1. Introduction
•Paradigm shift from expert or opinion
based practice to Evidence-based
practice.
•Has potential to increase patients’
involvement in clinical decision
making.
To improve health outcomes.
2. INTRODUCTION
T he concept of EBP emer ged out of
the Evidence-Based Medicine (EBM)
movement, which is rooted in the
wor k of A.L. Cochrane.
In the 1970s, Cochrane strongly
encouraged his colleagues to use
evidence from random controlled
trials to deter mine the ef fectiveness
and ef ficiency of medical
inter ventions (T he Cochrane
Collaboration, 2002).
3. Evidence-based practice(EBP)
Is the acknowledgement of uncertainty
followed by the seeking, appraising and
implementation of new knowledge.
It enables us to accept the difference,
possibly more effective, methods of care
than those currently employed.
4. Evidence-based nursing
"Evidence-based nursing (EBN)
means using the best available
evidence from research, along with
patient preferences and clinical
experience, when making nursing
decisions."
5. Evidence Based Nursing
Evidence Based Nursing is
the process by which nurses
make clinical decisions
using the best available
research evidence, their
clinical expertise and
patient preferences.
Three areas of research
competence are:
interpreting and using
research, evaluating
practice, and conducting
7. T he EBP- process
Evidence-Based Practice is a five-
step process:
Identify a knowledge need and
for mulate an answerable clinical
question
Locate the best available evidence
Critically evaluate the evidence
Inte grate the evidence with
patient’s unique biology
,preferences and values
Evaluate the outcome
8. Steps in EBN
•Select a topic
•Collect appropriate and accurate data to generate
evidence for nursing practice.
•Analyze data from clinical practice.
•Design interventions based on evidence.
•Predict and analyze outcomes.
•Examine patterns of behavior and outcomes.
•Identify gaps in evidence for practice.
•Evaluate project to determine and implement best
practices
10. Various Models-EBNP
•The IOWA Model of nursing utilization
•Rogers diffusion of innovation-model
•Stetler model for research utilization
•Disciplined clinical inquiry model
12. The IOWA Model
•Is a research utilization model and modified
to include more emphasis on EBP .
•The model is renamed, The IOWA Model of
evidence-based practice to promote quality
care.
•Problem focused triggers & knowledge
focused triggers
13. The IOWA Model-cont’d
•Assess, pilot the change in practice
•Continue to evaluate quality of care
and the new knowledge
•Institute the change in practice
•Monitor and analyze structure
,process &outcome
18. Stetler model for research
utilization
I Phase- preparation
II Phase-validation
III Phase – comparative
evaluation/decision making
IV Phase-translate or apply the
research in the
V Phase –evaluate the out come as
of the change in practice
21. Evidence-based practice
The quality of the evidence is based on:
Is this the best available evidence?
Best sources included peer reviewed
journals & reports no more than 3-5
years old.
Will the recommendations work for my
practice to solve the client’s problems?
Do the recommendations fit well with the
preferences & values of the clients the
nurse commonly works with?
23. Disciplined clinical inquiry
model
Phase I
Phase 3
Needs
assessment
Current Phase 4
state PC
KD&
Phase 2 EBNP CA EBPC
RE
Desired DCI
state Principles
Tools &
process
Phase 5
Outcomes& impact Evaluation
24. Nursing practices are examined for:
• Feasibility which relates to the
practicality of implementing the action.
•Appropriateness refers to whether it is
acceptable & justifiable with in ethical
guidelines.
•Meaningfulness provides the rationale
for the practice being adopted.
•Effectiveness relates to how much
evidence supports the practice & what
evidence provides divergent view points
25. Benefits of using evidence
base for clinical practice:
A sound foundation for practice
Enhanced self-confidence, autonomy,
critical thinking skills and
professional self-concept
Cost-effective patient care
Increased job satisfaction &quality of
care
26. BENEFITS cont’d..
Improved patient outcomes
A stimulus for collaborative practice,
retention & recruitment
An improved image of nursing
An ever –increasing scientific nursing
knowledge base
27.
28. What Data Do We Need for
Evidence-Based Practice?
•Information about the patient
•Domain information and knowledge
(“the evidence”) from systematic
inquiry and other sources
30. A successful EBP program
requires:
(a) consistent long-term vision and
support from senior leadership;
(b) resources such as trained
personnel, finances, and time; and
(c) structured approach to create an
environment that facilitates the
process.
31. Criticisms of the evidence –
based approach
•Health professionals are already doing it
•Evidence –based health care is ‘’cook
book’’ health care
•Evidence –based practice relies on RCT
&Meta -analyses
•There is no evidence
•Theory is more important than evidence in
guiding practice
32. Challenges to EBP
•Resistant to changes in nursing
practice.
•Ability to critically appraise research
findings.
•Time, workload pressures, and
competing priorities.
•Lack of continuing education
programs.
•Fear of "stepping on one's toes"
•Poor administrative support .
