This document provides an overview of evidence-based practice (EBP) in nursing. It defines EBP and discusses its aims, purposes, and historical development. The document outlines the differences between EBP and research utilization and describes various types of evidence and hierarchies. It also identifies resources for EBP, discusses its uses and barriers, and presents several EBP models and the process of implementing EBP. The document notes assumptions of EBP in nursing, its limitations, and the role of nurses in EBP. Overall, the document serves as an introduction to EBP for nursing by defining key concepts and outlining the principles and process of EBP.

1. “We cannot afford to live with “doing it
my way” as we always doing it mentally.
Avoid basing decisions on untested
but strong past beliefs or evidence can
bring changes, what the winners do
- B. Baruch

2. PROBLEM SOLVING APPROACH

3. TOOL

4. EVIDENCE
BASED
PRACTICE
-Ms. Sucheta Panchal

5. • Definitions
• Aims
• Purposes
• Research utilization
and EBP
• Historical view
• Types of Evidence
and evidence
hierarchies
• Resources
• Uses
• Barriers and Strategies
• EBP models
• Assumptions of EBP in
nursing
• Process of using
evidence in practice
• EBP in organizational
context
• Limitations
• Role of nurses
CONTENT

6. • Define evidence based practice
• Describe the aims and purposes of EBP
• Identify the difference between EBP and
research utilization
• Encounter the origin of concept of EBP
• Classify the evidences in hierarchial fashion
• Identify different resources of EBP
• Describe the uses of EBP
OBJECTIVES

7. • Identify the barriers and the strategies to
overcome
• Enlist the EBP models
• Explain the Assumptions of EBP in
nursing
• Follow the Process of using evidence in
practice
• Determine the Limitations to EBP
• Describe the Role of nurse in EBP
OBJECTIVES

8. DEFINITIONS

9. "The integration of the best research
evidence with clinical expertise and patient
values"
Sackett, et al. 2000
EVIDENCE BASED
PRACTICE

10. "The integration of the best available
research with clinical expertise in the
context of patient characteristics, culture
and preferences."
American Psychological Association
(2006, p. 273)
EVIDENCE BASED
PRACTICE

11. “A problem-solving approach to clinical decision making
within a health-care organization that integrates the
best available scientific evidence with the best
available experiential evidence. EBP considers
internal and external influences on practice and
encourages critical thinking in the judicious application
of evidence to care of the individual patient, patient
population, or system. EBP uses the latest research
evidence to produce high quality health care. The
challenge for health-care providers is to implement the
best interventions and practices informed by the
evidence.
Newhouse, Dearholt, Poe, Pugh, & White, 2005
EVIDENCE BASED
PRACTICE

12. EVIDENCE BASED
NURSING
“An integration of the best evidence
available, nursing expertise, and the
values and preferences of the individuals,
families, and communities who are
served.”

13. EVIDENCE BASED
NURSING
"Evidence-based decision-making is a
continuous interactive process involving
the explicit, conscientious and judicious
consideration of the best available
evidence to provide care."
Position Statement by Canadian Nurses'
Association

14. EVIDENCE BASED
NURSING
In increasing numbers, nurses as members
of interdisciplinary and transdisciplinary
teams are implementing evidence-based
practice (EBP) changes.
Worral PS, 2009

15. • To provide the highest quality and most cost-
efficient nursing care possible.
• To advance quality of care provided by nurses.
• To increases satisfaction of patients
• To focus on nursing practice away from habits
and tradition to evidence and research.
AIMS OF EVIDENCE BASED
NURSING PRACTICE

16. • Replaces practice as usual, with practice
guided by rigorous outcome-oriented
research, ideally randomized controlled trials.
• Makes practice a less subjective enterprise
• Raises the practice to a higher level of
accountability.
• Identifies best practices in nursing and other
disciplines. (Baumann SL, 2010)
PURPOSES OF EVIDENCE
BASED NURSING
PRACTICE

