EVIDENCE BASED NURSING PRACTICE (NURS 213/214)

EVIDENCE BASED NURSING PRACTICE (NURS 213/214)

INTRODUCTION TO EVIDENCE-BASED PRACTICE

  • Definition: Evidence-Based Practice (EBP) is a framework for approaching patient care.

  • Purpose: It requires nursing professionals to rely on scientific research and evidence to guide treatment of patients in a structured, step-by-step process.

COMPONENTS OF EVIDENCE-BASED PRACTICE

  1. Integration of Research and Clinical Practice:

    • Combines research, analysis, and patient history to provide the most comprehensive care possible.

  2. Continuous Education:

    • Involves life-long, self-directed, problem-based learning.

  3. Relationship Assessment:

    • Explores the relationship between clinical reasoning and research evidence.

  4. Best Practices Application:

    • Involves applying best practices in patient care.

MAINTAINING EVIDENCE-BASED PRACTICE

  • Keeping Updated:

    • Regularly read professional journals to enhance understanding and implementation of EBP.

    • Learn how to find and appraise the evidence to solve questions arising from clinical practice.

SIX STEPS OF EVIDENCE-BASED PRACTICE

  1. Spirit of Inquiry:

    • Cultivate curiosity and inquiry in clinical practice.

  2. Search for Evidence:

    • Conduct thorough searches in reliable databases for evidence.

  3. Appraise the Evidence:

    • Evaluate the quality and relevance of the evidence found.

  4. Integrate the Evidence:

    • Combine the evidence with clinical expertise and patient preferences to make decisions.

  5. Evaluate:

    • Assess the effectiveness of the practice changes initiated based on the evidence review.

  6. Disseminate:

    • Share findings and evidence with the broader community.

FORMULATING A PICOT QUESTION

  • Components of PICOT:

    • P (Population of interest): What are the characteristics of the patient or population?

    • I (Intervention or area of interest): What do you want to do with this patient (e.g., treat, diagnose, observe)?

    • C (Comparison intervention): What is the alternative to the intervention?

    • O (Outcome): What are you trying to achieve?

    • T (Time): What sort of time period are you focusing on?

EVIDENCE QUALITY

  • Levels of Evidence:

    • Best Form of Evidence:

      • Systems Summaries

      • Secondary Pre-appraised Evidence:

        • Synopses of Syntheses

        • Research Syntheses

        • Synopses of Studies

    • Primary Original Research: Individual Studies

      • Levels categorized as follows:

      1. Level I: Systematic Review, Meta-Analysis, Evidence-Based Guideline

      2. Level II: Randomized Control Trial (RCT)

      3. Level III: Controlled Trial Without Randomization (Quasi-experimental Study)

      4. Level IV: Non-Experimental Study (Case Control, Cohort, or Correlational)

      5. Level V: Systematic Review of Descriptive/Qualitative Studies

      6. Level VI: Descriptive/Qualitative Study

      7. Level VII: Opinion of Authorities (Expert Committee Reports)

RESOURCES FOR SEARCHING EVIDENCE

  • Key Databases:

    • CINAHL

    • Cumulative Index to Nursing and Allied Health Literature

    • Cochrane Library of Systematic Reviews

    • MEDLINE

    • PUBMED

SUMMARY OF EVIDENCE-BASED PRACTICE BENEFITS

  • Reduces Variations in Practice:

    • Standardizes patient care to minimize discrepancies in practice.

  • Improves Quality of Care Provided:

    • Ensures that care is based on the best available evidence.

  • Maintains or Improves Patient Outcomes:

    • Aims for favorable health results based on implementing EBP.

SYSTEMATIC APPROACH TO EVIDENCE-BASED PRACTICE

  • Integration of Key Aspects:

    • Clinical expertise must be combined with research evidence and patient preferences.

    • Resource Management:

    • Consideration of budget and availability of materials/resources essential for practice implementation.

WELL-BUILT CLINICAL QUESTION USING PICO MODEL

  • Components of the PICO Model:

    • P: Patient/Population/Problem - Characteristics of the patient or population and the condition/disease of interest

    • I: Intervention/Exposure - Desired intervention for the patient (e.g., treat, diagnose, observe)

    • C: Comparison - Alternative to the intervention (e.g., placebo, different drug, surgery)

    • O: Outcome - Relevant outcomes of interest (e.g., morbidity, death, complications)