evidence-based practice

1. EVIDENCE BASED PRACTICE [EBP]
IN NURSING/MEDICAL CARE

2. GROUP MEMBERS
S/N NAME REG. NUMBER
1 OKUMU IVAN ODIDA 1901600152
2 NALUBEGA LAILA 1901600146
3 SSEKABIRA ABDURAHUMAN 1901600153
4 OBBO FRANCIS 1901600102

3. CONTENT OUTLINE:
Definition of EBP
Benefits of EBP
Components of EBP
Steps in EBP
Barriers to EBP

4. What is Evidence Based Practice?
Evidence based practice (EBP) is a research-based, decision-making process
that is used to guide the delivery of holistic care by nurses.
Evidence based nursing (EBN) is a problem solving approach to clinical
decision-making process that incorporates a search for the best and latest
evidence, clinical expertise, assessment, and patient preference and values
within the context of caring (International Council of Nurses).
Evidence based practice in nursing involves providing holistic, quality care
based on the most up-to-date research and knowledge rather than traditional
methods, advice from colleagues, or personal beliefs (ANA., 2024)

5. The concept began to catch fire in the 1980’s.
The origins trace back to Florence Nightingale who gathered data and
conclusions regarding the relationship between unsanitary conditions and
failing health. It’s application remains essential today.
Improving patient care begins by asking how you can make it safer, more
compassionate, and personal experience.

6. Why is evidence based practice in nursing
essential?
“outdated practices are barriers to decreased length of stay, favorable
patient outcomes, and lowered costs”
Implementing EBP in nursing bridges the theory-to-practice gap and
delivers innovative patient care using the most current health care findings.
The goal of evidence based nursing is to improve the health and safety of
patients while also providing care in a cost-effective manner to improve
outcomes for both the patient and the healthcare system.

7. Benefits of Evidence Based Practice
Promotes positive patient outcomes.
Reduces healthcare cost by preventing complications.
Contributes to the growth of the science of nursing.
Allows for incorporation of new technologies into healthcare practice.
Increases nurse autonomy and confidence in decision making.
Ensures relevancy of nursing practice with new interventions and care
protocols.
Fosters shared decision making with patients in care planning.
Enhances critical thinking.
Encourages life long learning.

8. Components of Evidence based practice.
a) Research-based evidence: Utilizing current, relevant and reliable
research available to inform decision making eg Systematic review,
meta analysis etc.
b) Clinical expertise: Incorporating the nurses experience, skill and
knowledge into the decision making process during patient care.
c) Patient’s values and preferences: Considering individual
patient preferences, values and expectations in the decision making
process.

10. Barriers to EBP in Nurses
1. The nurse doesn't have enough time to read research or implement new
concepts.
2. Lack of resources e.g. relevant research materials databases and tools.
3. The nurse is either unaware of the research or doesn't think it has any
bearing on the way she practices.
4. The nurse lacks skills and training in interpretation of research findings.
5. The volume of research is challenging to keep up with. inadequate
resources and a lack of administrative support.
6. Patient factors: some pts have preferences that differ from evidence
based recommendations, influencing the nurses decision.

11. Steps in Evidence Based Practice
Evidence-Based Process includes incorporating the best external evidence,
your clinical expertise, and the patient’s values and expectations.
Melnyk and Fineout-Overholt (2005) delineated the process of EBP as
involving five (5) crucial steps.
Step 1: Ask a clear question about the patient’s issue and
determine an ultimate goal, such as improving a procedure to help
their specific condition. Development of a clear and concise clinical
question is of paramount importance, because the question directs the
entire process.

12. There are two(2) types of clinical questions
a) Foreground questions
b) Background questions.
(Fineout-Overholt E, Johnston L, 2005; Nollan R, et al, 2005; Straus SE, 2005)
a) Background Questions
• Are considerably broader and when answered, provide general knowledge:
- Who?
- What?
- Where?
- When?

13. b) Foreground questions
Are specific and relevant to the clinical issue
Foreground questions must be asked to determine which of two clinical
interventions are the most effective in improving patient outcomes and
clinical decision making
A specific, well-defined question generally can only be answered by
searching the current literature for studies comparing two interventions
Foreground questions include the following elements: (PICO)
- Population (P)
- Intervention or Issue of Interest (I)
- Comparison Intervention or Issue of Interest (C)
- Outcome (O)

15. Clinical Question
• In adults with type 2 diabetes(Population),
does regular exercise (intervention) compared to standard care without exercise
(comparison) result in improved glycemic control (outcome) ?

16. Step 2: Acquire the best evidence by searching relevant
clinical articles from legitimate source.
• Evidence from systematic reviews or meta-analysis of randomized
control trials
• Evidence from well-designed randomized control trials
• Evidence from systematic reviews of descriptive or qualitative studies
• Evidence from a single descriptive or qualitative study
• Evidence from expert opinions.

18. Step 3: Appraise the resources gathered to determine if the
information is valid, of optimal quality compared to the evidence levels,
and relevant for the patient.
There are normally three key questions:
1) Are the results of the study valid?
Measures the validity
• In order to be valid, the results of the study must be as close to the
truth as possible
• The study must also be conducted using best available research
methods.

19. 2) What are the results?
Measures the reliability of the study.
• If it is an intervention study, reliability consists of:
a) Whether the intervention worked
b) How large the effect was
c) Whether a clinician could repeat the study with similar results.
• If it is a qualitative study, reliability would be measured by determining if the
research accomplished the purpose of the study.
3) Will the results be applicable in caring for patients?
Measures the applicability
• The study may be used in practice when caring for patients if the subjects
are similar to the patients being cared for, the benefit outweighs the harm,
the study is feasible, and the patient desires the treatment.

20. Step 4: Apply the evidence to clinical practice by making
decisions based on your nursing expertise and the new information.

21. Step 5: Assess outcomes to determine if the treatment was effective
and should be considered for other patients.

22. Each of these steps must be
carefully completed to come to a
determination of best practices for a
nursing setting.
When practicing nurses cannot or
do not use research results to
strengthen and sustain holistic
nursing practice, the implementation
of EBP at the bedside becomes
incomplete

24. BONUS: What is Research utilization?
Research utilization involves the critical analysis and evaluation of
research findings and then determining how they fit into clinical
practice. Incorporating pertinent research findings into clinical practice
(and evaluating the changes’ effectiveness), helps close the gap between
research and practice.
More recently, research utilization efforts in nursing have been replaced
by evidence-based practice, which will be described above.

25. References:
Melynk B. M., & Fineout-Overholt E. (2005). Evidence based practice
in nursing and healthcare: A guide to best practice. Philadelphia:
Lippincott Williams &Wilkins.
Melnyk B. M. (2003). Finding and appraising systematic reviews of
clinical interventions: Critical skills for evidence-based practice.
Journal of Pediatric Nursing, 29(2), 125, 147-149

26. THANK YOU