Fundamentals of Nursing Practice - Lecture

STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR

Session # 17

LESSON TITLE: EVIDENCE- BASED PRACTICE IN Materials:

NURSING Pen and notebook
▪ RESEARCH-RELATED ROLES AND
RESPONSIBILITIES

LEARNING OUTCOMES:
Upon completion of this lesson, you can:
1. Discuss the benefits of evidence-based practice;
2. Describe the steps of evidence-based practice;
3. Develop a PICOT question;
4. Explain levels of evidence available in the literature;
5. Discuss ways to apply evidence in practice;
6. Explain how nursing research improves nursing
practice; Reference:
7. Discuss the steps of the research process;
8. Discuss priorities for nursing research; and,
Potter, P. A., Perry, A.G., et al. (2021). Fundamentals
9. Explain the relationship between evidence-based
of nursing (10th ed.). Singapore: Elsevier.
practice and performance improvement.

LESSON PREVIEW/REVIEW
Answer the posted question based on your understanding. You may use the back sheet of this page for your answers.
Here is the task:
What are problem- and knowledge-focused triggers?

MAIN LESSON
You will study the contents of this lesson and read your book, if available.

EVIDENCE-BASED PRACTICE
Evidence from research studies and opinions of nursing experts provide a basis for nursing care.

The Need for Evidence-Based Practice

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

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 ● 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

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 and patient
preferences and 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

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

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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 Critically Appraise the Evidence
● After critiquing all articles for a PICOT question:
□ Synthesize or combine the findings
□ Consider the scientific rigor of the evidence and whether it has application in practice

● Elements of an article
□ Abstract
□ Introduction
□ Literature review or background
□ Manuscript narrative
o Purpose statement
o Methods or design
o Results or conclusions
o Clinical implications

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

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?

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 ● Unexpected events or results may occur.
● Never implement a practice change without evaluating its effects.

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

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.

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.

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

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
• Non-experimental research
• Surveys
• Evaluation research
□ Qualitative
• Ethnography
• Phenomenology
• Grounded theory

Research Process

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 ● 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

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

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the
correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not
allowed.

1. Which of the following is the first step of the research process?

a. Analyze data c. Conduct study
b. Identify problem d. Use the findings
ANSWER: B.
RATIO: The first step of the research process is to identify area of interest or clinical problem.

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 2. Every health care organization gathers data on health outcomes. Examples of key quality-of-care or performance
indicators include:
a. discharges. c. healthy births.
b. medications administered. d. infection rates.
ANSWER: D.
RATIO: Indicators are quantifiable parts of practice for which there is evidence or agreement that they reflect the quality and thus help
to change the quality of care given. Indicators are usually focused on routinely data collected, data from electronic medical records, and,
in some cases, survey data.

3. Which of the following populations have the highest incidence of STI? (Select all that apply)
a. Hispanic women age 15 to 24 years
b. African-American men age 15 to 24 years
c. Caucasian men age 50 to 58 years
d. Caucasian women age 42 to 53 years
ANSWER: B.
RATIO: Every year, over 20 million persons in the United States are diagnosed with an STI; nearly half of them are between the ages of
15 and 24. STIs are passed from infected people to partners through intimate sexual contact.

4. Upon admission, when gathering a patient’s sexual history, nurses should:

a. focus only on physical factors that affect sexual functioning.
b. discuss sexual concerns only if the patient raises questions or concerns.
c. use emotionally laden terms when discussing sexual concepts.
d. include questions related to sexual function.
ANSWER: D.
RATIO: Establishing a routine approach for eliciting the patient's sexual history will make it easier to collect the necessary data. The
sexual history can be related to the patient's medical history or current health concern for a brief, guided office visit.

5. When caring for patients, the nurse must understand the difference between religion and spirituality. Religious care
helps individuals:
a. maintain their belief systems and worship practices.
b. develop a relationship with a higher being.
c. establish a cultural connectedness with the purpose of life.
d. achieve the balance needed to maintain health and well-being.
ANSWER: A.
RATIO: Religious care assists patients in remaining committed to their belief systems and worship rituals. Spiritual care assists people
in determining their life's meaning and purpose, looking beyond the present, and maintaining human relationships as well as a
relationship with a greater being or life force.

6. To assess, evaluate, and support a patient’s spirituality, the best action a nurse can take is to:
a. assist the patient to use faith to get well.
b. refer the patient to the health care facility chaplain.
c. provide the patient with a variety of religious literature.
d. determine the patient’s perceptions and belief system.
ANSWER: D.
RATIO: The nurse is able to provide patient-centered care for the patient by understanding the patient's views and belief system.

RATIONALIZATION ACTIVITY
The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER:
RATIO:

2. ANSWER:
RATIO:

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 3. ANSWER:
RATIO:

4. ANSWER:
RATIO:

5. ANSWER:
RATIO:

6. ANSWER:
RATIO:

LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT 3-2-1

This strategy provides a structure for you to record your own comprehension and summarize your learning.

Three things you learned:

1.
2.
3.

Two things that you’d like to learn more about:

1.
2.

One question you still have:

1.

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