Evidence based practice
Evidence-Based
Professional
Nursing Practice
Chapter 10
Evidence-Based Practice:
What Is It?
• Evidence-based practice (EBP) is a
framework used by nurses and other
healthcare professionals to deliver optimal
health care through the integration of best
current evidence, clinical expertise, and
patient/family values
Why Is EBP Relevant in Nursing? (1 of 2)
• Helps resolve problems in the clinical setting
• Results in effective patient care and better
outcomes
• Contributes to the science of nursing through
the introduction of innovation to practice
• Keeps practice current and relevant by helping
nurses deliver care based upon current best
research
Why Is EBP Relevant in Nursing? (2 of 2)
• Decreases variations in nursing care and
increases confidence in decision making
• Supports Joint Commission on Accreditation
of Healthcare Organizations (JCAHO)-
readiness since policies and procedures are
current and include the latest research
• Supports high quality patient care and
achievement of Magnet status
Steps in the EBP Process (1 of 2)
• Cultivate a spirit of inquiry and culture of EBP
among nurses and within the organization
• Identify an issue and ask the question
• Search for and collect the most relevant and
best evidence to answer the clinical question
Steps in the EBP Process (2 of 2)
• Critically appraise the evidence and synthesize
the evidence
• Integrate evidence with clinical expertise and
patient preferences to make the best clinical
decision
• Evaluate the outcome of any EBP change
• Disseminate the outcomes of the change
Barriers to EBP in Nursing (1 of 3)
• Lack of value for research in practice
• Difficulty in changing practice
• Lack of administrative support
• Lack of knowledgeable mentors
• Insufficient time
• Lack of education about the research process
• Lack of awareness about research or EBP
Barriers to EBP in Nursing (2 of 3)
• Research reports/articles not readily available
• Difficulty accessing research reports and articles
• No time on the job to read research
• Complexity of research reports
• Lack of knowledge about EBP
• Lack of knowledge about the critique of articles
Barriers to EBP in Nursing (3 of 3)
• Feeling overwhelmed by the process
• Lack of sense of control over practice
• Lack of confidence to implement change
• Lack of leadership, motivation, vision,
strategy, or direction among managers
Promoting EBP: Individual Nurse
• Educate yourself about EBP
• Conduct face-to-face or online journal clubs,
share new research reports and guidelines with
peers, and provide support to other nurses
• Share your results through posters, newsletters,
unit meetings, or a published article
• Adopt a reflective and inquiring approach to
practice
Strategies to Promote EBP:
Organizations
• Specific identification of the facilitators and
barriers to EBP
• Education and training to improve
knowledge and strengthen beliefs related to
the benefits of EBP
• Creation of an environment that encourages
an inquisitive approach to patient care
PICO(T)
• P: Patient, population, or problem
• I: Intervention, exposure, or topic of
interest
• C: Comparison or alternate intervention
• O: Outcome
• (T): Time or timeframe
PICO(T) Questions
• In (patient or population), what is the effect
of (intervention or exposure) on (outcome)
compared with (comparison or alternate
intervention)?
• For (patient or population), does the
introduction of (intervention or exposure)
reduce the risk of (outcome) compared with
(comparison or alternate intervention)?
Electronic Resources
• National Library of Medicine
• Cochrane Library
• National Guideline Clearinghouse
• Joanna Briggs Institute
• Agency for Healthcare Research and Quality
• Centre for Health Evidence
• Registered Nurses’ Association of Ontario
Evaluation of Evidence
• What is the source of the information?
• When was it developed?
• How was it developed?
• Does it fit the current clinical environment?
• Does it fit the current situation?
Levels of Evidence
• Meta-analysis or systematic reviews of multiple well-
designed controlled studies
• Well-designed randomized controlled trials
• Well-designed nonrandomized controlled trials
• Observational studies with controls
• Systematic review of descriptive and qualitative studies
• Single descriptive or qualitative study
• Opinions of authorities and/or reports of expert
committees
Appraisal of Research Using the
Critical Appraisal Skills Programme
(CASP)
• Checklists provide tools to interpret
research evidence
• Checklists are specific to types of research
• Checklists provide frameworks to determine
strength and reliability of research reports
Institute of Medicine (IOM)
Standards for Clinical Practice
Guideline Development • STANDARD 1: Establishing
• STANDARD 2: Management of conflict of interest
• STANDARD 3: Guideline development group composition
• STANDARD 4: Use of systematic reviews
• STANDARD 5: Establishing evidence and strength of
recommendations
• STANDARD 6: Articulation of recommendations
• STANDARD 7: External review
• STANDARD 8: Updating
Appraisal of Guidelines for Research and
Evaluation (AGREE II)
• Scope and purpose
• Stakeholder involvement
• Rigor of development
• Clarity and presentation
• Application
• Editorial independence
AGREE II Category #1
• Scope and purpose
– Overall objectives of the guideline are
specifically described
– The health questions covered by the guideline
are specifically described
– The population to whom the guideline is meant
to apply are specifically described
AGREE II Category #2
• Stakeholder involvement
– Guideline development group includes
individuals from all relevant professions
– The views and preferences of the target
population have been sought
– Target users of the guideline are clearly defined
AGREE II Category #3 (1 of 2)
• Rigor of development
– Systematic methods were used to search for
evidence
– The criteria for selecting the evidence are clearly
described
– The strengths and limitations of the body of
evidence are clearly described
– The methods used for formulating the
recommendations are clearly described
AGREE II Category #3 (2 of 2)
• Rigor of development (cont.)
– The health benefits, side effects, and risks have
been considered in formulating recommendations
– There is an explicit link between the
recommendations and the supporting evidence
– The guideline has been externally reviewed by
experts prior to publication
– A procedure for updating the guideline is provided
AGREE II Category #4
• Clarity and presentation
– Recommendations are specific and
unambiguous
– Different options for management of the
condition or health issue are clearly presented
– Key recommendations are easily identifiable
AGREE II Category #5
• Application
– The guideline describes facilitators and barriers to
its application
– The guideline provides advice and/or tools on how
the recommendations can be put into practice
– The potential resource implications of applying the
recommendations have been considered
– Guideline presents monitoring and/or auditing
criteria
AGREE II Category #6
• Editorial independence
– The views of the funding body have not
influenced the content of the guideline
– Competing interests of guideline development
group members have been recorded and
addressed
Implementation Models for EBP
• Center for Advancing Clinical Evidence (ACE)
Star Model of Knowledge Transformation
• The Iowa Model of Evidence-Based Practice
• Agency for Healthcare Research and Quality
Model
• Johns Hopkins Nursing Evidence-Based Practice
Model
• Diffusion of Innovation Framework
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