17. RESEARCH
UTILISATION AND
EVIDENCE BASED
PRACTICE

18. • Since the introduction of EBP in the 1990s,
questions regarding the relationship
between RU and EBP have been raised.
• The terms are often used interchangeably;
however, they are not synonymous.
RU & EBP

19. The two major differences
• RU uses only
research evidence
• RU is dependent on
research publication
and availability
• EBP incorporates
non-research
evidence
• EBP includes sources
of data not yet
published and
organizational data
RU & EBP

20. • EBP incorporates
– Theory
– Clinical decision making
– Clinical judgment
– Knowledge of research techniques
– followed by application of the best, most
effective, and clinically meaningful evidence
(Melnyk & Fineout-Overholt, 2005).
RU & EBP

21. • Evidence constitutes research findings as well
as other sources of credible information such
as
quality improvement data
operational data
evaluative data
consensus of experts
affirmed clinical experience
patient preference.
RU & EBP

22. RU uses the same critical review,
recommendation, and implementation process
as EBP
RU & EBP

23. • In 1972, A. L. Cochrane, a British
epidemiologist, criticized the health profession
for not knowing the outcomes of medical
treatment.
• In the 1980s, the term evidence based medicine
was being used at McMaster University Medical
School in Canada.
HISTORICAL VIEW

24. • These events led to the establishment, in 1993,
of the Cochrane Collaboration to provide
systematic reviews about the effects of health
care.
• These reviews provide logical reasoning and
sound evidence for providing effective treatment
regimes.
HISTORICAL VIEW

25. • Relatively new developments include:
– Increasingly sophisticated analytical techniques
– Improved presentation and dissemination of
information
– Growing knowledge of how to implement
findings while effectively considering patient
preferences, costs, and policy issues
– Better understanding of how to measure effect
and use feedback to promote ongoing
improvement.
HISTORICAL VIEW

26. WAYS OF ACQUIRING
KNOWLEDGE IN NURSING
Traditions
Authority
Borrowing
Trial & Error
Personal Experience
Role Modeling
Intuition
Reasoning
Research

27. • Used to rank study findings and other
information according to the strength of
evidence provided.
EVIDENCE HIERARCHES

28. • Best evidence refers generally to findings from
researches that are methodologically
appropriate, rigorous and clinically relevant for
answering pressing questions
• Questions are:
– Efficacy
– safety
– cost effectiveness of nursing interventions
– reliability of nursing assessment measures
– determinants of health and wellbeing.
EVIDENCE HIERARCHES

29. • Systematic reviews
• Cornerstone of EBP
• Rigorous integration of research evidence from multiple
studies on a topic
• Involve meta-synthesis of qualitative studies or meta-
analysis of quantitative studies
• Sources for systematic reviews are:
– Cochrane Collaboration (www.cochrane.org)
– Cochrane reviews
– Methodological abstracts
– Campbell collaboration (C2- SPECTR, RIPE)
RESOURCES OF EBP

30. • Clinical practice guidelines
–Evidence-based practice guidelines combine
a synthesis of research evidence with
specific recommendations for clinical
decision making
–Clinical practice guidelines should be
carefully and systematically appraised
RESOURCES OF EBP

31. • Clinical practice guidelines
–Sources are:
– MEDLINE
– National Guidelines clearinghouse
(www.guidelines.gov)
– RNAO (Registered Nurse Association of Ontario,
Canada- www.rnao.org/best practices.)
– National institute for clinical excellence
(www.nice.org.uk)
– Association of women’s health, obstetric and neonatal
nursing (AWHONN- www.awhonn.org)
RESOURCES OF EBP

32. • Other pre appraised evidence
–Preprocessed or pre-appraised evidence
is research evidence that has been
carefully selected from primary studies
and evaluated for use by clinicians.
–Sources are:
• Clinical evidence (www.clinicalevidence.com)
• Evidence based nursing
(www.evidencebasednursing.com)
RESOURCES OF EBP

