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Evidence Based
Practice
Strategies to Nursing Practice
L Anand,
Lecturer,
College of Nursing,NEIGRIHMS,
Shillong
“ARE YOU SURE NEW BATH TECHNIQUE WAS ON
THE EVIDENCED BASED PRACTICE LIST?”
EVIDENCE-BASED PRACTICE ?
 Evidence-based practice is the integration
of best research evidence with clinical
expertise a...
The concept of EBP
 EBP is a problem-solving approach to
clinical decision making
 EBP encourages critical thinking
 EB...
The value of EBP
 EBP ensures efficacy , efficiency and
effectiveness.
 EBP weighs risk, benefit, and cost
against a bac...
Models of EBP
 The Johns Hopkins Nursing Evidence-
Based Practice Model
 The Ace Star Model (Stevens, 2005)
 Lowa Model...
Models of EBP
Models of EBP
 Discovery
 Summary
 Translation
 Integration
 Evaluation
Process of EBP
N. MacIntyre, 2005
STEP 1: Identify an EBP question
The process of forming an EBP question often
begins when one of the fo...
N. MacIntyre, 2005
STEP 1: Identify an EBP question
 P Patient, population, or problem.
 I Intervention or Interest
 C ...
PICO
 A clinical question should incorporate at least three
elements
 Patient
 Age, sex, ethnicity, etc.
 Condition, d...
PICO
 Comparison Intervention
 Placebo, etc.
 Outcome
 Expected and actual effects on patient
PICO
 Do nurse led tobacco cessation interventions result
in decreased smoking rates after hospital admission
for coronar...
PICO
 PATIENT
 (Adult) coronary heart patients
 Smokers
 Discharged from hospital
 INTERVENTION
 Nurse led tobacco c...
PICO
 COMPARISON
 (Non-nurse led tobacco cessation programmes
 Self-administered, non-nurse administered, etc.)
 No co...
PICO
 Not all questions are of a clinical nature
 Intervention can be interpreted very broadly
N. MacIntyre, 2005
Sources of Evidence-Based Practice
Problems
N. MacIntyre, 2005
Step 2: Define the scope of the
practice question
The problem or question may relate to the
care of
 a...
N. MacIntyre, 2005
Step 3: Assign responsibility for leadership
Step 4: Recruit an interdisciplinary team
Step 5: Schedule...
N. MacIntyre, 2005
STEP 6: Conduct an internal and
external search for evidence
 Preprocessed resources - materials that ...
N. MacIntyre, 2005
STEP 6: Conduct an internal and external
search for evidence
 Evidence summaries - synthesized
literat...
N. MacIntyre, 2005
STEP 6: Conduct an internal and external
search for evidence
 Evidence summaries - synthesized
literat...
N. MacIntyre, 2005
STEP 7: Appraise all types of evidence

Claude Moore Health Sciences Library, 2003
Evidence Based Resources Models
SUNY Downstate Medical Center, 2003
Evidence Pyramid
Claude Moore Health Sciences Library, 2003
Evidence Based Resources Models
N. MacIntyre, 2005
STEP 8 – 10 : EBP
STEP 8: Summarize the evidence
STEP 9: Rate the strength of the evidence
STEP 10: Dev...
STEP 11: Determine the appropriateness and feasibility
of translating recommendations into the
specific practice setting
T...
N. MacIntyre, 2005
STEP 12 – 15 : EBP
 STEP 12: Create an action plan
 STEP 13: Implement the change
 STEP 14: Evaluate...
N. MacIntyre, 2005
STEP 12 – 18 : EBP
STEP 16: Secure support from decision
makers to implement the
recommended change
int...
Questions?
Evidence Based Practice - Strategies to Nursing Practice
Evidence Based Practice - Strategies to Nursing Practice
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Evidence Based Practice - Strategies to Nursing Practice

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Evidenced Based Practice

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Evidence Based Practice - Strategies to Nursing Practice

  1. 1. Evidence Based Practice Strategies to Nursing Practice L Anand, Lecturer, College of Nursing,NEIGRIHMS, Shillong
  2. 2. “ARE YOU SURE NEW BATH TECHNIQUE WAS ON THE EVIDENCED BASED PRACTICE LIST?”
  3. 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.
  4. 4. 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.
  5. 5. 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.
  6. 6. 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.
  7. 7. Models of EBP
  8. 8. Models of EBP  Discovery  Summary  Translation  Integration  Evaluation
  9. 9. Process of EBP
  10. 10. 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?
  11. 11. 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
  12. 12. 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.
  13. 13. PICO  Comparison Intervention  Placebo, etc.  Outcome  Expected and actual effects on patient
  14. 14. PICO  Do nurse led tobacco cessation interventions result in decreased smoking rates after hospital admission for coronary heart disease?
  15. 15. PICO  PATIENT  (Adult) coronary heart patients  Smokers  Discharged from hospital  INTERVENTION  Nurse led tobacco cessation programmes
  16. 16. 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
  17. 17. PICO  Not all questions are of a clinical nature  Intervention can be interpreted very broadly
  18. 18. N. MacIntyre, 2005 Sources of Evidence-Based Practice Problems
  19. 19. 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.
  20. 20. N. MacIntyre, 2005 Step 3: Assign responsibility for leadership Step 4: Recruit an interdisciplinary team Step 5: Schedule a team conference
  21. 21. 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. 
  22. 22. 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).
  23. 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. 24. N. MacIntyre, 2005 STEP 7: Appraise all types of evidence 
  25. 25. Claude Moore Health Sciences Library, 2003 Evidence Based Resources Models
  26. 26. SUNY Downstate Medical Center, 2003 Evidence Pyramid
  27. 27. Claude Moore Health Sciences Library, 2003 Evidence Based Resources Models
  28. 28. 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
  29. 29. STEP 11: Determine the appropriateness and feasibility of translating recommendations into the specific practice setting The practice guidelines development cycle
  30. 30. 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
  31. 31. 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
  32. 32. Questions?

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