Evidence Based Practice Notes

Evidence-Based Practice

What Is Evidence?

  • The term "evidence-based" applies to all healthcare disciplines.

  • Definition: Establishes benefit or harm.

  • A set of facts that confirm or disprove a conclusion.

  • How it is used:

    • Treatment efficacy

    • Diagnostic tool

    • Disease transmission

  • Learn to recognize & classify evidence to use it.

  • Nurses want to use evidence in daily practice.

  • Developing new knowledge advances the profession.

More Than Just Data

  • Definition: “The conscientious, explicit, judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups of patients and in consideration of individual needs and preferences.” – Giddens

  • All 3:

    • Evidence

    • Patient involvement

    • Nursing expertise

  • Evidence is scrutinized to compare with other information.

  • More credible than raw data.

  • Clinical practice use:

    • Research studies

    • Clinical experience

    • Expert opinion

Major Attributes of Evidence

  1. Replicability:

    • Research findings can be verified if other researchers can replicate them using the same methods.

  2. Reliability:

    • Measures evidence consistently & accurately, similar outcomes over time.

  3. Validity:

    • Successfully measures what the study set out to measure.

  • Minor attributes: Publicly available, understandable & usable.

Barriers to Use of Evidence-Based Practice

  • What are 3 barriers to using evidence-based practice?

Types of Evidence

Quantitative Research

  • Randomized control trials, Case studies, cohort studies

Qualitative Research

  • Focus on personal experiences, uses analysis of interviews, surveys

Mixed Methods

  • Both approaches, confirm findings between both methods

  • Examples: Primary evidence are original studies on which secondary literature is created

Types of Evidence

Evidence Summaries

  • Systematic reviews

  • Meta-analyses

  • Practice guidelines (U.S. Preventative Services Task Force; American College of Obst. & Gyn)

  • Secondary Evidence-Based Nursing journal summarizes results

  • Results of many studies are compiled, evaluated for treatment effectiveness

  • Summarize evidence in multiple studies, combine statistical results & analyze

  • Summarize & advise practitioners on current standard of care- address cost & variation

  • Examples: Secondary evidence is generated from primary evidence

Where do we find EBP?

  • Textbooks

  • Research articles

  • Quality improvement projects

  • Standards of care

  • Chart reviews

  • Clinical projects

Who Conducts Nursing Research?

PHD & EDD NURSE RESEARCHERS

  • Research doctoral degree

  • Lead a research study and act as principal investigator

  • PhD: Generate new research on a topic (patients typically the population of interest)

  • EdD: Generate new research on a topic concerning learning or education (students/instructors are typically the population)

DNP NURSE RESEARCHERS

  • Practice doctoral degree

  • Use evidence to solve problems & conduct scholarly project at the clinical bedside

  • Translate existing research into nursing practice

  • Collaborate with other nurse researchers on research teams

  • Present a scholarly project

Developing a PICOT Question

  • P = Population of interest

  • I = Intervention of interest

  • C = Comparison

  • O = Outcome

  • T = Timeframe

  • Example: For inpatients (P) is turning q2h (I) compared to using air mattresses (C) more effective at preventing pressure ulcers (O) while admitted to the hospital (T)?

Steps for Evidence-Based Practice

  1. Create an answerable PICOT question

  2. Search the literature to find evidence

  3. Evaluate the evidence found

  4. Apply the evidence to a clinical practice situation

  5. Evaluate the outcomes

  6. Share your findings with others

Rights of Participants

Institutional Review Board (IRB)

  • Protects welfare, rights, privacy of human subjects

  • Vulnerable populations: children, prisoners, pregnant women, mentally disabled

  • Can approve, disapprove, monitor or require modifications

Informed Consent

  • Participants receive full and complete information

    • Purpose of study

    • Risks/benefits

    • Any alternative procedures available & risks/benefits

    • Right to withdraw at any time (voluntary)

  • Confidentiality is always maintained