EVIDENCE-BASED PRACTICE IN NURSING

EVIDENCE-BASED
PRACTICE IN NURSING
REFERENCE: FUNDAMENTALS OF NURSING 10TH EDITION, 2021
(HALL, AMY M. PERRY, ANNE GRIFFIN POTTER ETC.)

THE NEED FOR EVIDENCE-BASED PRACTICE
Evidence-based practice (EBP) is a problem-solving approach
to clinical care that combines the purposeful and systematic
application of best evidence with a clinician's skills, patient
preferences and values, and accessible health care resources
when making patient care decisions.

THE NEED FOR EVIDENCE-BASED PRACTICE
…Implementing new knowledge into practice requires a
systematic approach that incorporates evidence-based
practices to enhance clinical educational and administrative
practice.

SOURCES OF EVIDENCE
 A textbook incorporates evidence into the
information, practice guidelines, and procedures it
includes.
 Articles from nursing and health care literature are
available on almost any topic involving nursing
practice in either journals or on the internet.

SOURCES OF EVIDENCE
The challenge is to obtain the very best, most relevant,
current, and accurate information when you need it for
patient care.
The best scientific evidence comes from well-designed studies
published in peer-reviewed journals. After a study is
completed, researchers can typically determine if a new
treatment or technique works.

SOURCES OF EVIDENCE
Application of evidence and outcomes vary depending
on your patients' values, health, preferences, worries,
and/or expectations. Evidence-based practice requires
ethical and accountable professional nursing practice.
As a nurse, you utilize critical thinking to decide which
evidence is relevant to your patients' situations.

STEPS OF EVIDENCE-BASED PRACTICE
Evidence-based practice is a methodical, problem-
solving approach that enables the implementation of
best practices. Adhering to a step-by-step process
consistently guarantees that you receive the strongest
available evidence for use in patient care.

1. Cultivate a spirit of inquiry within an EBP culture and
environment.
2. Ask a clinical question in picot format.
3. Search for the most relevant and best evidence.
4. Critically appraise the evidence you gather.

5. Integrate the best evidence with your clinical expertise and
patient preferences and values to make the best clinical
decision.
6. Evaluate the outcomes of practice changes based on
evidence.
7. Communicate the outcomes of EBP decision or changes.

Always keep your practice in mind when caring for
patients. What does not make sense to you and what
requires clarification? Consider a time-consuming,
costly, or irrational problem or area of interest. These
reflections are part of a continuing quest for best
practices.

TO FORMULATE QUESTIONS IN EVIDENCE BASED
PRACTICE, USE THE PICOT FORMAT
PICOT stands for:
• Population/ patient problem: who is your patient?
(Disease or health status, age, race, sex)
• Intervention: what do you plan to do for the patient?
(Specific tests, therapies, medications)
• Comparison: what is the alternative to your plan? (Ie. No
treatment, different type of treatment, etc.)

TO FORMULATE QUESTIONS IN EVIDENCE BASED
PRACTICE, USE THE PICOT FORMAT
• Outcome: what outcome do you seek? (Less
symptoms, no symptoms, full health, etc.)
• Time: how long does it take for an intervention to
accomplish a result (Example, How long does it take
to modify a patient's quality of life or behavior)?

YOUR PICOT QUESTION WILL FALL UNDER ONE OF
THESE TYPES:
 Therapy/prevention
 Diagnosis
 Etiology
 Prognosis

Once you have a PICOT question, you can start looking for
evidence. Evidence for your question can be found in agency
policy and procedure manuals, quality improvement statistics,
existing clinical practice recommendations, and journal papers.
Ask for help finding relevant evidence. Nurse educators, risk
managers, and infection control nurses are key resources.
YOUR PICOT QUESTION WILL FALL UNDER ONE OF
THESE TYPES:

RATING SYSTEM FOR THE HIERARCHY OF
EVIDENCE: QUANTITATIVE QUESTIONS
LEVEL 1
LEVEL 2
LEVEL 3
LEVEL 4
LEVEL 5
LEVEL 6
LEVEL 7

