new trends in nursing

1. By / Mahmoud Shaqria
‫شقريه‬ ‫محمد‬ ‫محمود‬

2. _ Introduction.
_ Definition of evidence based practice .
_ Benefits of evidence based practice .
_ Process of evidence based practice .
_ (Lowa) model of evidence based practice .
_ Factors affecting the decision making
process .
_ Barriers of evidence based practice .
_ Examples of Appling EBP in nursing field.

4. 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. various definitions of
evidence based practice ( EBP ) have emerged in
the literature, but the most commonly used definition
is," the conscientious, explicit, an judicious use of the
current best evidence in making decisions about the
care of individual patients ".

5. -Evidence based practice (EBP)
is a process through which
scientific evidence is identified,
appraised and applied in
health care interventions.
-OR

6. - Evidence based practice is a
process by which nurses make
clinical decisions using the
best available research
evidence, clinical expertise and
patient preferences.

7.  To Nurses:
 Achievement of optimum patient care by setting
maintaining research based standards is clear .
 Such nurses will know whether research findings are
Valid, reliable, and applicable.
 Increase staff member skills and confidence.
 Improve management and quality of educational
programs.

8.  To Health Care Organization:
 EBP allows healthcare organizations to position
themselves in the market as quality institutions.
 EBP promote optimal outcomes or equivalent
care at lower cost or in less time.

9.  To The patient:
 increases satisfaction of patients.
 Reduce cost and improve outcomes.
 Improve the quality of patient care.
 Keep practice current and relevant.
 Policies and procedures are current and include the
latest research

10. Incorporating best evidence into clinical
care requires a systematic approach
in order to be manageable. A clear
series of steps known as the evidence
cycle can provide an excellent
paradigm to guide you through this
process. The foundation of evidence
based care remains an excellent
clinical evaluation.

11. 1) ASSESS the problem to determine the related
issues.
2) Converting information needs into clear
questions ( ASK)
there are 4 components to every clinical question,
the patient population, intervention, comparison
and outcome (PICO).
Population .P
Intervention .I
Comparator .C
Outcome .O

12. 3) Seeking evidence to answer
those questions ( Acquire).
4) Evaluate the evidence for it's
validity and usefulness
(Appraise)
5) Integrating findings with
clinical expertise, patient
needs, applying the finding
(Apply).

14. Step 1 :_ Selecting of a topic
Selecting a topic of evidence based
practice according to the priority and
magnitude of the problem, the
availability of data and evidence in the
problem area and the commitment of
staff.

15. Step 2 :_ Forming a team
The team is responsible for
development, implementation, and
evaluation the plan. Team
members require support from
senior members from
implementing evidence based
practice.

16. Step 3 :_ Evidence retrieval
From the team formation and topic
selection, a brainstorming session
should be held to identify available
source and key terms to guide the
search for evidence. Evidence
should be retrieved through
electronic databases such as
medline, web of science and so no.

17. Step 4 :_ Grading the evidence
To grade the evidence. the team
will address quality areas of
the individual research and the
strength of the body of
evidence overall.

18. Step 5 :_ Developing an EBP standard
After a critique of literature, team
members come together to set
recommendations for practice.
The type and strength of evidence
used in practice needs to be clear
and based in the consistency of
replicated studies.

19. Step 6 :_ Implementing EBP
For implementation to occur, aspects
such as written policy, procedures and
guidelines that are evidence based
need to be considered. There needs
to be a direct interaction between the
direct care providers, the
organization, and it's leadership roles
( Eg. nurse managers ) to support
these changes.

20. Step 7 :_ Evaluation
Evaluation is essential to seeing the
value and contribution of the evidence
into practice. A baseline of the data
before implementation would benefit,
as it would show how the evidence
has contributed to patient care. Audit
and feedback trough the process of
implementation should be conducted.

