Models of Evidence Base Practice Made By Sonal Patel

1. Evidence-Based Practice
(EBP)

2. INTRODUCTION
• The concept of EBP emerged out of the Evidence-
Based Medicine (EBM) movement, which is rooted
in the work of A.L. Cochrane.
• In the 1970s, Cochrane strongly encouraged his
colleagues to use evidence from random controlled
trials to determine the effectiveness and efficiency
of medical interventions (The Cochrane
Collaboration, 2002).

3. EBP
• Integration of the best research evidence with
clinical expertise and patient values.
• using the best available research findings to
make clinical decisions that are most effective
and beneficial for patients.

4. 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.

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.
Patients' preferences
Research
evidence
Clinical Expertise
Resources

6. Goals of EBP
• Provide practicing nurses with evidence-based
data.
• Resolve problems in the clinical setting
• Achieve excellence in care delivery
• Introduce innovation
• Reduce variations in nursing care
• Assists with efficient and effective decision-
making.

7. Research Utilization vs EBP
Research Utilization
• Use results of studies
• Randomly selected
• Support nursing care
• Less systematic
Evidence-Based Practice
• Considers all research
• Utilized thorough
integrative review
• Context of clinical
expertise and value
system of the patient
• More systematic

8. Process of EBP

9. Evidence-Based Practice is a five-step process:
• Identify a knowledge need and formulate an
answerable clinical question
• Locate the best available evidence
• Critically evaluate the evidence
• Integrate the evidence with patient’s unique
biology,preferences and values
• Evaluate the outcome

10. Models of EBP

11. •The IOWA Model of nursing utilization
•Rogers diffusion of innovation-model
•Stetler model for research utilization
•Disciplined clinical inquiry model
•Conduct and Utilization of Research in Nursing
(CURN) model
•Translational research model

12. THE IOWA MODEL
(TILTER ET AL, 2001)

14. Rogers diffusion of innovation-
model(1995)
Knowledge diffusion is an evolutionary process
by which an innovation is communicated over
time to members of a social system.

15. Major concepts are :
•Innovation
•Communication
•Time
•Social system
ROGERS DIFFUSION OF INNOVATION-
MODEL

16. Innovation
–The new idea that if adopted results in changes
Communication channels
–Media through which the information regarding
the innovation is transmitted
–Most effective when there are shared beliefs &
expectations of senders and receivers.

17. Time
–Process occurs over time:
•From creation of knowledge 􀃆dissemination of
knowledge
•From knowledge awareness 􀃆decision to use or
reject it
Social system
–Interrelated units that seek to accomplish a
common goal
–Diffusion occurs within social systems that vary in
their norms and receptivity to innovations

18. 5 stages:
–Knowledge (awareness)
–Persuasion (formation of positive attitude)
–Decision (adopt or reject)
–Implementation (put into practice)
–Confirmation (effectiveness evaluated)

20. I Phase- preparation
II Phase-validation
III Phase – comparative evaluation/decision making
IV Phase-translate or apply the research in the
practice
V Phase –evaluate the out come as of the change in
practice
STETLER MODEL FOR RESEARCH
UTILIZATION

21. Stetler model for research utilization

22. Phase I-Needs assessment
Phase 2- learning and knowledge generation
Phase 3- knowledge assimilation
Phase 4 –knowledge application
Phase 5- Outcomes & impact evaluation
DISCIPLINED CLINICAL INQUIRY MODEL

23. Evidence Based Practice Model

24. The Joanna Briggs Institute (JBI) indicates that a
practice which is effective, appropriate,
meaningful or feasible that is derived from
experience, expertise, inference, deduction or the
results of rigorous inquiry is regarded as a form of
evidence.

25. JBI conceptualises evidence-based practice as
clinical decision making that gives equal weight to
the best available evidence; the context in which
the care is delivered; client preference; and the
professional judgement of health
professionals/care staff.

26. FAME scale
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.

27. Benefits of using evidence base
for clinical practice:
• A sound foundation for practice.
• Enhanced self-confidence, autonomy, critical
thinking skills.
• Cost-effective patient care.
• Increased job satisfaction &quality of care.

28. • Improved patient outcomes
• A stimulus for collaborative practice,
retention & recruitment
• An improved image of nursing
• An ever –increasing scientific nursing
knowledge base.

29. • Resistant to changes in nursing practice.
• Ability to critically appraise research findings.
• Time,workload pressures and competing priorities.
• Lack of continuing education programs.
• Poor administrative support .
CHALLENGES TO EBP

30. •Relevant research based evidence bases are not
comprehensive ( there is gap in the practice).
•The relevant evidence bases are not static.
•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

31. • 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.