33. • Journals and professional organizations
are increasingly publishing brief clinical
synopses of research evidence from high
quality studies and systematic reviews.
• e. g. CAT (critically appraised topic)- best
practice recommendations on a topic.
RESOURCES OF EBP

34. • Nurses (RN, NP)
• Nursing assistants
• Physicians
• Respiratory Therapists
• Physical Therapists
• Pharmacists
• Others
USERS OF EBP

35. • supports and informs clinical,
administrative, and educational
decision making.
• EBP ensures 3E
–E-efficacy
–E-efficiency
–E-effectiveness
USES OF EBP

36. • EBP weighs risk, benefit, and cost against a backdrop
of patient preferences.
• This decision making encourages health-care
providers to question practice and determine which
interventions work and which do not.
• EBP ensures that nurses use evidence to promote
optimal outcomes or equivalent care at lower cost or in
less time that health-care providers promote patient
satisfaction and higher health-related quality of life.
USES OF EBP

37. • Nancy Dickenson hazard states, “nurses have
the capacity to serve as caregivers and change
agents in creating and implementing community
and population-focused health systems”
• Evidence based nursing practice is an attempt to
facilitate the management of the growing
literature and technology accessible to health
care providers that can potentially improve
patient care and their outcomes.
BARRIERS AND STRATEGIES
TO OVERCOME

38. • There is also a need to overcome the barrier to
encourage the use of research by new
graduates in an attempt to ensure familiarity with
the process.
BARRIERS AND STRATEGIES
TO OVERCOME

39. • STETLER MODEL: Models that provide a
framework for individual clinicians
• IOWA MODEL: For organizations or team of
clinicians
• ROGER’S MODEL: Diffusion of innovations
theory
EBP MODEL

40. • Melnyk & Fineout Overholt 2005: Advancing
research and clinical practice through close
collaboration model (ARCC)
• Soukup 2000: Center for advanced nursing
practice model
• Goode & Piedalue, 1999: Evidence based
multidisciplinary practice model
EBP MODEL

41. • Newhouse et al, 2005: John’s Hopkins
Nursing EBP model
• Logan &Graham, 1998: Ottawa model of
Research use
• Dicenso et al.2005: Framework for adopting
an evidence based innovation
EBP MODEL

42. • Nursing is both a science and an applied
profession.
• Knowledge is important to professional
practice, and there are limits to knowledge
that must be identified.
• Not all evidence is created equal, and there is
a need to use the best available evidence.
• Evidence-based practice contributes to
improved outcomes (Newhouse).
ASSUMPTIONS OF EBP IN
NURSING

43. • Nurses have regular opportunity to put
research into practice
• EBP is the integration of clinical expertise,
patient values and the best research
evidence into the decision making process
for the patient care (sackett D, 2002)
PROCESS OF USING EBP

44. PROCESS OF USING EBP

45. – Clinical expertise
• Clinician’s cumulated experience
• Education and clinical skills
– Patient values
• Patient brings to encounter his or her own personal
preferences and unique concerns, expectations
and values
– Best research evidence
• Found in clinically relevant research that has been
conducted using sound methodology
PROCESS OF USING EBP

46. PROCESS OF USING EBP
• The evidence, by itself, does not make the
decision but it can help to support the patient
care process
• The full integration of these three
components enhances the opportunity of
optimal clinical outcomes and quality of life

47. PROCESS OF USING EBP
• The practice of EBP is usually triggered by patient
encounters which generate questions about the
effect of therapy, the utility of diagnostic tests, the
prognosis of diseases and/or the etiology of
disorders.
• EBP requires new skills of the clinician including
efficient literature searching and the application of
formal rules of evidence in evaluating the clinical
literature.