21. 1) Up to date research evidence.
2) Clinical expertise (knowledge, education
level, past and recent experience )
3) Factors related to patient and their family
such as beliefs, attitudes, value and needs.
4) Organizational factors as policies,
sources, funding, equipment and time.

22. 1) Lack of value for research in practice
2) Difficulty in changing practice.
3) Lack of administrative support.
4) Lack of knowledge mentors.
5) Insufficient time to conduct research.
6) Lack of awareness about research or
evidence based practice.

23. 6) Lack of awareness about research or
evidence based practice.
7) research reportsarticles not readily
available.
8) Difficulty accessing research reports and
articles.
9) No time on the job to read research.
10) Lack of education about the research
process.
11) Complexity of research reports.
12) Lack of knowledge about EBP critique of
article.

24.  Clinical Scenario:
 The patient is a 65 year old male with a long history of
type 2 diabetes and obesity. He does not smoke. He had
knee surgery 10 years ago, but has had no other major
medical problems. Over the years he has tried numerous
diets and exercise programs to reduce his weight, but
has not been very successful. His granddaughter just
started high school, and he wants to see her graduate
and go on to college. He understands that his diabetes
puts him at risk for heart disease and is frustrated that he
cannot lose the necessary weight. His neighbor told him
about a colleague at work who had his stomach stapled
(stomach surgery) and as a result not only lost over 30
kilos., but also "cured" his diabetes. He wants to know if
this procedure really works.

25.  How to apply the evidence-based practice
process through the following steps ?
1) Asking clinical question.
2) Acquiring the evidence.
3) Appraising the evidence.
4) Applying the result.
5) Assessing the outcome.

26. 1) We will use PICO to develop a clinical question.
 Question: In patients with type 2 diabetes and
obesity, does bariatric surgery (stomach stapled )
promote the management of diabetes and weight
loss as compared to standard medical care?
patients with type 2 diabetes and
obesity
populationP
(stomach stapled ) bariatric surgeryinterventionI
standard medical carecomparisonC
management of diabetes and weight
loss
outcomeO

27. 2) Acquiring the evidence
 Choosing Resources
 For Primary Resources:
 ACP Journal Club
 PubMed
 Cochrane Library
 For Background Information:
 UpToDate

28. 3) Appraising the Evidence
 Critical appraisal is the process of examining a
research article to determine its validity and
applicability to your clinical question. Critical
appraisal is important because is ensures that you
have a holistic view of the research article - including
any strengths, weaknesses, or biases
4) Applying the result
A) Moving Forward Applying the Evidence to your
Practice
B) Develop recommendations for practice.
C) Integrate the evidence recommendations, with
collaboration with patients, into a plan of care.
D) Complete human subject protection requirements

29. 5) Assessing the Outcome
 After implementing evidence-based practice, it's
important to monitor and evaluate any changes in
outcomes so that positive effects can be supported
and negative ones remedied.
6) Disseminating the Results
_This leads to needless duplication of effort, and
perpetuates clinical approaches that are not
evidence based.
_ Among ways to disseminate successful initiatives are
evidence-based practice rounds in your institution,
presentations at local, regional, and national
conferences, and reports in peer-reviewed journals,
professional newsletters, and publications for
general audiences.

30. https://www.slideshare.net/mobile/Akumengwa/health-
information-system-presentation/
https://www.asha.org/Research/EBP/Evidence-Based-
Practice/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2263
88/
http://www.apta.org/EvidenceResearch/
https://www.nurse.com/evidence-based-practice/

31. https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1
111/wvn.12223/
https://online.franu.edu/news/2018/11/05/benefits-
evidence-based-healthcare-implementation-nursing
practice/

https://woman.thenest.com/benefits-evidencebased-
practice-nursing-22791.html/
http://library.health.nt.gov.au/EBP/overview/
http://www.inquiriesjournal.com/articles/180/decision-
making-factors-that-influence-decision-making-
heuristics-used-and-decision-outcomes