This document discusses evidence-based nursing practice (EBNP). It defines EBNP as using the best available research evidence, clinical expertise and patient preferences to make clinical decisions. It describes several models of EBNP, including the Johns Hopkins Nursing EBP model and the Iowa model. It outlines the steps involved in EBNP, potential barriers to its implementation, and advantages such as improved patient outcomes. Overall, the document promotes EBNP as a way to provide the highest quality nursing care through integrating the best research evidence into daily clinical decision making.

1. Welcome

2. COLLEGE OF NURSING
MADRAS MEDICAL COLLEGE, CHENNAI.
ADVANCE NURSING PRACTICE.
SEMINAR ON
EVIDENCE BASED NURSING PRACTICE
SUBMITTED BY:
SUNDARAMOORTHY.M
MSc (N) I YEAR,
COLLEGE OF NURSING,
MMC, CHENNAI.

3. INTRODUCTION
* During 1980s the term evidence
based medicine emerged to describe
the approach that used scientific
evidence to determine the best
practice.

4. EB Nursing was started during the year of
1800s with the help of the Florence Nightingale.
As clinicians other than Physicians
recognized the importance of scientific
evidence in clinical decision Making.
Evidence – based medicine (or) evidence
based practice (EMP) is the judicious use of the
best current evidence in making decisions
about the care of individual patient.

5. MEANING:-
EVIDENCE:-
It is something that furnishes proof
or testimony or something legally submitted to
ascertain in the truth of matter.

6. EVIDENCE BASED PRACTICE:-
* It is systematic 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)

8. EBP IN NURSING:-
It is a process of Locating
,Appraising and Applying the best evidence
from the Nursing and Medical literatures to
improve the quality of clinical nursing practice.
(Suresh k.Sharma)

9. NEED FOR EBP IN NURSING :-
1)For making sure that each client get
the best possible services.
2)Update knowledge and is essential
for life long learning.
3)Provide clinical Judgment .
4)To Improve the nursing care and save
the lives .

10. PURPOSES
1. To eliminate unsound or excessively risky practices.
2. To provide highest quality & most cost effective
nursing care.
3. To contribute a lots towards better patient
outcome.
4. To specify the way enrich professionals or other
decision makers should make decision by identifying such
evidences. . ....... …………….. .

11. AIMS OF EBNP:-
* To provide the high quality and most cost
effective nursing care.
* To advance quality of care provided by the
nurse .
* To increase satisfaction among patients .
* To focus on nursing practice away from
habits and tradition to evidence and research.
* It results in better patient outcomes .
* It contributes to the science of nursing.
* It keeps practice current and relevant.
* It increases confidence in decision making.

12. Acquire
ASK
Audit
Apply Appraise
STEPS ON EVIDENCE BASED PRACTICE

13. STEPS OF EBNP:
1.Ask:- Form a clinical question to
identify a problem.
2.Acquire:- Gather the best evidence.
3.Appraise:- Analyze the best evidence.
4.Apply:- Apply the evidence to clinical
practice.
5.Audit:- Assess the result.

14. SOURCES OF EVIDENCE:-
The sources of evidence are
categorized into following headings.
* Filtered sources
*Unfiltered sources
*Clinical Experience
*Knowledge from patient
*Knowledge from local context.

16. MODELS OF EBNP
JOHN HOPKINS NURSING EBP MODEL:-
Used as a framework to guide the
synthesis and translation of evidence into practice.
PHASES OF JHNEBP MODEL:-
1.Identification of an answerable question
2.A systematic review and synthesis of both
research and non research evidence.
3.Translation includes implementation of the
practice change as a pilot study, measurements of
outcomes and dissemination of findings

17. JOHN HOPKINS NURSING EBP MODEL:-
RESEARCH
*Experimental
*Quasi experimental
*Non experimental
*Qualitative
NON RESEARCH
*Organizational experience
*Quality improvement
*Financial data
*clinical expertise
*patient preference
PRACTICE
EDUCATION RESEARCH
INTERNAL FACTORS
Culture
Environment
Equipment/supplies
Staffing
Effectiveness
Standards
EXRERNAL FACTORS
Accreditation
Core measures
Legislation
Licensing
Standards

18. IOWA MODEL
The IOWA model focuses on organization
and collaboration incorporating conduct and
use of research, along with other types of
evidence. It was originated in 1994.
TRIGGERS IN THE MODEL
*Knowledge focused trigger
*Problem focused trigger

19. KNOWLEDGE FOCUSED TRIGGER
*New research or other literature.
*National agencies or
organizational standards of care.
*Philosophies of care.
*Questions from institutional
standards committee.

20. PROBLEM FOCUSED TRIGGER:-
*Risk management data.
*Process improvement data.
*Internal/External benchmarking
data.
*Financial data.
*Identification of clinical problem.

22. STETLER MODEL
.
In this model examine how to use
evidence to create formal change with in
organization policies or procedure as well
as how individual practitioner can use
research on an informal basis as part of
critical thinking and reflective practice

23. PHASES OF STETLER MODEL:
1. Preparation phase
2. Validation phase
3. Comparative
Evaluation/Decision making
phase
4.Translation/Application phase
5.Evaluation phase. .

24. . 1. PREPARATION:-
- Identify a priority need.
- Review the content in which research
utilization would occur.
- Organize the work.
- Initiate the research systematically.
2. VALIDATION:-
- Critique each study systematically.
- Choose and summarize the collected
research that relates to the identified need.

25. 3. DECISION MAKING:-
Make decisions about use after synthesizing
body of summarized evidence.
4. TRANSLATION:-
Converting findings, planning their
application, putting the plan to use and then
implementing use with an evidence based practice.
5. EVALUATION:-
Evaluate the plan in terms of goals.

27. BARRIERS TO EBP:-
* Lack of value for research practice.
* Difficulty in bringing change.
* Lack of administrative support.
* Lack of knowledge.
* Lack of time for research.
* Many nurse have not receive any formal
instruction in research and they lack skill to
judge the merits of study.

28. cont
* Un availability of research reports ,which
are not easily gathered.
* Complexity of research reports, which
are not easily gathered.
* Complexity of the research regarding
evidence based practice.
* There is a shortage of role model nurse,
who can be evaluated for their success in using
or promoting the use of research in clinical
practice.

29. ADVANTAGES OF EBNP:-
1) Provide better information to practitioner
2) Enable consistency of care
3) Better patients outcome
4) Provide client focused care
5) Structured process
6) Increase confidence in decision making
7) Generalize information
8) Contribute to science of nursing
9) Provide guidelines for further research
10)Helps nurses to provide high quality patient care

30. DISADVANTAGE IN EBNP :-
1)Not enough evidence for EBP
2)Time consuming
3)Reduce client choice
4)Professional judgment/autonomy
5)Suppress creativity
6)Influence legal proceedings
7)Publication bias .

31. CONCLUSION:-
Evidence based nursing care is
lifelong approach to clinical decision
making and excellence in practice.
Evidence based nursing care is
informed by research findings, clinical
expertise, patient’s values and its use
can improve patient’s outcomes..