Evidence Based PracticeStrategies to Nursing Practice

L Anand,

Lecturer,

College of Nursing,NEIGRIHMS,

Shillong

“ARE YOU SURE NEW BATH TECHNIQUE WAS ON THE EVIDENCED BASED PRACTICE LIST?”

EVIDENCE-BASED PRACTICE ?

Evidence-based practice is the integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making.

Evidence-based clinical decision making should incorporate consideration of the patient’s clinical state, the clinical setting, and clinical circumstances.

The concept of EBP EBP is a problem-solving approach to

clinical decision making

EBP encourages critical thinking

EBP uses the latest research evidence to produce high quality health care.

The value of EBP EBP ensures efficacy , efficiency and

effectiveness. EBP weighs risk, benefit, and cost

against a backdrop of patient preferences.

promote patient satisfaction and higher health-related quality of life.

Models of EBP The Johns Hopkins Nursing Evidence-

Based Practice Model The Ace Star Model (Stevens, 2005) Lowa Model Rosswurm and Larrabee Model. Stetler Model.

Models of EBP

Models of EBP

Discovery Summary Translation Integration Evaluation

Process of EBP

N. MacIntyre, 2005

STEP 1: Identify an EBP question

The process of forming an EBP question often begins when one of the following questions arises:

1. What evidence is the basis for this treatment?

2. Is there a scientific basis for this treatment?

3. What was the rationale for making that decision?

4. What are the clinical implications of this practice?

N. MacIntyre, 2005

STEP 1: Identify an EBP question

P Patient, population, or problem.

I Intervention or Interest

C Comparison intervention or status

O Outcome

PICO A clinical question should incorporate at least

three elements

Patient Age, sex, ethnicity, etc. Condition, diseases, general health status

Intervention Education, diagnostics, treatment plan, self-care,

etc.

PICO

Comparison Intervention Placebo, etc.

Outcome Expected and actual effects on patient

PICO

Do nurse led tobacco cessation interventions result in decreased smoking rates after hospital admission for coronary heart disease?

PICO

PATIENT (Adult) coronary heart patients Smokers Discharged from hospital

INTERVENTION Nurse led tobacco cessation programmes

PICO

COMPARISON (Non-nurse led tobacco cessation programmes

Self-administered, non-nurse administered, etc.) No comparison

OUTCOME Lower rates of tobacco use among Patient group

PICO

Not all questions are of a clinical nature

Intervention can be interpreted very broadly

N. MacIntyre, 2005

Sources of Evidence-Based Practice Problems

N. MacIntyre, 2005

Step 2: Define the scope of the practice question

The problem or question may relate to the care of

an individual patient,

a specific population of patients, or

the general patient population in the organization.

N. MacIntyre, 2005

Step 3: Assign responsibility for leadership

Step 4: Recruit an interdisciplinary team

Step 5: Schedule a team conference

N. MacIntyre, 2005

STEP 6: Conduct an internal and

external search for evidence Preprocessed resources - materials that

have been reviewed and chosen based on methodological standards for inclusion.

Primary evidence - usually data collected at the point of patient contact. This evidence can come from hospital-wide data, clinical trials, peer-reviewed research journals, conference reports, monographs, or summaries.

N. MacIntyre, 2005

STEP 6: Conduct an internal and

external search for evidence Evidence summaries -

synthesized literature and provide broader foci on topics. (systematic reviews, integrative reviews, book chapters, and meta-analyses).

Translation literature - quality-filtered Internet and Intranet sources(practice guidelines, critical pathways, care plans, clinical innovations, protocols, standards).

N. MacIntyre, 2005

STEP 6: Conduct an internal and

external search for evidence Evidence summaries -

synthesized literature and provide broader foci on topics. (systematic reviews, integrative reviews, book chapters, and meta-analyses).

Translation literature - quality-filtered Internet and Intranet sources(practice guidelines, critical pathways, care plans, clinical innovations, protocols, standards).

N. MacIntyre, 2005

STEP 7: Appraise all types of evidence

Claude Moore Health Sciences Library, 2003

Evidence Based Resources Models

SUNY Downstate Medical Center, 2003

Evidence Pyramid

Claude Moore Health Sciences Library, 2003

Evidence Based Resources Models

N. MacIntyre, 2005

STEP 8 – 10 : EBPSTEP 8: Summarize the evidence

STEP 9: Rate the strength of the evidence

STEP 10: Develop recommendations for change in systems or processes

of care based on the strength of the evidence

STEP 11: Determine the appropriateness and feasibility of translating recommendations into the specific practice setting

The practice guidelines development cycle

N. MacIntyre, 2005

STEP 12 – 15 : EBP STEP 12: Create an action plan

STEP 13: Implement the change

STEP 14: Evaluate outcomes

STEP 15: Report the results of the preliminary evaluation to decision makers

N. MacIntyre, 2005

STEP 12 – 18 : EBP

STEP 16: Secure support from decision makers to implement the recommended change internally STEP 17: Identify the next steps

STEP 18: Communicate the findings

Questions?