EvidenceBased Practice EBP

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Evidence-Based Practice(EBP)

• Joan Pollner, RN, BSN, CHPN
• October 18, 2006

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Objectives

• Define Evidence-based practice (EBP)
• Identify the goals of EBP
• Distinguish between the characteristics of
  Research Utilization and EBP
• Describe the steps in the EBP process
• Explain the challenges and misconceptions of EBP
• Utilize resources to further knowledge of EBP

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Some Definitions

• Evidence-based practice can be thought of as
  requiring "the integration of the best research
  evidence with our clincial expertise and our
  patient's unique values and circumstances."
  (Straus, et al., 2005) "Fortunately,
  evidence-based practice (EBP) is an approach that
  enables clinicians to provide highest quality of
  care in meeting the multifaceted needs of their
  patients and families." (Melnyk
  Fineout-Overholt, 2005) (Yale, 2005)

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Definitions (cont)

• Integration of the best research evidence with
  clinical expertise and patient values. (Spector,
  n.d.).
• using the best available research findings to
  make clinical decisions that are most effective
  and beneficial for patients. (Chitty, 2005).

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Goals of EBP

• Provide practicing nurses with evidence-based
  data
• Resolve problems in the clinical setting
• Achieve excellence in care delivery
• Introduce innovation
• Reduce variations in nursing care
• Assists with efficient and effective
  decision-making

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Goals (cont)

• Using best evidence to implement the regulation
  of nurses
• Resolve regulatory problems
• Achieve excellence in regulation
• Introduce regulatory innovation

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Research Utilization vs EBP

• Research Utilization
• Use results of studies
• Randomly selected
• Support nursing care
• Less systematic

• Evidence-Based Practice
• Considers all research
• Utilized thorough integrative review
• Context of clinical expertise and value system of
  the patient
• More systematic

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EBP is multi-step process

• Define patient problem
• Identify information needed to solve problem
• Search of literature
• Critical appraisal of the evidence
• Extraction of the clinical answer
• Protocol development
• Evaluation

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Stevens ACE Star Model

• Discovery
• Summary
• Translation
• Implementation
• Evaluation

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Stevens ACE Star ModelDiscovery

• Original research
• Conduct a literature search utilizing recognized
  techniques

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Stevens ACE Star ModelSummary

• Synthesize all research into a single meaningful
  whole
• This step differentiates research utilization
  from Evidence-based practice
• Can be called evidence synthesis
• Increase power and effect of data
• Reduce bias
• Assess consistencies
• Establish generalizability
• Reduce data into an manageable form

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Stevens ACE Star ModelTranslation

• Scientific evidence is considered in the context
  of clinical expertise and values
• Results in clinical practice guidelines, best
  practices, protocols, standards or clinical
  pathways

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Stevens ACE Star ModelImplementation

• Translation of research into practice
• Where changes take place

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Stevens ACE Star ModelEvaluation

• Impact of the change is measured
• Assess variables (health outcomes, efficiency,
  cost or satisfaction)

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Challenges and Misconceptions

• Merely a collection of statistics?
• Need more qualitative research
• Nurses need to develop good search strategies
• Nurses must learn to do critical appraisals
• Faculty members must embrace and learn EBP

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Resources

• Yale University Nursing Library and Information
  Resources
• http//www.med.yale.edu/library/nursing/education/
  ebhc2.html
• Oncology Nursing Society
• http//onsopcontent.ons.org/toolkits/evidence/
• United States Department of Health and Human
  Services Agency for Healthcare Research and
  Quality
• http//www.ahrq.gov/clinic/epcix.htm
• University of Iowa Hospitals and Clinics Nursing
  Services and Patient Care
• http//www.uihealthcare.com/depts/nursing/rqom/evi
  dencebasedpractice/index.html

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Resources (cont)

• University of Texas Health Science Center at San
  Antonio Acedemic Center for Evidence-Based
  Practice
• http//www.acestar.uthscsa.edu/About.htm
• Medical Library Association Nursing and Allied
  Health Resources Section
• http//nahrs.library.kent.edu/resource/symposium/
  
• University of Minnesota Evidence-based Health
  Care Project
• http//evidence.ahc.umn.edu/ebn.htm

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References

• Chitty, K.K. (2005). Professional nursing
  Concepts and challenges. 4th ed. Philadelphia
  Saunders.
• Spector, N. (n.d.). Evidence-Based Health Care
  in Nursing Regulation. Retrieved on October 8,
  2006 from Nation Council of State Boards of
  Nursing web site on World Wide Web
• http//www.ncsbn.org/pdfs/Evidencebased_NSpector.p
  dfsearch22evidence20based20practice20in20nu
  rsing22
• Yale University. (2005). Evidence-Based
  Practice. Nursing Library and Information
  Resources. Retrieved on October 8, 2006 from
  World Wide Web http//www.med.yale.edu/library/n
  ursing/education/ebhc2.html