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Evidenced Based Practice
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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?