Level I: Evidence from a systematic review of all relevant randomized
controlled trials (RCT's), or evidence-based clinical practice guidelines
based on systematic reviews of RCT's
Level II: Evidence obtained from at least one well-designed
Randomized Controlled Trial (RCT)
Level III: Evidence obtained from well-designed controlled trials
without randomization, quasi-experimental

Level IV: Evidence from well-designed case-control and cohort studies
Level V: Evidence from systematic reviews of descriptive and qualitative
studies
Level VI: Evidence from a single descriptive or qualitative study
Level VII: Evidence from the opinion of authorities and/or reports of expert
committees

ELEMENTS OF EVIDENCE-BASED ARTICLES
1. ABSTRACT. An abstract rapidly tells you if the article is
scientific or clinical. An abstract outlines the article's goal.
2. INTRODUCTION. The introduction explains the article's
There is generally a brief explanation of the topic's importance.
The abstract and introduction combined help you decide
whether to read the whole article.

3. LITERATURE REVIEW OR BACKGROUND. A good
author provides a full background of the topic's
scientific or clinical facts. The literature review
explains why the author chose to examine or report
on a clinical subject.

4. MANUSCRIPT NARRATIVE. The article's "middle
section," or narrative, varies according on the sort of
evidence-based article.
Example: A clinical article explains a patient population, the nature of
an illness or health change, how patients are affected, and the
necessary nursing therapies.

5. PURPOSE STATEMENT: Describes a study's
purpose. Predictions concerning the relationship or
differences among study variables (concepts,
qualities, or characteristics that vary among subjects)
are called research questions.

6. METHODS OR DESIGNS: This section outlines the
steps taken to address the research question or test
the hypothesis. This section describes the study's
design and the number of participants. Patients,
family members, and health care workers are
common research subjects.

7. ANALYSIS: This section outlines how a study's
data is analyzed. If the study collects quantitative
data such as physical measures or survey ratings, the
results are discussed.

8. RESULTS OR CONCLUSIONS: An article's
summary section. In a clinical paper, the author
discusses the topic's clinical consequences. A
research article describes the findings of a study and
how a hypothesis or research question is answered.

…In this part, an author should also highlight study
limitations. The limits information might help you
determine whether to utilize the evidence with your
patients. Ask a professor or a nurse to assist you
comprehend statistical data.

9. CLINICAL IMPLICATIONS: A research paper
contains a section describing if the study's findings
have clinical relevance. The researcher discusses the
generalizability of the findings or how to use them in
practice for the sort of subjects researched.

INTEGRATE THE EVIDENCE
Once you have determined that the evidence is
reliable and pertinent to your patients and clinical
setting, you may begin determining how to
incorporate it into practice. The first step is to
incorporate the study into your patient's plan of
care. Utilize the evidence you discover to justify an
intervention you intend to try.

When you work on a hospital committee or task
force, EBP changes can be significant. Engaging all
stakeholders (individuals who have an interest or
concern in the practice change) requires explaining
the importance of evidence-based treatments.

Consider the setting in which the evidence will be
used and inquire if stakeholders support the change.
To incorporate evidence into practice, all
stakeholders must be educated. This includes
educational seminars, informative newsletters, and
periodic staff meetings.

Integrating evidence into practice is frequently
accomplished by incorporating new evidence into
policies and processes (P&Ps). A critical aspect of an
evidence-based practice environment is the
requirement that clinical practice policies and
procedures be evidence-based.

EVALUATE THE OUTCOMES OF THE
PRACTICE DECISION OR CHANGE
After using evidence in your practice, evaluate the
results. How does it work? Is your patient or practice
setting the clinical decision? Sometimes evaluating
an intervention is as simple as verifying whether the
intended outcomes are met.

COMMUNICATE THE OUTCOMES OF THE
EVIDENCE-BASED PRACTICE DECISION
It's critical to communicate the results of EBP
changes. If you use an evidence-based intervention
on one patient, you and the patient decide how
effective it is. When a nursing unit changes a
practice, the clinical staff on that unit is often the
first to discuss the outcomes.

Huddles and visual management tools like a Gemba
board for process issues are useful ways to
communicate EBP modifications.
Share the data with professional bodies such as the
nursing practice council, EBP council, or research council
to support professional development and improved
patient outcomes.

