MS 2

Learning Outcomes

• Define ​evidence-based practice (EBP) ​and ​evidence-informed practice (EIP)
  • EBP: A systematic approach that integrates the best current evidence, clinical expertise, patient preferences/values, and available resources to make decisions aimed at providing quality care and achieving optimal patient outcomes.
  • EIP: Broader concept acknowledging that while the best research evidence is central, decisions may also draw on contextual factors, local data, professional judgement, and patient experience when gold-standard studies are not available.
• Explain why EBP is the “gold standard,” enabling nurses to deliver the best care possible.
• Identify where and how to locate, appraise, and apply nursing evidence.
• Describe the complete EBP process and list its six steps (ASKMME!).
• Clarify who should provide evidence-based nursing care, when, and where.
• Demonstrate the link between EBP, quality improvement (QI), and patient safety through the QSEN competencies.

Key Chapter Concepts

• Caring
• Evidence-Based Practice
• Health-Care Technology
• Quality Improvement
• Safety

Evidence-Based Practice (EBP): Definition & Rationale

• Systematic process that blends research evidence, clinician expertise, and patient preferences.
• Drives patient-care decision making → delivers quality care & optimal outcomes.
• Considered the gold standard in contemporary health care.

Why Use EBP?

• Provides a defensible, reproducible method for care decisions.
• Reduces practice variation and reliance on tradition (“We’ve always done it this way”).
• Improves safety, quality, and cost-effectiveness.

EBP Decision-Making Components

• Evaluation of quality of existing research.
• Applicability to the specific clinical setting.
• Patient preferences & values.
• Costs (financial, time, resources).
• Clinical expertise of the nurse/team.
• Characteristics of the clinical setting (culture, staffing, technology, policies).

Outcome Measurement

• Built into the EBP process—outcomes must be defined, collected, and analyzed.
• Demonstrates the value (or lack thereof) of any practice change.

Levels of Evidence Quality (Strongest → Weakest)

• Level I – Systematic reviews of randomized controlled trials (RCTs) (true experimental studies with maximal control of confounders).
  • Examples: Joanna Briggs Institute Evidence-Based Resources, Cochrane Reviews.
• Level II – At least one well-designed RCT.
• Level III – Quasi-experimental studies (lack full randomization/control → less predictive).
• Level IV – Well-designed case-control or cohort studies.
• Level V – Systematic reviews of qualitative or descriptive studies.
• Level VI – Single qualitative or descriptive study.
• Level VII – Expert opinion (weakest evidence).
• Visual mnemonic: $\text{Level I > II > III > IV > V > VI > VII}$

Process for Evidence-Based Practice

Dependent vs. Independent Nursing Interventions

• Dependent: Require a health-care provider’s order (e.g., medication administration).
• Independent: Within nursing scope; implemented under RN supervision without provider order (e.g., patient education, positioning).

The "ASKMME!" Six-Step Model

1. Ask the burning clinical question.
   • Common prompts: “Why do we do it that way?”, “How can we improve?”
   • Use PICOT to structure the question.
2. Search for and collect the most relevant, best evidence.
   • Databases: CINAHL, PubMed, Cochrane Library, Joanna Briggs, etc.
3. Think critically – appraise the evidence for
   • Validity (rigor, bias control)
   • Relevance to the clinical issue
   • Applicability to your patient population/setting
4. Measure outcomes before and after introducing the change (baseline & follow-up data).
5. Make it happen – implement the change in practice.
6. Evaluate the practice change – compare outcome data, solicit stakeholder feedback, and decide to adopt, modify, or abandon the change.

PICOT Framework (Step 1 Tool)

• Population/Patient problem – Who is the patient or population?
• Intervention – What action, treatment, or process is planned?
• Comparison – Alternative action for comparison?
• Outcome – Desired effect or result?
• Time – (Optional) Time frame for outcome measurement.
• Benefits: Narrows the search, provides keywords, saves time.

Quality & Safety Education for Nurses (QSEN)

• Website: www.qsen.org
• Integrates six core competencies into nursing curricula/practice:
  • Evidence-based practice
  • Safety
  • Teamwork & collaboration
  • Patient-centered care
  • Quality improvement
  • Informatics
• Embeds EBP in a broader culture of safety and continual improvement.

NCLEX-PN/LVN Practice Links

• NCLEX expects LPN/LVN to apply EBP when providing care.
• Participation in quality improvement (QI) activities is also tested (e.g., data collection, committee membership).

Review Questions & Correct Answers (Self-Test)

1. Strongest evidence level?
   • Answer: Level I.
2. Example of Level I evidence?
   • Answer: Systematic review of randomized controlled trials.
3. Sources that provide Level I evidence? (Select all that apply)
   • Answer: Cochrane Reviews, Joanna Briggs Institute’s Evidence-Based Resources. (Other listed sources like American Journal of Nursing, Google, WebMD are not guaranteed Level I.)

Ethical, Practical & Philosophical Implications

• Ethical duty: Providing care known to be inferior (lower evidence level, higher risk) violates professional responsibility.
• Resource stewardship: EBP promotes cost-effective, high-value care.
• Patient autonomy: Incorporating patient values/preferences honors autonomy and shared decision-making.
• Continuous learning: EBP fosters a culture where nurses regularly question practice and seek improvement.

Quick Reference / Summary

• EBP combines best evidence + clinical expertise + patient preferences.
• ASKMME! = Ask → Search → Think → Measure → Make → Evaluate.
• PICOT provides efficient search keywords.
• Level I = Systematic review of RCTs; Level VII = Expert opinion.
• QSEN embeds EBP within six safety and quality competencies.
• LPN/LVN scope: Apply EBP at bedside and engage in QI efforts.