EBP

• Evidence-based practice


  A problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician's expertise and patient preferences and values in making decisions about patient care
• Evidence-based care


  • Improves quality, safety, and patient outcomes
  • Increases nurse satisfaction
  • Reduces costs
• Implementing evidence-based practice or EBP helps you make effective, timely, and appropriate clinical decisions in response to the broad political, professional and societal forces present in today's healthcare environment
• Nurses make important clinical decisions when caring for patients
• It is important to translate best evidence into best practices at a patient's bedside
• Sources of evidence


  • Textbooks
  • Articles from nursing and health care literature
  • Quality Improvement and risk management data
  • Standards of care
  • Infection control data
  • Benchmarking, retrospective, or concurrent chart reviews
  • Clinicians' expertise
• Best information


  Evidence that comes from well-designed, systematically conducted research studies, mostly found in scientific journals
• It is important to rely more on research evidence rather than solely on evidence that is not research based
• When you face a clinical problem, always ask yourself where you can find the best evidence to help you find the best solution in caring for patients
• Even when you use the best evidence available, application and outcomes will differ on the basis of your patients' values, preferences, concerns, and/or expectations
• As a nurse, you develop critical thinking skills to determine whether evidence is relevant and appropriate to your patients and to a clinical situation
• Using your clinical expertise and considering patient values and preferences ensures that you apply the evidence available in practice both safely and appropriately
• Steps of evidence-based practice

  1. Cultivate a spirit of inquiry

  2. Ask a clinical question in PICOT format

  3. Search for the most relevant evidence

  4. Critically appraise the evidence you gather

  5. Integrate all evidence with your clinical expertise & patient preferences & values

  6. Evaluate the outcomes of practice decisions or changes using evidence

  7. Share the outcomes with others
• Cultivate a spirit of inquiry


  • Question what does not make sense to you and what needs to be clarified
  • Gain evidence-based practice (EBP) knowledge and skills
  • Be committed to providing the best care possible
  • Use problem-and knowledge-focused triggers
  • Consider data gathered from a health care setting to examine clinical trends
• PICOT question


  P = Patient population of interest

  I = Intervention of interest

  C = Comparison of interest

  O = Outcome

  T = Time
• The more focused your question is, the easier it becomes to search for evidence in the scientific literature
• Proper question formatting allows you to identify keywords to use when conducting your literature search
• A well-designed PICOT question does not have to follow the sequence of the P, I, C, O, T
• Interventions, comparison, and time are not appropriate to be used in every question, the aim is to ask the question that contains as many of the PICOT elements as possible
• Experts to ask for help

  • Nursing faculty
  • Advanced practice nurses
  • Staff educators
  • Risk managers
  • Librarians
• Medical librarian can


  • Identify the databases that are available
  • Identify key words that will provide the best answer to your PICOT question
• Hierarchy of available evidence

  Stronger evidence is farther up the triangle, with well-designed randomized controlled trials (RCTs) carrying more weight than expert opinions
• Systematic reviews or meta-analyses

  State-of-the-art summaries from individual researchers or panels of experts

  Meta-analyses use statistics to show the effect of an intervention on an outcome, while systematic reviews draw conclusions about the evidence without using statistics

  They are the perfect answers to PICOT questions because they rigorously summarize current evidence
• Opinion of authorities or expert committees

  At the bottom of the evidence pyramid, but still a valuable source of evidence as expert clinicians use evidence frequently and are rich sources of information for clinical problems
• Critically appraising the evidence

  Synthesize or combine the findings

  Consider the scientific rigor of the evidence and whether it has application in practice
• Elements of an article

  Abstract - Quickly tells you if the article is researched or clinical based, and summarizes the purpose, major themes/findings, and implications for nursing practice

  Introduction - Contains more information about the purpose of the article and brief supporting evidence as to why the topic is important

  Literature review or background - Offers a detailed background of the level of science or clinical information about the topic

  Manuscript narrative - Includes the purpose statement, methods/design, and results/conclusions
• Methods or design


  Explains how a research study was organized and conducted to answer the research questions or test the hypothesis. This section explains the type of study that was conducted. For example, RCT case control study or qualitative study and the number of people who participated in the study
• Results or conclusions


  In a clinical article, the author explains the clinical implications for the topic presented. In a research article, the author details the results of the study and explain whether a hypothesis is supported or how a research question is answered. This section includes a statistical analysis if it is a quantitative research study, a qualitative study summarizes the descriptive themes and ideas that arise from a researcher's analysis of data
• Clinical implications


  A research article includes a section that explains if the findings from the study have clinical implications. The researcher explains how to apply findings in a practice setting for the type of subjects studied
• Know the elements of an article and use a careful approach when reviewing each one
• Clinical article


  Describes a clinical topic which often includes a description of the patient population, the nature of a certain disease or health alteration how patients are affected and the appropriate nursing therapies
• Integrating evidence


  Teaching, assessment or documentation tools, clinical practice guidelines, policies and procedures
• Depending on the amount of change needed to apply the evidence in practice, you may need to involve other stuff from the nursing unit
• Applying evidence


  Consider setting, staff support, scope of practice, resources
• Pilot study


  A small scale research study or one that includes a quality or performance improvement project
• Evaluating the practice decision or change

  Determine if the change was effective, if modifications are needed, or if the change should be discontinued
• Unexpected events or results may occur
• Never implement a practice change without evaluating its effects
• Sharing the outcomes with others

  Clinical staff on the unit, Nursing practice council or the research council, Clinicians, Professional conferences and meeting
• When a practice change occurs on a nursing unit level, the first group to discuss the outcomes of the change is often the clinical staff on that unit – to enhance professional development and promote positive patient outcomes beyond the unit level, share the results with various groups of nurses or other care providers such as the nursing practice council or the research council