As a professional nurse, you must contribute to the
developing body of nursing knowledge. Nurses
frequently report EBP changes during clinical grand
rounds and professional conferences. Professional
organizations enable them to present EBP
improvements in scientific abstracts, posters, or even
podium presentations.

SUSTAIN KNOWLEDGE USE
It's difficult to sustain EBP-induced changes in
practice. Government and accrediting bodies,
internal administrative initiatives, and the continual
pressures of providing safe and effective patient care
bombard health care organizations.

SUSTAIN KNOWLEDGE USE
It is critical to integrate new practice changes into an
organization's culture and practice environment.
Institutions must adopt targeted measures to sustain
EBP choices and modifications. Major health care
systems often recruit nurse researchers or scientists to
run and expand their EBP and nursing research
programs.

NURSING RESEARCH
By conducting nursing research, you can
discover out new information, improve nursing
education, and better utilize healthcare
resources. To re-search or re-examine. ..

NURSING RESEARCH
…It is a methodical procedure of asking and
answering questions. The knowledge supports
nursing practice and validates nursing
interventions.

NURSING RESEARCH
Nursing research improves professional
education and practice, and helps nurses use
resources efficiently (e.g., establishing the
optimal nurse-assistant ratio on a nursing
unit). ..

NURSING RESEARCH
…Science in nursing continues to expand,
allowing nurses to deliver safe and effective
patient care. There are many professional and
specialized nursing organizations with research
goals for their members.

TRANSLATION RESEARCH
― Translation research aims to improve
patient outcomes and population health by
exploring implementation methods.
― It is also called implementation science.

― Translation research studies aim to examine
implementation tactics to see which ones
perform best to enhance EBP use.

― By performing translation research, nurses
can enhance and sustain the use of the best
available evidence in clinical practice, with
the aim of enhancing patient care,
population health, and health outcomes.

5 PHASES OF TRANSLATION RESEARCH
Preclinical and animal studies—basic science
research
Phase 1 clinical trials - testing safety and
efficacy in a small group of human subjects

Phase 2 and 3 clinical trials - testing safety and
efficacy in a larger group of human subjects and
testing for comparison to standard treatment.
Phase 4 clinical trials and outcomes research -
translation to practice

Phase 5 population-level outcomes research—
translation to community
In translation research, a study evaluates the tactics used to
implement and maintain EBP, whereas EBP focuses on the
utilization of the best available evidence in practice.
Research into translation poses a research topic and a
hypothesis.

OUTCOMES RESEARCH
Outcomes research assists patients, health care
professionals, and everyone involved in health care
policy in making evidence-based decisions. Typically,
outcomes research examines the benefits, dangers,
costs, and overall effects of a treatment on patients.

OUTCOMES RESEARCH
Components of an outcome consist of the
outcome itself, how it is observed (the
indicator), its important qualities (how it is
assessed), and its spectrum of parameters.

SCIENTIFIC METHOD
The scientific method is the most dependable and
impartial way to gather knowledge. This method is a
scientific way to learn. Incorporate research-based
evidence into practice and do more research. When
completed correctly, you know that the study
supports the validity, reliability, and generalizability
of the data.

CHARACTERISTICS OF SCIENTIFIC
RESEARCH
1. The research identifies the problem or study area.
2. A research study is planned and executed in a
systematic manner.
3. Researchers try to control variables that aren't being
researched but can affect a link between variables.

CHARACTERISTICS OF SCIENTIFIC
RESEARCH
4. Researchers employ empirical data
collected through observations and
assessments to uncover new information.
5. The goal is to apply study findings to a
larger patient population.

NURSING AND THE SCIENTIFIC
APPROACH
Nursing research addresses key nursing
topics. Some of these concerns concern the
profession itself, nurse education, individual
patient and family requirements, and issues
within the health care delivery system.

NURSING AND THE SCIENTIFIC
APPROACH
After research is completed, it is critical to
share the findings. Publication of
discoveries in professional publications is
one form of dissemination. Clinical issues
are studied in nursing research.

TYPES OF RESEARCH
1. Historical research designed to establish facts and links
relating to the past
2. Exploratory research. Initial investigation aimed at
developing or refining the dimensions of phenomena (facts
or happenings) or developing or refining a hypothesis
regarding the links between phenomena.

