each project tested
Evidence-Based interventions to facilitate research use in
Practice practice
 The Nursing Child Assessment Satellite
Training Project (NCAST)
 The Western Interstate Commission for
Higher Education (WICHE) Regional
Program for Nursing Research
Development (WICHEN)
 The Conduct and Utilization of Research
in Nursing Project (CURN)
  In the late 1970s, David Sackett, a medical doctor and
clinical epidemiologist at McMaster University, published a
History of series of articles in the Canadian Medical Association Journal
describing how to read articles in clinical journals.
Evidence-Based  Later, Sackett proposed the phrase “bringing critical
Nursing Practice appraisal to the bedside” to describe the application of
evidence from medical literature to client care.
 Gordon Guyatt as Residency Director of Internal Medicine at
McMaster eventually called evidence-based medicine as
being “aware of the evidence on which one’s practice is
based, the soundness of the evidence, and the strength of
inference the evidence permits
TYPES OF
EVIDENCE
 Within public health Engaging the
community in
Using data and
information systems
Making decisions on the
basis of the best
assessment and decision systematically available peer-reviewed
practice, guidelines for making evidence (both
quantitative and

finding and using

qualitative)

evidence include the

following:
Applying program Conducting sound Disseminating what is
planning frameworks evaluation learned
(often based in health
behavior theory)

EBP represents a cultural
change in practice. It
provides an environment to
improve both nursing
practice and client
outcomes.
Factors leading to change
These factors include the following:
• Knowledge of research and current evidence
• Ability to interpret the meaning of the
evidence
• Individual professional’s characteristics, such
as a willingness to change, or personal
viewpoints about the quality and credibility of
evidence
• Commitment of the time needed to implement
EBP and to engage in education and directed
practice
• The hierarchy of the practice environment
and the level of support of managers and the
ability to engage in autonomous practice

EBP represents a cultural
change in practice. It
provides an environment
to improve both nursing
practice and client
outcomes.
Factors leading to change
These factors include the
following:
• The resources available to engage in EBP,
such as amount of work, proper
equipment, computer-based EBP
programs, and information systems
• The practice characteristics, such as
leadership and colleague attitudes
• Links to outside support such as teaching
facilities like a teaching health department
or a university
• Political constraints and the lack of
relevant and timely public health practice
research
Barriers to Evidence-Based Practice
Community-focused nursing agencies may lack the resources needed for its implementation
in the clinical setting, such as time, funding, computer resources, and knowledge.

Nurses may be reluctant to accept findings and feel threatened when long-established
practices are questioned.

Cost as change will require more funds than the agency has available.

Compliance, if client will not follow the recommended intervention.

Steps in the Evidence-Based Practice Process
 Form a coordination team to guide the review process

Develop a conceptual framework called a logic model for

the review

HOW TO Develop an Identify and select interventions that the review will cover
Evidence-Based
Define and develop a conceptual approach for evaluating
Practice guide for a the interventions, called an analytic framework

Community Preventive Identify criteria for including and excluding studies

Service
Use the criteria to search for, retrieve, and screen abstracts

Review the full text of every study and code the data from
each using The Community Guide abstraction from
 Assess the quality of each study

Summarize all of the evidence found, called the body of

evidence

HOW TO Develop an Identify issues of applicability and barriers to implementation

(when available) for recommended interventions
Evidence-Based
Summarize information about other benefits or harms that
Practice guide for a might result from interventions

Community Preventive Identify and summarize evidence gaps

Service
Develop recommendations and findings

Conduct an economic evaluation of the interventions found to

be effective
Approach for evaluating evidence
Thank you!