This document discusses evidence-based practice (EBP) in nursing. It defines EBP as integrating the best research evidence, clinical expertise, and patient values in clinical decision making. The document outlines several models of EBP and describes the 5-step EBP process developed by Johns Hopkins which involves: formulating an answerable clinical question using PICO, searching for evidence, critically appraising the evidence, integrating the evidence with clinical expertise and patient preferences, and evaluating outcomes. The full 18-step EBP process developed by MacIntyre is also summarized.

1. Evidence Based
Practice
Strategies to Nursing Practice
L Anand,
Lecturer,
College of Nursing,NEIGRIHMS,
Shillong

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

3. 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.

5. 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.

6. 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.

7. 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.

8. Models of EBP

9. Models of EBP
 Discovery
 Summary
 Translation
 Integration
 Evaluation

10. Process of EBP

11. 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?

12. 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

13. 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.

14. PICO
 Comparison Intervention
 Placebo, etc.
 Outcome
 Expected and actual effects on patient

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

16. PICO
 PATIENT
 (Adult) coronary heart patients
 Smokers
 Discharged from hospital
 INTERVENTION
 Nurse led tobacco cessation programmes

17. 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

18. PICO
 Not all questions are of a clinical nature
 Intervention can be interpreted very broadly

19. N. MacIntyre, 2005
Sources of Evidence-Based Practice
Problems

20. 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.

21. N. MacIntyre, 2005
Step 3: Assign responsibility for leadership
Step 4: Recruit an interdisciplinary team
Step 5: Schedule a team conference

22. 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.


23. 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).

24. 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).

25. N. MacIntyre, 2005
STEP 7: Appraise all types of evidence


26. Claude Moore Health Sciences Library, 2003
Evidence Based Resources Models

27. SUNY Downstate Medical Center, 2003
Evidence Pyramid

28. Claude Moore Health Sciences Library, 2003
Evidence Based Resources Models

29. N. MacIntyre, 2005
STEP 8 – 10 : EBP
STEP 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

30. STEP 11: Determine the appropriateness and feasibility
of translating recommendations into the
specific practice setting
The practice guidelines development cycle

31. 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

32. 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

33. Questions?