Chapter 10 Evidence-Based Professional Nursing Practice Evidence-Based Practice: What Is It? • Evidence-based practice (EBP) is a framework used by nurses and other healthcare professionals to deliver optimal health care through the integration of best current evidence, clinical expertise, and patient/family values Why Is EBP Relevant in Nursing? (1 of 2) • Helps resolve problems in the clinical setting • Results in effective patient care and better outcomes • Contributes to the science of nursing through the introduction of innovation to practice • Keeps practice current and relevant by helping nurses deliver care based upon current best research Why Is EBP Relevant in Nursing? (2 of 2) • Decreases variations in nursing care and increases confidence in decision making • Supports Joint Commission on Accreditation of Healthcare Organizations (JCAHO)readiness since policies and procedures are current and include the latest research • Supports high quality patient care and achievement of Magnet status Steps in the EBP Process (1 of 2) • Cultivate a spirit of inquiry and culture of EBP among nurses and within the organization • Identify an issue and ask the question • Search for and collect the most relevant and best evidence to answer the clinical question Steps in the EBP Process (2 of 2) • Critically appraise the evidence and synthesize the evidence • Integrate evidence with clinical expertise and patient preferences to make the best clinical decision • Evaluate the outcome of any EBP change • Disseminate the outcomes of the change Barriers to EBP in Nursing (1 of 3) • Lack of value for research in practice • Difficulty in changing practice • Lack of administrative support • Lack of knowledgeable mentors • Insufficient time • Lack of education about the research process • Lack of awareness about research or EBP Barriers to EBP in Nursing (2 of 3) • Research reports/articles not readily available • Difficulty accessing research reports and articles • No time on the job to read research • Complexity of research reports • Lack of knowledge about EBP • Lack of knowledge about the critique of articles Barriers to EBP in Nursing (3 of 3) • Feeling overwhelmed by the process • Lack of sense of control over practice • Lack of confidence to implement change • Lack of leadership, motivation, vision, strategy, or direction among managers Promoting EBP: Individual Nurse • Educate yourself about EBP • Conduct face-to-face or online journal clubs, share new research reports and guidelines with peers, and provide support to other nurses • Share your results through posters, newsletters, unit meetings, or a published article • Adopt a reflective and inquiring approach to practice Strategies to Promote EBP: Organizations • Specific identification of the facilitators and barriers to EBP • Education and training to improve knowledge and strengthen beliefs related to the benefits of EBP • Creation of an environment that encourages an inquisitive approach to patient care PICO(T) • P: Patient, population, or problem • I: Intervention, exposure, or topic of interest • C: Comparison or alternate intervention • O: Outcome • (T): Time or timeframe PICO(T) Questions • In (patient or population), what is the effect of (intervention or exposure) on (outcome) compared with (comparison or alternate intervention)? • For (patient or population), does the introduction of (intervention or exposure) reduce the risk of (outcome) compared with (comparison or alternate intervention)? Electronic Resources • National Library of Medicine • Cochrane Library • National Guideline Clearinghouse • Joanna Briggs Institute • Agency for Healthcare Research and Quality • Centre for Health Evidence • Registered Nurses’ Association of Ontario Evaluation of Evidence • What is the source of the information? • When was it developed? • How was it developed? • Does it fit the current clinical environment? • Does it fit the current situation? Levels of Evidence • Meta-analysis or systematic reviews of multiple welldesigned controlled studies • Well-designed randomized controlled trials • Well-designed nonrandomized controlled trials • Observational studies with controls • Systematic review of descriptive and qualitative studies • Single descriptive or qualitative study • Opinions of authorities and/or reports of expert committees Appraisal of Research Using the Critical Appraisal Skills Programme (CASP) • Checklists provide tools to interpret research evidence • Checklists are specific to types of research • Checklists provide frameworks to determine strength and reliability of research reports Institute of Medicine (IOM) Standards for Clinical Practice Guideline Development • STANDARD 1: Establishing • STANDARD 2: Management of conflict of interest • STANDARD 3: Guideline development group composition • STANDARD 4: Use of systematic reviews • STANDARD 5: Establishing evidence and strength of recommendations • STANDARD 6: Articulation of recommendations • STANDARD 7: External review • STANDARD 8: Updating Appraisal of Guidelines for Research and Evaluation (AGREE II) • Scope and purpose • Stakeholder involvement • Rigor of development • Clarity and presentation • Application • Editorial independence AGREE II Category #1 • Scope and purpose – Overall objectives of the guideline are specifically described – The health questions covered by the guideline are specifically described – The population to whom the guideline is meant to apply are specifically described AGREE II Category #2 • Stakeholder involvement – Guideline development group includes individuals from all relevant professions – The views and preferences of the target population have been sought – Target users of the guideline are clearly defined AGREE II Category #3 (1 of 2) • Rigor of development – Systematic methods were used to search for evidence – The criteria for selecting the evidence are clearly described – The strengths and limitations of the body of evidence are clearly described – The methods used for formulating the recommendations are clearly described AGREE II Category #3 (2 of 2) • Rigor of development (cont.) – The health benefits, side effects, and risks have been considered in formulating recommendations – There is an explicit link between the recommendations and the supporting evidence – The guideline has been externally reviewed by experts prior to publication – A procedure for updating the guideline is provided AGREE II Category #4 • Clarity and presentation – Recommendations are specific and unambiguous – Different options for management of the condition or health issue are clearly presented – Key recommendations are easily identifiable AGREE II Category #5 • Application – The guideline describes facilitators and barriers to its application – The guideline provides advice and/or tools on how the recommendations can be put into practice – The potential resource implications of applying the recommendations have been considered – Guideline presents monitoring and/or auditing criteria AGREE II Category #6 • Editorial independence – The views of the funding body have not influenced the content of the guideline – Competing interests of guideline development group members have been recorded and addressed Implementation Models for EBP • Center for Advancing Clinical Evidence (ACE) Star Model of Knowledge Transformation • The Iowa Model of Evidence-Based Practice • Agency for Healthcare Research and Quality Model • Johns Hopkins Nursing Evidence-Based Practice Model • Diffusion of Innovation Framework
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