48. 1. FRAMING AN ANSWERABLE CLINICAL
QUESTION
– Include PICO (patient intervention comparison
outcome)
– P- Patient disorder or disease
– I- Intervention or finding under review
– C- compare intervention
– O-Outcome
– PICO application is a systematic way to identify
important concepts in a case and formulate a
question for searching
STEPS IN EBP

49. 2. SEARCHING FOR RELEVANT
RESEARCH BASED EVIDENCE
• Consult several type of information
resources such as:
–General information resources ( E-books)
–Filtered resources (Cochrane, natural
standard)
–Unfiltered resources (CINHAL, BIOSIS,
PsycINFO)
STEPS IN EBP

50. 3. CRITICAL APPRAISAL
An appraisal of the evidence involves such
considerations as the validity of study findings,
their clinical importance, the precision of
estimates of effects, associated costs and risks
and utility in a particular clinical situation.
STEPS IN EBP

51. 4. INTEGRATING EVIDENCE WITH OTHER
FACTORS
Integration with clinical expertise, patient
values and best research evidence.
STEPS IN EBP

52. 5. IMPLEMENTING THE EVIDENCE AND
EVALUATING OUTCOMES
–It is to determine whether our action or
decision was useful and achieved the
desired outcome.
–Outcomes will be evaluated on the basis of:
• Transferability
• Feasibility
• Cost/ benefit ratio
STEPS IN EBP

53. • Selecting a problem for an EBP project
• Addressing practical issues in organizational
EBP efforts
• Finding and appraising evidence clinical practice
guidelines
• Making decisions based on evidence appraisals
• Assessing implementation potential
• Developing evidence based guidelines
• Implementing and evaluating the innovation
EBP IN AN ORGANISATIONAL
CONTEXT

54. • Resistant to changes in nursing practice.
• Ability to critically appraise research
findings.
• Time, workload pressures, and competing
priorities.
• Lack of continuing education programs.
• Fear of "stepping on one's toes"
• Poor administrative support.
LIMITATIONS

55. • Read widely and critically:
– Professionally accountable nurses keep abreast of
important developments and real journals relating
to their specialty, including research report in
them.
• Attend professional gathering:
– Conferences, workshops, CNEs include
presentation of studies that have clinical
relevance. Attendees get opportunities to meet
researches and to explore practice implications.
NURSE’S ROLE IN EBP

56. • Learn to expect evidence that a
procedure is effective:
– Standardization of any procedure is based on
the effectiveness of its outcome. Nurses need
to develop expectations that the made
decision is based on sound evidence based
rationales.
• Involve in journal club:
– Many organizations employ nurses sponsor
journal clubs that review research articles that
have potential relevance to practice.
NURSE’S ROLE IN EBP

57. • Pursue and participate in research
utilization/ evidence based practice
projects:
– Nurses need to develop more positive attitude
towards research and better research skills.
NURSE’S ROLE IN EBP

58.
“EBP is not cook-book practice-
evidence needs extrapolation to
the patient’s unique biology and
values
EBP is not cost-cutting practice-
when efficacy for the patient is
paramount, costs may rise, not

59. SUMMARY

60. BIBLIOGRAPHY
• Ciliska, D. (2005). Educating for evidence-based practice. Journal of
Professional Nursing. Dec., 21(6), 345.
• Gambrill, E. (2003). Evidence-based practice: Implications for
knowledge development and use in social work. In A. Rosen & E.
Proctor (Eds.), Developing practice guidelines for social work
intervention (pp. 37-58). New York: Columbia University Press.
• Gibbs, L. (2003). Evidence-based practice for the helping
professions. New York: Wadsworth.
• Nancy Dickenson-Hazard (2004) Global Health Issues and
Challenges Journal of Nursing Scholarship 36 (1) , 6–10.
• Polit F. Denise and beck C. Tatano, Nursing research-generating
and assessing evidence for nursing practice, 8th
edition, Wolters
Kluwer (India) Pvt Ltd, New Delhi, page no 28-53