Module 2: Evidence Based Practice

(EBP)

Module 2.2: Concept of EBP

Introduction
During the 1980s, the term evidence-based medicine emerged to
describe the approach that used scientific evidence to determine the best
practice. Later, the term shifted to become evidence-based practice as
clinicians other than physicians recognized the importance of scientific
evidence in clinical decision-making.

The ultimate goal of nursing is to provide evidence based care that

provides quality outcomes for patients and their families, healthcare
providers, and the healthcare system.
Definition
Evidence-based practice is the conscientious use of current best
evidence of making clinical decisions about patient care (Sacheet et. Al.,
2000).

Evidence-based practice evolves from the integration of the best

research evidence with clinical expertise and patient needs and values
(Institute of Medicine, 2001;Sachett, et. Al., 2000).

Process by which nurses make clinical decisions using best available

evidence, clinical expertise, & patient preferences in the context of
available resources.
The Components of EBP
1. Best Research Evidence

2. Clinical knowledge ( Expertise)

3. Patient values/preferences/expectations.
Optimal Decision

Patient Values/ What does the patient want?

Preferences Or What are they willing to do?
Expectations

Optimal
Decision

Research Clinical Data/

Evidence Knowledge
What does the What does your experience tell you?
research say? What has been the experience of
your colleagues?
Evidence Based Practice Inquiry Process
Assess Create
Adopt
Finalize team translation action Evaluate Report
change
membership of evidence plan outcome results
and
and schedule into and and/or to
identify
conferences practice implement impact decision-
next steps
setting change makers

If answer is yes,
proceed to EBP
Project.

Assemble Appraisal
Unit Consult
initial Focus of Adequate
or
Initial
question department
project the
Librarian &
Do Lit. Search literature evidence? Disseminate
team question
resource

If answer is no,
proceed to research
project

Contact Research IRB

Assign / Impact
Advisory Council Proposal Data Data
Find and/or
or & collection analysis
mentor outcome
Group (If Applicable) Approval
Evidence-Based Nursing Practice
Builds on process of research use, but more encompassing
More specific than term best practices
Does not foster rigid adherence to standardized guidelines
Recognizes the role of clinical expertise
EB nursing practice is a state of mind!
Importance Evidence-Based Nursing Practice
Fueled by accrediting bodies, professional organizations, third party
payers
Potential to improve quality, reduce variations in care
Focus on practices that result in best possible outcomes at possibly lower
cost
Provides a way to keep pace with advances it increases confidence in
decision-making potential to narrow the research-practice gap:
adoption of research findings into practice can take as long as 17 years
(Balas & Boren)
Impacted by perception that published research is not relevant to
practice
Provides a means to answer problematic clinical practice issues
Potential to improve individual bedside practice; supports/improves
clinical decision-making skills
Bedside nurse as conduit!!
Traditional Basis for Nursing Practice
Rituals, unverified rules
Anecdotes, isolated experiences
Customs, opinions, unit cultures
Physicians authority
Bases for Practice in Nursing
Philosophical/conceptual basis: mission; values; professional practice
models; conceptual frameworks; professional codes
Regulatory basis: state practice act; JCAHO; regulatory agencies
Traditional basis
*Evidence-based practice
Alternative Approach
Core Competencies
Ask:
why are we doing this..
what is the evidence?
Think critically!
Think out of the box!

Prioritize and clearly articulate answerable clinical questions with a

focus on outcomes
Appreciate role of quality improvement activities
Evaluate practice outcomes
*Work effectively with others
Alternative Approach
Read and understand research Search for evidence

Evaluate the evidence

Levels of Evidence Pyramid
Level I: Meta-analysis of multiple RCTs (gold standard)
Level II: Individual RCTs
Level III: Quasi-experimental
Level IV: Non-experimental; qualitative
Level V: Program evaluation; QI; RU; case reports
Level VI: Opinion of respected authorities
EBP in Nursing
Models for Research Utilization in Nursing to Understand Evidence-
Based Nursing Practice
1. The conduct and utilization of research in nursing (CURN) project was
designed to develop and test a model for using research - based
knowledge in clinical practice settings. Research utilization is viewed
as an organizational process. Planned change is integrated throughout
the research utilization process. Systems change is essential to
establishing research-based practice on a large scale.
2. The stetler model of research utilization applies research findings at
the individual practitioner level. The model has six phases:
(1) Preparation,
(2) Validation,
(3) Comparative evaluation,
(4) Decision making,
(5) Translation and application, and
(6) Evaluation. Critical thinking and decision making are
emphasized.
Models for Research Utilization in Nursing to Understand
Evidence-Based Nursing Practice
(3) The Iowa Model of Research in Practice infuses research into practice to
improve the quality of care , and is an outgrowth of the Quality Assurance
Model Using Research (QAMUR). Research utilization is seen as an
organizational process. Planned change principles are used to integrate
research and practice. The model integrates evidence-based healthcare
acknowledges and uses a multidisciplinary team approach.
Evidence based Practice Process
The Process of Doing EBP
The Process of Doing EBP
PICO Format
P Patient, population, or problem.

I Intervention or Interest

C Comparison intervention or status

O Outcome
Strategies to Promote EBP
Barriers to Implementing Evidence-Based Practice
Lack of value for research in practice
Difficulty in changing practice
Lack of administrative support
Lack of knowledgeable mentors
Insufficient time to conduct research
Lack of education about the research process
Lack of awareness about research or evidence-based practice
Research reports/articles not readily available
Difficulty accessing research reports and articles
No time on the job to read research
Complexity of research reports
Lack of knowledge about EBP and critique of articles
Feeling overwhelmed by the process
Deficits Among Nurses
Conclusion
To be successful with evidence-based practice, one needs to be willing to
challenge ones own assumptions and be willing to work with others to
improve care processes and patient outcomes. Evidence-based practice
takes resources, work, time, and effort, but the outcomes make them
worthwhile. Every patient deserves care that is based on the best scientific
knowledge and that ensures high-quality, cost-effective care