Out lines

Evidence Based Practice Process 1.Definitions of Evidence Based Practice process

1- Formulate Clinical question 2.Steps of Evidence Based Practice Process
3.Selection of a topic and formulate clinical question + examples+
application
4.Frameworks to develop focus question
-PICO with examples and application
-PICOS
-PICOTS with examples and application
5. Guides which study designs are likely to provide the most valid
Evidence.
١
6. Research question

Objectives
Evidence-Based Practice process/ Models
• At the end of the session, the students will be able to:
1. Define Evidence Based Practice process
2. Explain steps of Evidence Based Practice process  Frameworks that provide a guide for clinical leaders and their
3. Select a topic and formulate clinical question
4. Use frameworks to develop focus question teams as they decide to launch, implement, and complete an
5. Determine guides which study designs are likely to provide the
most valid Evidence. evidence-based project to improve quality of care.
6. Describe research question

4
 Steps of Evidence Based Practice Process
Steps of Evidence Based Practice Process
1. Convert information needs about clinical problems into clear
questions ( select topic and formulate clinical question)
2. Seek evidence to answer those questions
3. Evaluate (critically appraise) the evidence for its validity
(truthfulness) and usefulness
4. Integrate findings with clinical expertise, patient needs, and patient
preferences to reach a decision as to the optimum course of action,
and then apply this decision
5. Evaluate performance and the outcome of the decision
Sackett et al., 2000
© Elsevier 2020

1- Selection of a Topic and formulate clinical

question
 Problem-focused triggers—those identified by staff through quality
improvement, risk surveillance, benchmarking and financial data, or
recurrent clinical problems.
Example
Should patients with acute coronary syndrome wear sequential
compression hose to prevent deep vein thrombosis?

 Knowledge focused triggers—arise when health providers hear

scientific presentations, read research articles, or published evidence-
based practice guidelines and question practice.
Copyright © 2019, Elsevier Inc. All rights reserved. 8
 Example Frameworks to Help Develop Focused
To successfully advise teenagers on asthma management, the nurse Questions
needs: Frameworks encourage clarification of each item needed to address the

• a degree of understanding of the pathology of asthma particular information need to create clinical question
foundational/background information; changes fairly slowly 
textbooks okay 1-PICO
• an understanding of the effectiveness, benefits, harms of each
intervention; how well tolerated or accepted by patients 2- PICOS
foreground information; new evidence regularly emerges  research
articles
3-PICOTS

© Elsevier 2020 © Elsevier 2020

PICO PICO
Population, Intervention, Comparison intervention (if
any), Outcomes.

“In critically ill children (P), are pressure alternating

mattresses (I) more effective than high-specification foam

mattresses (C) in preventing pressure injuries (O)?”

© Elsevier 2020
 Intervention or Clinical Issue of Interest—
Patient/ population/problem Components
 Diagnosis  Risk behavior (e.g., unprotected sex)

 Age  Therapy/intervention

 Gender  Exposure to disease

 Ethnicity/race  Prognosis

 Marital status

Copyright © 2019, Elsevier Inc. All rights reserved. 13 Copyright © 2019, Elsevier Inc. All rights reserved. 14

Comparison Intervention or Clinical Issue of

Interest Outcome

 No risk behavior (e.g., protected sex)  Risk of disease or condition

 Alternative therapy/intervention, placebo, no intervention at all  Expected/predicted outcome expected from therapy/intervention

 No disease (e.g., decreased CAUTIs)

 Alternative prognosis  Accuracy of diagnosis (e.g., sensitivity and specificity)

 Rate of occurrence of adverse outcome (e.g., mortality)

Copyright © 2019, Elsevier Inc. All rights reserved. 15 Copyright © 2019, Elsevier Inc. All rights reserved. 16
 Therapy/Intervention PICO Diagnosis/Assessment PICO

 For XXXXX population, does________ (tool or procedure) yield

 In ____ (population), what is the effect of ___ (intervention), in
comparison to ____ (comparison intervention), on more accurate or more appropriate diagnostic/assessment

____(outcome)? information than______ (comparison tool/procedure)

about_______(outcome)?

Copyright © 2019, Elsevier Inc. All rights reserved. 17 Copyright © 2019, Elsevier Inc. All rights reserved. 18

Prognosis PICO Cause/Harm/Etiology PICO

 For____ (population), does_______ (disease/condition), relative  Does_______ (exposure or characteristic) increase the risk for

to___________ (comparison disease or condition) increase the _______ (outcome) compared with______ (comparison exposure

risk for or influence ______ (outcome)? or condition) in _____ (population)?

Copyright © 2019, Elsevier Inc. All rights reserved. 19 Copyright © 2019, Elsevier Inc. All rights reserved. 20
 Meaning or Process PICO PICOs

 What is it like for____(population) to experience___ (condition,  P: Population and problem

illness, circumstances?)  I: Intervention

Or  C: Comparison

 What is the process by which______ (population) cope with,  O: Outcome

adapt to, or love with ____ (circumstance)?  S: Study design

Copyright © 2019, Elsevier Inc. All rights reserved. 21 Copyright © 2019, Elsevier Inc. All rights reserved. 22

PICOTS
Example
PICOS PICOTS
Time frame for attaining or sustaining the outcome of interest
Population, Intervention, Comparison intervention (if any), Outcomes, Study
• “In family carers of people with dementia (P), what are the effects of a
design
mindfulness-based stress-reduction program (I) compared with usual
• “In critically ill children (P), are pressure alternating mattresses (I) more
practice (C) on carers’ symptoms of depression, anxiety, and feelings of
effective than high-specification foam mattresses (C) in preventing pressure burden (O) when assessed 4 months after start of treatment (T).”
injuries (O)?”
• The preferred study design (S) = as per previous slide; information on
• The preferred study design (S) for this question of effectiveness is an feelings of burden could also be addressed in qualitative research
Randomize Control Trail (RCT) © Elsevier 2020 © Elsevier 2020
 Guides Which Study Designs Are Likely to Provide the Most
Valid Evidence
Research Question
1-Questions about effectiveness of an intervention  Key preliminary steps in conducting research studies
• Randomized controlled trial  Guide the design and implementation of a research study
2-Questions about the accuracy of a diagnostic test  Used by researchers to test the relationships between and among
• Studies that compare the new test against a reference standard test variables
3-Questions about prognosis  Written as questions that address a gap or conflict in the literature
• Cohort studies; case-control studies when outcome is rare or follow-up is  Test a measureable relationship between the independent and
long dependent variable that is examined in the study
 Research question is answered by the findings of the study.
4-Questions about etiology (causation)
 A properly written research question will be clear and concise.
• Case-control or cohort study
5-Questions about perceptions, attitudes, beliefs, and experiences
• Qualitative research (numerous approaches) OR, ideally, guidelines informed by
studies of these designs © Elsevier 2020 Copyright © 2019, Elsevier Inc. All rights reserved. 26

Components of Research Question

 Topic being studied (purpose)

 Variable(s)

 Population

Copyright © 2019, Elsevier Inc. All rights reserved. 27