Evidence Based Practice
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Evidence Based Nursing Practice in Nursing
“Doing the right things right” (Craig & Smyth, 2002, p.4)
Used to improve the experiences associated with health care and illness
Early examples
Infection control (aseptic technique)
DVT (deep vein thrombosis) prevention
Development of the EBP Concept
Began with medicine
Archie Cochran, a British epidemiologist in 1972 published a book criticizing the medical profession for not reviewing medical research studies
Believed that the strongest evidence came from RCT (randomized clinical trials). RCT are the most strict kind of research design.
A RCT has to have three things:
Control group
Placebo group
Experimental group
Founded the Cochran Foundation in 1992 after his death
Defined as “the conscientious, explicit and judicious use of current best evidence in making decisions about the health care of patients” (Sackett, et al)
Focused on findings of randomized clinical trials only
New definition: “the integration of best research evidence with clinical expertise and patient values (Sackett, et. al.)
Current Definition in Nursing
“Evidence-based practice (EBP) is a problem solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinicians expertise as well as patient preferences and values to make decisions about the type of care that is provided” (Melnyk, 2004)
Definition of Terms
Best research evidence is patient centered research that is clinically relevant
Clinical expertise: the ability to use clinical skills and clinical decision-making to identify patients health states and risks and benefits of interventions.
Patient Values: preferences, concerns and expectations that must be integrated into patients health care.
Why Evidence-Based Practice?
Despite an aggressive research movement, the majority of findings from research often are not integrated into practice.
It take approximately 17 hears to translate research findings into practice (if at all)
Without current best evidence, practice becomes rapidly out of date to the detriment of patients.
In order to keep up with the journals relevant to our practice, we need to review 19 articles a day, 365 days of the year!!!
Textbooks may be out of date by the time they are printed
Traditional continuing education conferences do not significannot
ly improve clinical practice.
To advance our profession and enhance life long learning
In the near future, 3rd party payers will only provide reimbursement for healthcare practices that are supported with evidence.
Practice routed in tradition are often out dated and does not lead to the best patient outcomes
Use of soap and water to massage a bony coccyx or reddened heels in bed-ridden patients
Exacerbated condition
Daily changing of IV dressings every 24 hours
Now done every 72 hours
Perineal shaves before child birth
Really did nothing
Rule 5 of the 10 rules for healthcare in Crossing the Quality Chasm is “evidence-based decision making (IOM, 2001)
Competency 3 of the 5 core competencies deemed necessary by the recent Summit on healthcare Professions Education is
Employ Evidence Based Practice!
What EBP is NOT
NOT Cookbook care that has no latitude for clinical judgment
NOT Care that excludes patient preferences
NOT Care that excludes a clinicians expertise
NOT A process that ignores findings from qualitative and descriptive studies
NOT Something for academicians
Five Steps of EBP
Ask the burning clinical question Ð- “Why do we do things this way?”
Give priority to questions that have the most important consequences
Also give priority to questions that come up more frequently
Collect the best evidence
Comes from systematic reviews which are also previously called “a meta-analysis”
Critically appraise the evidence
What were the results of the study?
Are the results valid?
Will the results help me in caring for my patients?
Integrate evidence, clinical expertise, and patient factors/preferences to implement a decision.
Evaluate the outcome
Challenges of EBP
Gaps in the evidence for what nurses do
Rapidly changing evidence bases
Life-long