TYPES OF RESEARCH
3. Evaluation research. Evaluation of the
effectiveness of a program, practice, or policy.
4. Descriptive research. A study that examines the
qualities of individuals, circumstances, or groups, as
well as the frequency of events or attributes.

TYPES OF RESEARCH
5. Experimental research: The researcher controls the
study variable and randomly assigns individuals to various
situations in order to test the variable.
6. Correlational research. Study that explores the
interrelationships among variables of interest without any
active intervention by the researcher.

TYPES OF RESEARCH APPROACH
1. QUANTITATIVE RESEARCH (Experimental, non-
experimental, surveys, evaluation research)
2. QUALITATIVE RESEARCH

QUANTITATIVE RESEARCH
Quantitative research is the exact, methodical, and
objective analysis of concepts. It emphasizes
numerical data, statistical analysis, and controls in
order to avoid bias in the conclusions.

TYPES OF QUANTITATIVE METHOD
a. Experimental research - The standard of care is
compared to an intervention (e.g., a new medicine,
therapy, or instructional method). Subjects are
randomly assigned to either the control or treatment
group.

b. Nonexperimental Research. Nonexperimental
descriptive studies describe, explain, or predict phenomena
(an observable fact, event, or occurrence). Example: A case-
control study investigates if one or more predictor
variables are associated with the condition.

…Correlational research explicates the connection between
two variables (e.g., the age of the adolescents and whether
the adolescents smoke). The researcher determines
whether and to what extent the two variables are
connected or associated with one another.

c. Surveys collect data about people's habits, perceptions,
education, experience, and opinions. A survey's primary
function is description. Surveys collect a lot of data on the
population and the study issue. In surveys, the population
sampled must be large enough to minimize sampling error.

d. Evaluation research determines why a program (or
some program components) is effective or ineffective.
When programs are failing, evaluation research
identifies program faults, potential for change, and
implementation hurdles.

QUALITATIVE RESEARCH
Qualitative nursing research examines difficult-to-
quantify or-categorize phenomena, such as patients'
views of sickness or quality of life. This research
approach describes information gathered in a
nonnumerical manner, for as data in the form of
transcribed interview transcripts.

QUALITATIVE RESEARCH
It uses inductive reasoning to generate
generalizations or hypotheses from specific
observations or interviews

RESEARCH PROCESS
The research process consists of a sequence of
phases that enable a researcher to progress from
posing a research question to discovering the
answer…

RESEARCH PROCESS
…Typically, the solution to the initial research
question generates more questions and study
fields. The research procedure generates
knowledge applicable to comparable
circumstances.

RIGHTS OF HUMAN SUBJECT
1. INFORMED CONSENT
2. CONFIDENTIALITY

INFORMED CONSENT
a. Are given full and complete information about the
purpose of a study, procedures, data collection,
potential harm and benefits, and alternative methods of
treatment.
b. Are capable of fully understanding the research and
the implications of participation.

INFORMED CONSENT
b. Are capable of fully understanding the research and
the implications of participation.
c. Have the power of free choice to voluntarily consent
or decline participation in the research.
d. Understand how the researcher maintains
confidentiality or anonymity.

CONFIDENTIALITY
It guarantees that any information a subject
provides will not be reported in any manner that
identifies the subject and will not be accessible to
people outside the research team

COMPARISON OF STEPS OF THE NURSING
PROCESS WITH THE RESEARCH PROCESS
NURSING
PROCESS
RESEARCH PROCESS
ASSESSMENT Identify area of interest or clinical problem.
• Review literature.
• Formulate theoretical framework.
• Reflect on personal practice and/or discuss
clinical issues with experts to better define
the problem.

NURSING
PROCESS
RESEARCH PROCESS
PLANNING Determine how study will be conducted:
• Select research design/methodology.
• Identify plan to recruit sample, taking into
consideration population, number, and
assignment to groups.

NURSING
PROCESS
RESEARCH PROCESS
PLANNING • Identify study variables: specific
interventions (independent variable) and
outcomes (dependent variables).
• Select data collection methods.