33. Challenges to EBP-cont’d
•Relevant research based evidence
bases are not comprehensive
( there is gap in the practice)
•The relevant evidence bases are
not static
•Life long-learning is generally
accepted as an important priority in
the 21 st century
34. Challenges to EBP-cont’d
•The piece of research conducted
does not mean that the finding s
should be transferred directly in to
the clinical setting
•Demands from patients for a certain
type of treatment
35. Challenges to EBP-cont’d
•Peer pressure to continue with
practices that are stepped in
tradition
•Inadequate content and behavioral
skills regarding EBP in educational
programs
•Lack of commitment and computer
skills
36. Facilitating conditions to
enhance EBP
•Support and encouragement from
administration
•Time to critically appraise studies and
important findings
•Clearly written research reports
•Adequate resources and time
•Characteristics of health care team(shared
vision & mission)
•Guideline characteristics
37. Strategies that guide our work
include:
•Providing superior educational
opportunities
•Enhancing health-related quality of life
through development, acquisition, and
application of knowledge
•Generating and using empirical data to
develop informed nursing policies and
practice
38. Strategies that guide our
work-cont’d
•Developing a dynamic nursing culture
that is embraced and respected, both
internally and externally
•Fostering excellence in practice and
continuity of care
•Synchronizing best practices throughout
to quality outcomes
39. EBP-CMC
•Reduction in IM injection
•Chlorhexidine Hand rub in ICU to prevent
infection
•Preparation of patient education materials
to enhance increase patient outcomes
•Most patient friendly strategies to improve
Quality of care
•Strategies to minimize patient fall, pressure
sore care
•Independent nursing practice( nurse
educators in the specialty areas)
40. EBP –C MC, cont’d
•Open and closed endo tracheal suctioning
•Use of coconut oil instead of powder to
reduce pressure sore
•Use of vegetable oil instead of glycerine
to prevent glossitis
•Use of NRS to assess pain management
• use of Postoperative check list
41. EBP –CMC, cont’d
•use of lactulose enema instead of bowel
wash for hepatic encephalopathy
•Use of dry/empty humidifier to prevent
infections
•Use of mild sedation instead of
mechanical restraints in the ICU
•Use of tap water to clean RTA wounds in
Emergency unit
•Kangaroo care for neonates
•No skin preparation and soap and water
enema for woman in labour
42. Best evidence to guide
clinical practice:
Exercise improves glycemic control
and reduces plasma triglycerides
and visceral adipose tissue in type-
2 diabetes; evidence obtained from
-14 RCT, Meta-analysis(JEBN-
2007).
A low protein diet delays ESRD in
chronic kidney disease.
43. Best evidence to guide
clinical practice-cont’d…
Peri operative education coordinated at
one facility identified the occurrence of
deep vein thrombosis as a significant
problem. Nurse conducted a literature
review ,created an evidence –based
practice change.
Life style education programmes lower
glucose concentrations & reduce the
incidence of type 2 diabetes
44. Best Evidence cont’d..
McCormack investigated existing
evidence-based literature to
answer the clinical question How
effective is the use of wrist splints
as a single first-line therapy for
the relief of symptoms in adults
Carpel Tunnel Syndrome-suggest
the Wrist splints as a first-line
therapy.
45. Best evidence-cont’d
•Allowing wounds to be uncovered
and wet in the first 48 hours after
minor skin excision did not differ from
standard dry management for wound
infection.
•Meta-analysis of (28 RCTs) exercise
training decreased long term cardiac
mortality, MI recurrence & major
cardiac risk factors( BP, total serum
cholesterol, weight ).
46. Best evidence contd….
RCTs (19 studies) to evaluate the
effectiveness of nurse delivered
smoking cessation intervention for
adults, had >2 groups & had > 6 months
of follow-up. At longest follow up, pts’
who received advice from a nurse were
more likely to stop smoking than
received usual care.
47. Best evidence cont’d..
RCT to compare the effectiveness and
cost-effectiveness of aggressive versus
symptomatic therapy in established
rheumatoid arthritis(2005).
The finding reported that there was no
significant difference between the
groups for any of the clinical outcome
measures.
48. Best evidence cont’d…
Research makes a difference in
practice. A meta-analysis designed
to determine the contribution of
research-based practice to patient
outcomes.
Heater & Colleagues reported that
patients who receive research
based nursing care make “sizable
gains” compared to those receiving
routine nursing care.
49. Best Evidence cont’d..
Interventions involving family care
givers to improve outcomes of
hospitalized elders; the finding of
studies suggest that family member
involvement has benefits for both
the elder and the family members.
50. Summary
•Evidence based nursing started in the
1800s with Florence Nightingale.
•EBN is a problem solving approach to
clinical decision making.
•EBN integrates providers' clinical
expertise with the best external clinical
evidence.
51. Summary-cont’d
EBN is the process of integrating
• Clinical knowledge
• Judgement
• Proficiency skills
• with the best available clinical
evidence, such as nursing
practice in to patient care (TRIP
&GRIP).
52. Conclusion
•A commitment to the continued
preparation of nurses as scientist is vital
to achieve excellence in nursing practice
•we can continue to shape the future of
nursing and healthcare...through the
planning, implementation and
dissemination of quality research studies.
54. REFERENCES:
• Ellis, J. R & Hartley C. L (2005). Managing and Coordinating nursing care (4thed.).
PhiladelphiaLippincott Williams & Wilkins Company.
• Heidenthal, P.K (2004).Essentials of Nursing Leadership &Management. USA, Delmar learning.
• Journal of Evidence Based Nursing, January, 2007.
• Kathuric, O. (2003).Evidence Based Nursing practice. The Nursing Journal of India.
No.11.p251-252
• Rose, M., Best, D & Higgs, J (2005). Transforming practice through Clinical
Education, Professional Supervision & Mentoring. Philadelphia, Elsevier
Company.
• Vanwicken, W. Cantrell, W. (2006). Implementing a research utilization plan
for prevention of deep vein thrombosis.AORNJ,83(6) 1353-62
55. References contd..
Melnyk,B. & Fineout-Overholt, E.(2005).
Evidence-based Practice in Nursing & Health care.
Philadelphia. Lippincott Williams & Wilkins
Company.
Web sites:
www.ebn.bmj.com/cgi/
www.cebm.utoronto.ca/syllabi/nur/
www.ahrq.gov/qual/
www.himiss.org/content/
www.tripdatabase.com
