Evidence-Based

Practice
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The Need for
Evidence-
Based Practice

• Evidence-based care
• Improves quality,
safety, and
patient
outcomes
• Increases nurse
satisfaction
• Reduces costs

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 3
The Need for Evidence-
Based Practice (Cont.)
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 • Sources of evidence
• Textbooks
• Articles from
Copyright © 2017, Elsevier Inc. All Rights Reserved.

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

The Need for Evidence-Based Practice (Cont.)

4
 Steps of
Evidence-Based
Practice
• 0. Cultivate a spirit of inquiry.
• 1. Ask a clinical question in PICOT
format.
• 2. Search for the most relevant
evidence.
• 3. Critically appraise the evidence
you gather.
• 4. Integrate all evidence with your
clinical expertise and patient
preferences and values.
• 5. Evaluate the outcomes of
practice decisions or changes using
evidence.
• 6. Share the outcomes with
others.
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 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

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Ask a Clinical Question
• Developing a PICOT question:
• P = Patient population of interest
• I = Intervention of interest
• C = Comparison of interest
• O = Outcome
• T = Time

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Collect the Best Evidence
Ask experts for help
• Nursing faculty
• Advanced practice nurses
• Staff educators
• Risk managers
• Librarians

A medical librarian can

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

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Collect the
Best
Evidence
(Cont.)
 • After critiquing all articles for a
Critically PICOT question:
Synthesize or combine the
Appraise •
findings
the • Consider the scientific rigor of the
evidence and whether it has
Evidence application in practice

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 Critically
Appraise the
Evidence (Cont.)
• Elements of an article
• Abstract
• Introduction
• Literature review or
background
• Manuscript narrative
• Purpose statement
• Methods or design
• Results or conclusions
• Clinical implications

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 Integrate the
Evidence
• Integrating evidence:
teaching, assessment or
documentation tools, clinical
practice guidelines, policies
and procedures
• Applying evidence: consider
setting, staff support, scope
of practice, resources
• A pilot study may be
conducted when evidence is
not strong enough to apply in
practice

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 Evaluate the
Practice Decision
or Change
• After applying evidence, evaluate
the outcome.
• When evaluating an EBP change
determine:
• Was the change effective?
• Are modifications needed?
• Should the change be
discontinued?
• Unexpected events or results
may occur.
• Never implement a practice
change without evaluating its
effects.

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Share the
Outcomes
with Others
• After implementing an
EBP change, it is
important to
communicate the
results
• Clinical staff on
the unit
• Nursing practice
council or the
research council
• Clinicians
• Professional
conferences and
meeting Copyright © 2017, Elsevier Inc. All Rights Reserved. 14
Nursing
Research

• A way to identify new

knowledge, improve
professional education
and practice, and use
resources effectively
• Many professional and
specialty nursing
organizations support
the conduct of research
for advancing nursing
science.

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 Case Study
• Shana and Eric are
nurses who work in the
surgical intensive care
unit (ICU). They belong
to their unit practice
committee, which meets
monthly to discuss
practice issues. They
have received a copy of
the monthly report on
quality indicators.

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Case Study (Cont.)
• Shana notes that the incidence of
catheter-related bloodstream infections
(CR-BSIs) has steadily increased during
the last 3 months.
• Patients with central venous catheters,
used to deliver fluids and medications
over extended periods of time, are
becoming infected, but why?
• Is there a problem with the type of
dressing placed over the catheter or the
way the site is cleansed before insertion?

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 Outcomes
Research

• Helps patients, health care

providers, and those in health
care policy make informed
decisions on the basis of
current evidence.
• Typically focuses on the
benefits, risks, costs, and
holistic effects of a treatment
on patients.
• Outcomes must be observable
or measurable.
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Scientific Method

• The foundation of research

• The most reliable and objective means of acquiring
and conducting research and gaining knowledge.
• A step-by-step process to ensure that findings from a
study are valid, reliable, and generalizable to a similar
group of subjects

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Quick Quiz!

• 1. Which of the following is

the first step of the
research process?
• A. Analyze data
• B. Identify problem
• C. Conduct study
• D. Use the findings

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 Nursing and the
Scientific Approach
• Research allows you to study nursing
questions and problems in greater depth
within the context of nursing.
• Quantitative
• Experimental research
• Nonexperimental research
• Surveys
• Evaluation research
• Qualitative
• Ethnography
• Phenomenology
• Grounded theory

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 Research Process

Nursing Process Research Process

Identify area of interest or clinical

Assessment
problem
Develop research
Diagnosis
question(s)/hypotheses
Planning Determine how study will be conducted
Implementation Conduct the study
Analyze results of the study
Evaluation
Use of the findings

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 Research Process
(Cont.)
• Institutional Review Board (IRB)
• Human Research Terminology
• Informed consent means
• Participants receive full and
complete information
• They can understand the
information
• They have free choice to participate
• They understand how their
confidentiality will be kept
• Confidentiality

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 Case Study (Cont.)
• Shana and Eric volunteer as part of
their committee responsibilities to
implement an EBP project.
• Their first step will be to develop a
clinical question and then search the
scientific literature.
• Their aim is to determine what
evidence is available so that they
can make an informed decision
about the best approaches for
reducing CR-BSIs among their
patients.
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 The Relationship between
EBP, Research, and QI
• Although EBP, research, and QI are closely
related, they are separate processes.
• EBP: Use of information from research and
other sources to determine safe and
effective nursing care with the goal of
improving patient care and outcomes
• Research: Systematic inquiry answers
questions, solves problems, and contributes
to the generalizable knowledge base of
nursing; may or may not improve patient
care
• QI: Improves local work processes to
improve patient outcomes and health
system efficiency; results usually not
generalizable

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The
Relationship
between EBP,
Research, and
QI (Cont.)

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 Quick Quiz!
• 2. Every health care organization
gathers data on health outcomes.
Examples of key quality-of-care or
performance indicators include:
• A. discharges.

• B. medications administered.

• C. healthy births.
• D. infection rates.

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