Evidence-Informed Practice in Nursing: Key Concepts and Steps

Evidence

Information acquired through research and scientific practices (CNA, 2010).

Evidence-based medicine

Integrating individual clinical expertise + the best available external clinical evidence from systematic research.

Evidence-based practice (EBP)

A problem-solving approach to clinical practice that involves integrating high-quality research, clinical expertise, and patient/family values.

Best evidence for practice

Includes empirical evidence from systematic reviews, randomized controlled trials, and other scientific methods such as descriptive and qualitative research.

Critics of EBP

Argue that it will turn clinicians into technicians who follow a recipe and that there is a tendency to forget the client's or patient's values.

Research utilization

The process of using research findings to improve patient care, often based on a single study (Melnyk & Fineout-Overholt, 2019).

Evidence-informed practice

A broader term that encompasses not only research utilization but also the use of case reports and expert opinion in deciding the practices to be used in health care.

High-quality research in nursing practice

Will improve patient outcomes when combined with individual patient values and clinical expertise from nurses.

Barriers to implementing evidence into practice

Include the perception that it takes too much time, lack of evidence-informed practice knowledge and skills among clinicians, and lack of support in organizations.

Dissemination

The communication of research findings; dissemination activities take many forms, including publications, conferences, consultations, and training programs.

Lack of evidence-informed practice mentors

A barrier to implementing evidence into practice.

Resistance from colleagues

A barrier to implementing evidence-informed practice changes.

Focus in health professional education

Often on the research process rather than evidence-informed practice.

Patient factors in EBM or EBP

Indicate that EBM or EBP requires the integration of the best research evidence with our clinical expertise and our patient's unique values and circumstances.

Evidence-informed safety practices

Now an expected standard in many institutions.

Time perception barrier

The perception that it takes too much time to implement evidence into practice.

Knowledge and skills barrier

A lack of evidence-informed practice knowledge and skills among clinicians.

Support in organizations

Lack of support is a barrier to implementing evidence-informed practice.

Appropriate resources barrier

Lack of appropriate resources is a barrier to implementing evidence-informed practice.

Conceptual forms of using research evidence

Influence the thinking of the health care provider but not necessarily the action.

Decision-driven forms of using research evidence

Using evidence in practice encompasses application of scientific knowledge as part of a new practice, policy, procedure, or intervention.

Evidence-Based Practice to Promote Excellence in Health Care

Iowa Model Collaborative, 2017.

The Ottawa Model of Research Use

OMRU; Logan & Graham, 1998.

The Promoting Action on Research Implementation in Health Services model

i-PARIHS model; Kitson & Harvey, 2016.

Conduct and Utilization of Research in Nursing model

CURN model; Haller, Reynolds, & Horseley, 1979; Horsley, Crane, Crabtree, et al., 1983.

Identification of a clinical problem or question of practice

The first step common to most models of evidence-informed practice.

Search for best evidence

The second step common to most models of evidence-informed practice.

Critical appraisal of evidence

Involves assessing the strength, quality, quantity, and consistency of evidence.

Recommendation for action

Based on the appraisal of evidence, this can be no change, change, or further study.

Implementation of recommendation

The process of putting the recommended action into practice.

Evaluation of recommendation

Assessing the recommendation in relation to desired outcomes.

Selection of a Topic

The first step in the evidence-based process.

Forming a Team

The second step in the evidence-based process.

Evidence Retrieval

The fourth step in the evidence-based process.

Implementing the Practice Change

The fifth step in the evidence-based process.

Development of Evidence-Informed Practice

The third step in the evidence-based process.

Decision to Change Practice

The third step in the evidence-based process.

Critique of Evidence

An essential part of evaluating the quality of published articles.

Setting Forth Evidence-Informed Practice Recommendations

The second step in the evidence-based process.

Synthesis of the Research

The first step in the evidence-based process.

Selection Criteria for an Evidence-Informed Practice Project

Criteria include priority of the topic, magnitude of the problem, and applicability to clinical areas.

Strength of Evidence

High: Further research is very unlikely to change our confidence in the estimate of effect.

Quality of Evidence

Moderate: Further research is likely to have an important impact on our confidence in the estimate of effect.

Low Quality of Evidence

Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

Low

Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

Very Low

Any estimate of effect is very uncertain.

Strength of Evidence

Level of evidence + quality of evidence = strength of evidence and confidence to act and change practice.

American Association of Critical-Care Nurses

Professional organization that published evidence informed practice guidelines.

American Pain Society

Professional organization that published evidence informed practice guidelines.

Canadian Heart and Stroke Foundation

Professional organization that published evidence informed practice guidelines.

National Institute for Health and Care Excellence

Professional organization that published evidence informed practice guidelines.

Registered Nurses' Association of Ontario (RNAO)

Professional organization that published evidence informed practice guidelines.

American College of Physicians

Source for best evidence from studies of clinical problems.

Centre for Health Evidence

Source for best evidence from studies of clinical problems.

Cochrane Library

Source for best evidence from studies of clinical problems.

Joanna Briggs Institute

Source for best evidence from studies of clinical problems.

Steps of Evidence-Informed Practice

Selecting a topic, forming a team, retrieving the evidence, grading the evidence, developing an evidence-informed practice standard, implementing the evidence-informed practice, and evaluating the effect on staff, patient, and fiscal outcomes.

Evaluation

Includes both process and outcome measures.

Culture of Evidence-Informed Practice

Creating this culture requires an interactive process.

Research Utilization

The terms research utilization and evidence-informed practice are sometimes used interchangeably.

Forms of Evidence Use

There are two forms of evidence use: conceptual and decision driven.

Models of Evidence-Informed Practice

A key feature of all models is the judicious review and synthesis of research and other types of evidence to develop an evidence-informed practice standard.

Evidence-Informed Practice in Nursing

The integration of the best available research evidence with clinical expertise and patient preferences.

Important Step in Developing Evidence-Informed Practice

Evaluating the strength of the evidence from research studies.

Role of the Nurse in Evidence-Informed Practice

Incorporating clinical expertise, patient preferences, and the best available evidence.

First Step in Implementing Evidence-Informed Practice

Formulate a clinical question based on patient care needs.