NURSING
PROCESS
RESEARCH PROCESS
PLANNING • Select approach for measuring outcomes:
questionnaires, surveys, physiological
measures, interviews, observations.
• Formulate plan to analyze data: statistical
methods to answer research
questions/hypotheses.

NURSING
PROCESS
RESEARCH PROCESS
IMPLEMENTATION Conduct the study:
• Obtain necessary approvals.
• Recruit and enroll subjects.
• Implement the study protocol/collect
data.

NURSING
PROCESS
RESEARCH PROCESS
EVALUATION Analyze results of the study:
• Continually analyze study methodology. Is
study consistently carried out? Are all
investigators following study protocol?
• Interpret demographics of study population.

NURSING
PROCESS
RESEARCH PROCESS
EVALUATION Use of the findings:
• Formulate recommendations for further
research.
• Determine implications for nursing.
• Disseminate the findings: presentations,
publications, need for further study, how to
apply findings in practice.

PERFORMANCE IMPROVEMENT
• Performance improvement (PI) is a systematic method for
analyzing processes connected to health care.
• It is the attempt to achieve measurable improvements in
the efficiency, effectiveness, performance, accountability,
results, and other quality indicators of services or
processes.

PROGRAMS
It focuses on processes or systems that
significantly contribute to an organization's
outcomes and plans to sustain measurable gains
over time. Facilities need a structured way to
ensure everyone supports continual performance
improvement.

PROGRAMS
The Performance Improvement (PI) process begins
with staff involvement in detecting quality issues.
Staff employees must know the organization's
results and the practice standards or rules that
define quality.

EXAMPLES OF PERFORMANCE
IMPROVEMENT MODELS
1. Balanced Scorecard
2. Root cause Analysis (RCA)
3. Six Sigma
4. Plan-Do-Study-Act (PDSA)

BALANCED SCORECARD
A multidimensional framework for strategy
management that links objectives, initiatives,
targets, and performance measurements across
major organizational viewpoints.

ROOT CAUSE ANALYSIS
A standardized strategy for analyzing major adverse
occurrences. A basic principle of root cause analysis is to
discover underlying problems that increase the chance
of errors without falling into the trap of focusing on
errors.

SIX SIGMA
A process improvement methodology that employs a
wide array of instruments based on thorough data
analysis to discover sources of performance variation
and methods for eliminating them.

PLAN-DO-STUDY-ACT (PDSA)
A method of experiential learning that involves assessing a
quality problem and testing a change by making a strategy to
test the change (Plan), executing the test (Do), seeing the results
and learning from them (Study), and identifying which
improvements should be made to the test (Modify) (Act).

THE RELATIONSHIP BETWEEN EBP,
RESEARCH, AND PERFORMANCE
IMPROVEMENT
EBP, research, and performance improvement (PI) are
intertwined and create a clinical scholarship continuum.
To give the finest patient care, you must use all three
procedures…

IMPROVEMENT
…As a nurse, you must know the differences and which
approach to use when dealing with clinical issues or
improving patient care. Although you will utilize them all
in nursing, it is crucial to understand their similarities
and distinctions.

IMPROVEMENT
Before starting an EBP project, it is critical to
review relevant research and PI data. This data
helps you understand the scope of a problem in
your organization.

IMPROVEMENT
Personal improvement data provide information
about how processes run within an organization
and hence how to change EBP. EBP and PI can
indicate research prospects.

IMPROVEMENT
RESEARCH
EVIDENCE-
BASED
PRACTICE
PERFORMANCE
IMPROVEMENT

Similarities and Differences
among Evidence-based
Practice, Research, and
Performance Improvement

PURPOSE
Utilization of research, expert opinion, personal experience, and patient
preferences to determine safe and effective nursing interventions with the
aim of enhancing patient outcomes.
Systematic inquiry provides answers to questions, solves issues, and
contributes to the generalizable body of nursing knowledge; yet it may
or may not improve patient care.
Improves local work processes to enhance patient outcomes and health
system efficiency; findings are typically not generalizable.
RESEARCH
PERFO
RMANC
E
EVIDENCE-
BASED
PRACTICE

