Evidence-Based Practice Summary

The Need for Evidence-Based Practice

  • Purpose of Evidence-Based Care
    • Improves quality, safety, and patient outcomes
    • Increases nurse satisfaction
    • Reduces costs

Sources of Evidence

  • Multiple sources contribute to evidence-based decision-making:
    • Research studies, evidence-based theories, clinical expertise, and opinions from leaders
    • Patient assessment history and available healthcare resources
  • Types of evidence sources:
    • Textbooks
    • Articles from nursing and healthcare literature
    • Quality Improvement data
    • Standards of care
    • Infection control data
    • Benchmarking and chart reviews
    • Clinicians' expertise

Steps of Evidence-Based Practice

  1. Cultivate a spirit of inquiry
  2. Ask a clinical question using the PICOT format:
    • P = Patient population of interest
    • I = Intervention of interest
    • C = Comparison of interest
    • O = Outcome
    • T = Time
  3. Search for the most relevant evidence
  4. Critically appraise the evidence gathered
  5. Integrate all evidence with clinical expertise and patient preferences
  6. Evaluate the outcomes of practice decisions using evidence
  7. Share results with others

Cultivating a Spirit of Inquiry

  • Challenge assumptions and seek clarity in clinical practices
  • Develop knowledge and skills for evidence-based practice (EBP)
  • Remain committed to providing optimal care
  • Use both problem-focused and knowledge-focused triggers to assess clinical trends

Collecting Evidence

  • Seek help from:
    • Nursing faculty
    • Advanced practice nurses
    • Staff educators
    • Risk managers
    • Medical librarians
  • A medical librarian can assist with:
    • Identifying databases
    • Identifying keywords for the PICOT question

Types of Evidence Levels

  • Hierarchy of Evidence:
    1. Systematic reviews and meta-analysis of RCTs
    2. One well-designed RCT
    3. Well-designed controlled trials without randomization
    4. Well-designed case control studies
    5. Systematic reviews of descriptive and qualitative studies
    6. Single descriptive or qualitative studies
    7. Expert opinions

Critically Appraising Evidence

  • After gathering articles, synthesize findings and evaluate their scientific rigor and practical application
  • Elements of a research article:
    • Abstract
    • Introduction
    • Literature Review
    • Purpose Statement
    • Methods/Design
    • Results/Conclusions
    • Clinical Implications

Integrating the Evidence

  • Integration of evidence informs teaching, documentation, and clinical practice guidelines
  • Consider institutional context, staff support, resources available, and scope of practice
  • Pilot studies may be necessary when evidence is insufficient

Evaluating Practice Decisions

  • Assess the impact of implemented changes:
    • Was the change effective?
    • Are modifications required?
    • Should the change be withdrawn?
  • Evaluate the effects thoroughly before making changes permanent

Sharing Outcomes

  • Communicate results to the following:
    • Clinical staff
    • Nursing practice council
    • Clinicians
    • Professional conferences

Nursing Research

  • Key to developing new knowledge, improving education, and utilizing resources efficiently
  • Supported by professional nursing organizations

Case Study Example

  • Nurses Shana and Eric in surgical ICU notice a spike in catheter-related bloodstream infections (CR-BSIs) and deliberate on contributing factors

Outcomes Research

  • Focuses on making informed decisions by assessing the benefits, risks, and costs associated with treatments
  • Outcomes must be measurable or observable

Scientific Method in Research

  • Foundation of research, ensuring valid, reliable, and generalizable findings through a structured process

Research Process vs. Nursing Process

  • Research Process consists of:
    • Assessment: Identify problem
    • Diagnosis: Formulate research question
    • Planning: Design study approach

Ethical Considerations

  • Institutional Review Board (IRB) requirements include:
    • Informed consent process ensuring participant freedom and confidentiality

Relationship Between EBP, Research, and QI

  • EBP utilizes various evidence sources for optimizing patient care
  • Research involves systematic inquiry that may not improve care directly
  • Quality Improvement (QI) is focused on localized process enhancements for better outcomes
Quick Quiz Considerations
  1. First step in research process?
    • Identify problem
  2. Quality indicators in health care?
    • Infection rates, medication administered, etc.