Evidence based practice (EBP) involves integrating the best available research evidence with clinical expertise and patient values. EBP begins with identifying an issue and searching for relevant research evidence, which is then evaluated and applied. Several models describe the EBP process, including the Stetler, Iowa, and ACE Star models. Barriers to EBP include limitations in the available research evidence as well as nurse, organizational, and professional barriers. The key steps in the EBP process are selecting an issue, assembling and evaluating evidence, assessing implementation potential, and developing, implementing, and evaluating guidelines through a pilot study.

1. EVIDENCE BASED
PRACTICE (EBP)

2. INTRODUCTION
• RESEARCH UTILIZATION (RU) :
RU is the use of findings from a study or set of
studies in a practical application that is unrelated
to original research.
• EVIDENCE BASED PRACTICE :
– Broader concept than RU which integrates
research findings with other factors.

4. EVIDENCE BASED PRACTICE
EBP begins with a search for information about
how best to solve specific practical problem
• Definition:
“Evidence based practice is using the best evidence
available to guide clinical decision making”
-Benefield –
“The integration of best research evidence with clinical
expertise and patient values”
-sackett-

5. Evidence based practice in nursing
Evidence based practice(EBP) in nursing is
a process of locating, appraising and applying
the best evidence from nursing and medical
literature to improve the quality of clinical
nursing practice.

6. Purposes
• EBP is an approach which tries to specify the way
in which the professional or other decision maker
should make decisions by identifying evidences
• Eliminate unsound or excessively risky
procedures.
• Contributed towards better patient outcome
• To provide highest quality and most cost-efficient
nursing care possible
• To improve the quality of nursing care
• Clinical decision making

7. Features of EBP
• It deemphasizes decision making based on
custom, authority opinion or ritual,
• Identifying the best available research
evidence and integrating with clinical
expertise, patient input and existing resources.
• Solution to sustaining high health care quality
in our current cost-constrained environment.

8. TYPES OF EVIDENCE
AND
EVIDENCE HIERARCHIES

9. Types of evidence and evidence
hierarchies
• According to the strength of the evidences
positions has been given to evidences, represents
as evidence hierarchies :-
– Level 1:systematic Review
– Level 2: Individual RCT/Single RCT
– Level 3:Single Non-Randomized-Trail (Quasi-
Experiment )
– Level 4:Single Prospective / Cohort Study
– Level 5:Single Case-control Study.(Eg: Survey)
– Level 6:Single In-depth Qualitative Study
– Level 7: Expert Opinion, Case Reports, Etc

11. Resources of evidences
• Systematic reviews
– Meta analysis
– Meta synthesis
• Clinical practice guidelines
– Eg :
• The Canadian Medical Association
• National Guidelines Clearing House
• Other appraised evidence

12. MODELS AND THEORIES
OF
EVIDENCE BASED PRACTICE

13. Models and theories of evidence based
practice
• Models offers frame works for understanding
the EBP process and designing and
implementing on EBP project in setting.
• Each models offers,
– Different perspectives in how to translate research
findings into practice.
• Several steps and procedures are similar across the
models

14. Models and theories of evidence based
practice
• Stetler model
• Iowa model
• ACE- star model

15. Stetler model

16. Iowa model

17. ACE- star model of knowledge
transformation

18. BARRIERS
IN
EVIDENCE BASED PRACTICE

19. Barriers in EBP
• Research related barriers
• Nurse related barriers
• Organizational barriers
• Barriers relating to nursing profession

20. Research related barriers
• The state the act of research knowledge is fairly
primitive
• Result reported in literature may not merit
translation into practice of methodologic flaws
are extensive
• A solid base of valid and trustworthy study
results has not been developed
• Nurses have to wait for ‘perfect studies’ before
basic clinical decisions on research findings

21. Research related barriers
• Single studies rarely provide an adequate basis
for making changes in nursing practice.
• Researches reported in way that make
findings inaccessible to practitioners.
• Complex statistical information and dense
research jargon

22. Tips .…..
Collaborate with clinicians
Do high quality research
Replicate
Communicate clearly
Present findings amenable to meta analysis
Suggest clinical implications
Disseminate aggressively
Disseminate broadly
Prepare integrative research review

23. Nurse related barriers
• Educational preparation and their research
skills (not received any formal instructions)
• Lacks skills to judge the merits of study
• Nurses attitudes towards research and their
motivation to engage in EBP.
Some nurses considered as research utilization as
little more than a “necessary evil”
• People are often resistant to change

24. Nurse related barriers
• Change also perceived as threatening (Eg: Job
security)
• Opposition to introducing innovations in
practice setting

25. Tips…..
Read widely and critically
Attend professional conferences
Learn to expect evidence that a procedure is
effective
Become involved in a journal club
Pursue and participate in EBP project

26. Organizational barriers
• Failed to motivate or reward nurses to seek
ways to implement appropriate findings in
their practice
• Insufficient time on the job to implement new
ideas
• Organization may be reluctant to expand
resource for EBP activities or for changing
organizational policy

27. Tips…..
• Foster a climate of intellectual curiosity
• Offer emotional and moral support
• Offer financial or research support for
utilization
• Reward efforts for using research
• Seek opportunities for institutional RU/EBP
projects

28. Barriers relating to nursing profession
• Shortage of appropriate role models- nurses.
Tips …
Incorporate research findings into the
curriculum
Encourage the research and research use
Place demands on researcher

29. THE PROCESS OF USING
RESEARCH
IN
NURSING PRACTICE

30. The process of using research in
nursing practice
1. Selecting a topic or problem
2. Assembling and evaluating evidences
3. Assisting implementation potential
4. Developing, implementing and evaluating the
observations

31. The process of EBP….
1. Selecting a topic or problem
– Selected problem should have,
• Clinical relevance
• Research literature
2. Assembling and evaluating evidence
– Team have to be formed to work on project
– Search for assemble research evidence
– Doing literature review
– High-quality integrative review

32. The process of EBP….
3. Assisting implementation potential
– Pilot testing of innovation
– Evaluate the appropriateness of innovation
• Issues to be considered,
– Transferability of the innovation
– Feasibility of implementing
– Its cost benefit ratio

33. The process of EBP….
4. Developing, implementing and evaluating
the observations
1. Developing an evaluation plan
2. Collecting baseline data relating to those outcome
3. Developing a written EBP guidelines based on
the synthesis of evidence
4. Training relevant staff in the use of evidence
5. Trying the guidelines out one more units or a
sample of clients

34. The process of EBP….
4. Developing, implementing and evaluating
the observations
6. Evaluating the pilot project in terms of both
processes and outcome
 Dissemination
 The end result this process is a decision about
whether to adopt the innovation or to revert to
the prior practice .

35. Conclusion

36. THANK YOU