EBP and Caring - Study Notes
Evidence-Based Practice (EBP) in Nursing: From Question to Implementation
Real-world scenario to illustrate EBP process:
A pregnant heroin user expresses fear of involving child protective services (CYF) and wants to avoid trouble for herself and baby.
The speaker notes there is no definitive study answering why people with substance use disorder (SUD) don’t seek treatment; existing knowledge is anecdotal.
Conclusion: need to develop an evidence-based practice (EBP) paper and conduct a study to identify reasons for non-seeking of treatment among this population.
Research methods and types mentioned:
Anecdotal vs. evidence-based: anecdotal evidence comes from brain-based experience or individual cases; lacks generalizability.
Randomized Controlled Trials (RCTs): a type of study that uses medications vs. placebo to determine efficacy (foreground to pharmacologic questions).
Various study designs exist; when creating a study, form a team rather than doing it alone.
Steps in the EBP cycle (foreground questions to implementation):
Ask the clinical question (define the problem clearly).
Retrieve the evidence (literature search, databases).
Create a study scenario to collect data (design an interview/survey, etc.).
Data collection plan: reach the target population (e.g., clinics or outreach to the community).
Sample size and reach: example given is surveying up to people in the community, including pregnant substance users, to obtain responses.
Literature review and evidence appraisal: examine what is already known; identify databases and resources; assess relevance and quality.
Evidence evaluation: determine relevance and validity (statistical relevance and applicability across populations).
Determine usefulness: is the information actionable and helpful for improving patient care?
Ethical implications: consider social justice and the obligation to provide equal care to vulnerable populations (e.g., pregnant individuals with SUD).
Key concepts in evaluating evidence:
Relevance vs. statistical relevance: a study may yield data but not point to a single causal reason.
Validity: ensure the study population and setting are appropriate for generalizing findings (e.g., large, diverse samples vs. a single community).
Usefulness: does the information lead to practical interventions or policy changes?
Examples to illustrate usefulness: a mattress color preference study might be interesting but not clinically useful for patient care.
Ethical and practical implications of EBP:
Social justice: ethical obligation to ensure equal care and access for vulnerable populations like pregnant individuals with SUD.
Applying evidence to practice: integrate best available evidence, evaluate changes in practice, and, if beneficial, modify facility policies with management input.
Real-world example (McGee Women’s Hospital, Pittsburgh): a PACES program exists to support women with SUD who are pregnant, providing:
Medical-assisted treatment
Follow-up with physicians
Psychiatric care within the clinic
Care delivered without triggering punitive consequences for the patient
The value of translating evidence into programs that improve access to treatment.
Critical appraisal and self-assessment in EBP:
Do not rely solely on a preceptor’s instruction; be able to justify the method and rationale behind actions.
Question the reasoning: “Why are we doing it this way? What is the evidence supporting this approach?”
Reflect on potential obstacles and biases that might affect judgment.
Obstacles to implementing EBP:
Three initial obstacles discussed: main themes
Position preference (personal or cultural comfort with certain practices)
Money (costs of implementing evidence-based changes)
Misconceptions about what EBP actually means
Additional barriers: lack of management support, time limits, resistance to change, and attitudes toward EBP.
Practice questions: evaluating whether a proposed change would be accepted by patients and staff.
Why these obstacles matter: without addressing them, evidence may not translate into practice.
Implementing EBP and using available resources:
It is not required to read articles daily, but clinicians should utilize available resources.
In the speaker’s setting (UPMC), there are 24/7 resources on the clinical unit, including:
Computer labs with access to MicroMedics and other databases
Resources are based on current research, not solely on AI or generic search engines
The importance of critical reading and appraisal of articles found by patients or independently:
Consider who sponsors the research (vested interests) and whether sponsorship might bias results.
Example: cannabis/cannabinoid research often sponsored by cannabis companies; independent sponsorship is preferable for reducing potential bias, though sponsored studies are not automatically invalid.
The spectrum of barriers continues to include systemic factors:
Lack of management support, time constraints, and cost barriers to adopting new practices.
Misperceptions about EBP and resistance to change among staff.
Attitudes about medications (e.g., nursing staff hesitance to take certain medications personally) and the need to understand research supporting pharmacologic decisions.
Vaccination and other public health measures sometimes face similar misperceptions despite strong evidence.
Case study mention:
A case study involving an asthma patient discusses joining a study and the information needed to participate (to illustrate how patients are engaged in research opportunities).
Transition to caring interventions between EBP and the caring aspect of nursing:
Maslow’s hierarchy of needs will be revisited in relation to caring interventions.