FOCUS
Implementation of evidence already known into practice
To discover answers to unanswered questions regarding nursing
practice, new information is developed.
Evaluates the effects of practice and/or practice modification on a
particular patient population.
RESEARCH
PERFO
RMANC
E
EVIDENCE-
BASED
PRACTICE

DATA SOURCES
Multiple research studies, expert opinion, personal experience,
patients
The qualities of subjects or participants that determine their
inclusion or exclusion from a study are predefined. Researchers
collect and evaluate data from people.
Data from patient records or patients who are in a certain place,
such as on a patient care unit or who have been admitted to a
specific hospital.
RESEARCH
PERFO
RMANC
E
EVIDENCE-
BASED
PRACTICE

WHO CONDUCTS THE
ACTIVITY?
Practicing nurses and possibly other members of the health care
team.
Researchers who may or may not be hired by the health care
organization and who are typically not members of the clinical
health care team.
Employees of a health care agency, including nurses, doctors, and
pharmacists.
RESEARCH
PERFO
RMANC
E
EVIDENCE-
BASED
PRACTICE

IS THE ACTIVITY PART OF THE
REGULAR CLINICAL PRACTICE?
YES
NO
YES
RESEARCH
PERFO
RMANC
E
EVIDENCE-
BASED
PRACTICE

IS IRB APPROVAL NEEDED?
SOMETIMES
NO
SOMETIMES
RESEARCH
PERFO
RMANC
E
EVIDENCE-
BASED
PRACTICE

FUNDING SOURCES
Internal, from health care agency
Typically, funding is external, such as a government grant.
However, foundations of larger health care organizations
frequently offer internal funds.
Internal, from health care agency
RESEARCH
PERFO
RMANC
E
EVIDENCE-
BASED
PRACTICE

The example below illustrates how the
three stages combine to enhance
nursing practice:
Recently, a nursing unit has seen a drop in patient
satisfaction with pain management. PI data
highlight factors linked with pain treatment (e.G.,
Typical pain medication orders, patient reports of
pain alleviation)

Following a thorough evaluation of PI data, a unit-
based quality council team of nurses implements
the best evidence available to improve their pain-
management policy for the unit's patients. The
team revises the pain management protocol and
evaluates it…

…Despite the improved pain-management
approach, patient satisfaction remains low. So, to
better understand this clinical issue and improve
patient care, staff perform a research study.

KEY ELEMENTS
EBP assists nurses and other healthcare professionals in
making timely, effective, and appropriate clinical decisions.
Cultivate a spirit of inquiry, formulate a clinical question
using the PICOT format, search for the most relevant and
best evidence, critically appraise the evidence…

KEY ELEMENTS
…integrate the best evidence, evaluate the outcomes of
the practice change, and communicate the results of the
change are the steps of EBP.

KEY ELEMENTS
Defining a PICOT question requires using problem-
and knowledge-focused triggers to think critically
about clinical and operational nursing unit concerns.
A PICOT question allows you to search the scientific
literature for proof.

KEY ELEMENTS
If, after evaluating the evidence for a PICOT question,
the question remains unresolved and a knowledge gap
exists, the research process is the next option for
acquiring new evidence.

KEY ELEMENTS
The research process consists of six sequential steps
that allow the researcher to progress from identifying
the problem to answering the research question.

KEY ELEMENTS
The hierarchy of evidence provides a framework for
evaluating literature or information and determining if
a source is relevant, reliable, and appropriate for use in
clinical settings.
A RCT represents the pinnacle of experimental
research.

KEY ELEMENTS
Use your clinical skills and consider the values and
preferences of patients to ensure that you use the
evidence safely and correctly in practice.
Research is a systematic process that generates
information and provides a scientific foundation for
nursing practice by posing and answering questions.

KEY ELEMENTS
Well-designed, methodically conducted research
projects provide the strongest scientific evidence.
Although EBP, research, and PI are closely related, they
are distinct nursing processes that need the utilization
of the best available evidence to provide high-quality
patient care.

EVIDENCE-BASED PRACTICE IN NURSING

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Similar a EVIDENCE-BASED PRACTICE IN NURSING

Similar a EVIDENCE-BASED PRACTICE IN NURSING (20)

Último

Último (20)

EVIDENCE-BASED PRACTICE IN NURSING