Evidence-Based Practice

Evidence-Based Practice

Overview of Evidence-Based Practice (EBP)

  • Definition: EBP is a systematic process that incorporates current evidence into patient care decision-making to ensure quality care and optimal patient outcomes.

Importance of Evidence-Based Practice

  • Serves as the gold standard of healthcare, allowing nurses to provide the best care possible.

  • Outcome Measurement: Built into the practice change process; demonstrates the value of the implementation of new methods.

Key Concepts in Evidence-Based Practice

  • Evaluation of Quality: Involves assessing existing research for applicability to specific situations, considering patient preferences, costs, and clinical expertise relevant to the clinical setting.

Hierarchy of Evidence Levels

Level I: Strongest Evidence

  • Definition: Involves systematic reviews of randomized controlled trials (RCTs).

  • Characteristics:
      - True experimental studies are used.
      - Attempts to control confounding factors that could skew results.

  • Examples:
      - Joanna Briggs Institute's Evidence-Based Resources
      - Cochrane Reviews

Level II: Well-Designed Randomized Controlled Trial

  • Definition: Contains at least one well-designed RCT, providing reliable findings.

Level III: Quasi-Experimental Research Studies

  • Definition: Evidence that does not fully control for factors that may affect results; hence, it's less predictive of effectiveness.

Level IV: Case-Control or Cohort Studies

  • Definition: Evidence derived from well-designed, observational studies lacking randomization.

Level V: Systematic Review of Qualitative or Descriptive Studies

  • Definition: Involves reviews of qualitative or descriptive research studies that aggregate findings.

Level VI: Qualitative or Single Descriptive Study

  • Definition: Involves qualitative research or a singular descriptive study focusing on specific patient experiences or outcomes.

Level VII: Expert Opinion

  • Definition: Represents the weakest evidence level, relying solely on expert perspectives without robust data.

Evidence-Based Practice Process

  • Nursing Interventions:
      - Dependent nursing interventions are delegated by a healthcare provider.
      - Independent nursing interventions do not require a provider's order but fall under the supervision of a registered nurse.

Six Steps of Evidence-Based Practice (EBP) – “ASKMME!”

  1. Ask the Burning Question: Initiate inquiry regarding practice methods; examples include:
       - “Why do we do it that way?”
       - “How could we do that better?”

  2. Search for Best Evidence: Utilize computer databases to collect relevant data and research.

  3. Think Critically: Appraise the evidence for:
       - Validity
       - Relevance to the clinical situation
       - Applicability in practice

  4. Measure Outcomes: Assess the outcomes from practice changes before and after implementing the changes.

  5. Make it Happen: Implement the necessary changes based on collected evidence.

  6. Evaluate the Practice Change: Assess the effectiveness of the changes made and their impact on patient care.

PICOT Framework

  • Definition: A structured framework used to form searchable questions for databases.

  • Components:
      - Population/Patient Problem: Identify the patient demographic or problem being addressed.
      - Intervention: Specify the planned intervention for the patient.
      - Comparison: Outline alternative interventions for comparison.
      - Outcome: Define the desired outcome or result of the intervention.
      - Time: Establish the time frame for achieving the outcome (may not always be included).

EBP, Quality, and Safety

  • Interrelationship: EBP is closely tied to quality and safety in healthcare, emphasizing the importance of improving patient care.

QSEN Project Focus Areas

  1. Evidence-Based Practice

  2. Safety

  3. Teamwork and Collaboration

  4. Patient-Centered Care

  5. Quality Improvement

  6. Informatics

NCLEX-PN® Links to Practice

  • The Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN) is expected to apply EBP when providing care by utilizing data from credible sources for clinical decision-making, which includes participating in quality improvement (QI) activities, such as data collection and involvement in QI committees.

Review Questions

  • Evaluating research studies can include identifying the strongest level of evidence as Level I, which includes systematic reviews of randomized controlled trials.

  • Identifying Level I evidence could include examples such as systematic reviews and finding sources like Cochrane Reviews and Joanna Briggs Institute’s Evidence-Based Resources.

  • QSEN Competencies include evidence-based practice, safety, teamwork and collaboration, and quality improvement without including non-relevant options like health insurance coverage.