The discussion links caring with practical nursing actions and ethical implications.
Caring interventions: what is caring and why it matters:
Caring is the ability to feel interest or concern for another person.
Compassion: a core emotional driver of caring; when caring is present, it signals genuine concern for the patient’s well-being.
Burnout and numbness: burnout can erode the ability to care; nurses may become numb and treat patients as numbers rather than individuals.
Core behaviors demonstrating caring:
Treat patients as humans with individual needs (e.g., not just a room number)
Maintain eye contact and demonstrate genuine listening
Respect confidentiality and privacy in patient information
Acknowledge patient pain and respond promptly (e.g., even small requests like offering a glass of water matter)
The balance between being present and being efficient in high-pressure situations (e.g., emergencies) is crucial.
Honesty with patients about mistakes and limits while remaining compassionate.
Theoretical foundations of caring in nursing:
Leininger: Culture and Diversity in caring; caring is culturally informed
Roach’s Six Cs of Caring (emphasis on caring as an ongoing process):
Compassion
Confidence
Consciousness
(Other two or more Cs discussed by the speaker, though phrasing in transcript is unclear; note: in Roach’s model, commonly cited Cs include care, compassion, competence, confidence, conscience, and commitment)
Watson’s Theory of Human Caring: ten curative factors within the nurse–patient relationship; emphasizes spirituality and a higher sense of purpose in care
Peplau’s Interpersonal Relations Theory: caring requires an interpersonal relationship between nurse and patient
Orem’s Self-Care Theory: focus on supporting patient self-care to promote independence; care is most effective when patients regain independence
Overall takeaway: caring is not separate from clinical practice; it is shaped by environment, training, and culture, and it should be sustained across different care contexts
Four types of knowledge in nursing (with emphasis on their roles in caring and practice):
Empirical knowing (science): objective, evidence-based findings; foundational for technical and procedural aspects
Aesthetic knowing (art): personalized, intuitive, and relational aspects of care; understanding the patient’s experience
Personal knowing: ongoing self-awareness and growth; appreciation of the nurse’s own experiences and biases
Ethical knowing (moral knowing): the nurse’s moral framework guiding decisions in ethically charged situations
The speaker emphasizes that all four kinds of knowledge are needed:
Too much empirical (science) can feel clinical and distant
Too much aesthetic (art) can feel vague or ungrounded
Balance of science and art, along with personal and ethical knowing, yields holistic care
Interplay of knowing in practice (practical takeaway):
The goal is to integrate science (empirical knowledge) with the art of nursing (aesthetic knowing) to deliver compassionate, competent care.
Personal knowing informs how you apply ethical principles in real-world dilemmas.
Moral (ethical) knowing helps navigate dilemmas where patient autonomy, safety, and justice intersect.
The concept of empirical knowing is introduced as a grounding framework for nursing practice.
Quick notes on structure and readiness for exams:
Expect questions on how to identify, appraise, and apply evidence in nursing practice (EBP cycle, PICO framing, critical appraisal skills).
Expect questions about barriers to EBP and strategies to overcome them (education, management support, time management, resource allocation).
Expect questions about caring theories and how they inform nurse–patient interactions (Leininger, Roach, Watson, Peplau, Orem).
Expect questions about the balance of knowledge types and how to demonstrate them in patient care.
Summary of key phrases to remember:
Evidence-based practice integrates best research evidence, clinical expertise, and patient values.
Ethical obligation in nursing includes social justice and equitable care for vulnerable populations (e.g., pregnant individuals with SUD).
Critical appraisal includes assessing relevance, validity, and usefulness of studies, as well as potential sponsorship bias.
Caring involves seeing patients as humans with dignity, maintaining confidentiality, and practicing attentiveness and honesty.
Four types of knowledge: empirical, aesthetic, personal, ethical; balance them with clinical judgment.
Quick reference to terms and programs mentioned:
PACES program at McGee Women’s Hospital (pregnant women with SUD provided integrated care)
UPMC clinical unit resources and MicroMedics database for evidence-based information
24/7 access to databases and decision-support resources on the hospital unit
Cannabis/cannabinoid research: critical appraisal needed for sponsorship and bias considerations
Final note on applicability:
The transcript emphasizes moving from question to data to evidence to action, ensuring that patient care is guided by valid, useful evidence and delivered with caring, ethical consideration.
End of notes on empirical knowing and readiness for practice:
The final prompt encourages recognizing empirical knowing as the base science of nursing while integrating art, personal insight, and ethical considerations to provide holistic, high-quality care.