4. INTRODUCTION
• Evidence-based medicine (EBM) or evidence based practice
(EBP), is the judicious use of the best current evidence in making
decisions about the care of the individual patient.
• Evidence-based practice represents both an ideology and a method.
The ideology springs from the ethical principle that clients deserve
to be provided with the most effective interventions possible. The
method of EBP is the way we go about finding and then
implementing those interventions.
5.
6. DEFINITIONS
Evidence: It is something that furnishes proof or
testimony or something legally submitted to ascertain in
the truth of matter.
Evidence based practice: It is systemic inter
connecting of scientifically generated evidence with the
tacit knowledge of the expert practitioner to achieve a
change in a particular practice for the benefit of a well-
defined client / patient group. (French 1999).
7. • Evidence based nursing- it is a process by which
nurses make clinical decisions using the best available
research evidence, their clinical expertise and patient
preferences (mulhall, 1998).
• Evidence based medicine or practice-The
conscientious, explicit and judicious use of current
best evidence in making decision about the care of
individual patient. (Dr. David Sackett, Rosenberg,
1996)
8. CONTD….
providing• EBP in nursing is
nursing
a way of
care that is guided by the
integration of the best available scientific
expertise. Thisknowledge with nursing
approach requires nurses to critically
assess relevant scientific data or research
evidence and to implement high quality
interventions for their nursing practice.
9. Health care that is evidence-based and conducted
in a caring context leads to better clinical decisions and
patient outcomes. Gaining knowledge and skills in the
EBP process provides nurses and other clinicians the
tools needed to take ownership of their practices and
transform health care.
10. KEY COMPONENTS OF EBP
A. Research evidence.
B. Clinical expertise, judicious use.
C. Patient values and circumstances.
11.
12. NEED FOREBP
For making sure that each client get the
best possible services.
Update knowledge and is essential for
lifelong learning.
Provide clinical judgment.
Improvement care provided and save lives.
13. GOAL OFEBP
Provide practicing nurse the evidence based data to
deliver effective care.
Resolve problem in clinical setting.
Achieve excellence in care delivery.
Reduces the variations in nursing care and assist
with efficient and effective decision making.
16. STEPS OF EVIDENCE BASED
PRACTICE
Step 1: formulating a well built question
Step 2: collecting the most relevant and best evidence to answer the
clinical question including searching for systematic
reviews/identifying articles
Step 3: Critically appraising the evidence that has been collected
for its validity, relevance and applicability.
17. Step 4: integrating the evidence with ones clinical expertise,
assessment of patient’s condition and available health care
resources along with the patients preferences and values to
implement the evidence.
Step 5: Evaluating the change resulting from application of
evidence in practice. Determine the areas for improvement.
18. STEP-1: FORMULATING THE QUESTION
With clinical areas ,there is often a barrage of details to digest. a
well built question includes the following components
The patients disorder or disease
The intervention or finding under review
A comparison intervention
The question should be in PICOT or PICO format
19. PICOT FORMAT
Patient, Population or Problem
What are the characteristics of the patient or population?
What is the condition or disease you are interested in? ( i.e. age,
gender, ethnicity, with a certain disorder)
Intervention or exposure
What do you want to do with this patient (e.g. treat, diagnose,
observe)? (exposure to a disease, risk behavior, prognostic factor)
Comparison
What is the alternative to the intervention (e.g. placebo, different
drug, surgery)? (could be a placebo or "business as usual" as in
no disease, absence of risk factor, Prognostic factor B )
20. Outcome
What are the relevant outcomes (e.g. morbidity, death,
complications, risk of disease, accuracy of a diagnosis, rate of
occurrence of adverse outcome)
Time
What time it takes to demonstrate an outcome (e.g. the time it
takes for the intervention to achieve an outcome or how long
participants are observed).
21. EXAMPLE: Are insulin pumps more effective than
conventional therapies in managing type 2 diabetes in
pregnant women?
Patient/Population - Pregnant women with type 2
diabetes
Intervention - Insulin pump therapy
Comparison - Conventional insulin therapy
Outcome - Improved management of glucose levels
22. SEARCH STRATEGIES BACKGROUND
INFORMATION
Background information may be found in sources such
as: reference book entries textbooks, chapters,
appendices drug monographs, guides to diagnostic
tests the library’s Bobcat catalog selected
electronic Reference Tools for Background information
in the health science.
23. Step 2. DATABASE /RESOURCE SEARCHING
Once a clinical practice question has been selected,
the next step is to search and assemble research evidence on
the topic. In doing a literature review as a background for a
new study, the central goal is to discover where the gap are
and how best to advance knowledge.
Step 3. CRITICALLY APPRAISING THE ARTICLE
The assessment of evidence by systematically
reviewing its relevance, validity and results of specific
situations.
24. Step 4. APPLYING THE EVIDENCE/INTEGRATING
EVIDENCE WITH ONES CLINICAL EXPERTISE
If the implementation criteria are met the team can design
and plot the innovation. To reach your conclusion you may consult
questions related to diagnosis ,therapy, harm and prognosis keep in
mind that you must interpret the information based on a number of
criteria and depending on your skill and experience ,you may need
to confer with a peer. example- Sample evidence practice e.g.
consider a nine year old girl present in the ER with abdominal pain
and you suspect appendicitis. which imaging modality is best for
making the diagnosis CT or ultrasound.
25. Step 5. EVALUATING THE CHANGE
The fifth step of the process, outcome evaluation,
attempts to interpret the results and evaluate the outcomes
of the applied evidence (intervention). Outcome measures
may be psychosocial (quality of life, improved patient
perception of care, reduction in depressive and anxiety
symptoms), physiologic (improved health, reduced
complications), or functional improvement. Evaluation of
the process and the results may occur through peer
assessment, audit, or even self reflection.
26. Barriers inEBP
Lack of value for research in practice
Difficulty in bringing change
Lack of administrative support
Lack of knowledge mentors
Lack of time for research
Lack of knowledge about research
Research reports not easily available
Complexity of research reports
Lack of knowledge about EBP
27. Advantages ofEBP
Provide better information to practitioner
Enable consistency of care
Better patient outcome
Provide client focused care
Structured process
Increases confidence in decision-making
Generalize information
Contribute to science of nursing
Provide guidelines for further research
Helps nurses to provide high quality patient care
