EVIDENCE-BASED

PRACTICE
Presented By: Abdulmajeed Albishri (20210777), &
Mutad Alofi (20210776)
M
 At the completion of this chapter, the students should
be able to:
1 Define evidence-based practice (EBP).

2 Explain what is meant by “best available evidence.”

3 Describe the significance of a hierarchy of types of evidence that inform an EBP project.

4 Appraise the quality of evidence using appropriate appraisal tools.

5 Explore how clinical expertise is determined.

6 Explain the significance of including patient preferences for EBP.

7 Describe the models and frameworks for EBP.

 As per the Centers for Medicare and
Medicaid Services (CMS), there will be
no reimbursement for any hospital-
acquired UTIs. This prompted all
healthcare professionals and
healthcare institutions to set a goal to
use the best available evidence
throughout the healthcare delivery
process. This is a lofty goal that
requires healthcare workers to develop
skills for EBP and knowledge about the
steps in the process. Is it best practice?
 These steps in EBP include the following:

• Asking a searchable question based • Searching the literature for the best
• Identifying a clinical problem
on a clinical problem available evidence

• Synthesizing the best available

• Determining the level of the • Appraising the quality of the
evidence into guidance for clinical
evidence based on a hierarchy evidence
practice

• Implementing the best available • Evaluating the outcomes from the

• Sustaining the change
evidence into healthcare practice change

This chapter explores models that guide EBP and models for implementing evidence into practice
for nursing. The chapter also explores tools for appraising the quality of the evidence and
hierarchies that identify the level of evidence types. The role of nurses in EBP projects is detailed.
 DEFINING EVIDENCE-BASED PRACTICE

While nursing has always been based on research, the introduction of evidence-based practice (EBP)
has revolutionized the science aspect of nursing.

The first definition of EBP was “… integrating individual clinical expertise with the best available
external clinical evidence from systematic research” (Sackett, Rosenberg, Muir-Gray, Haynes, &
Richardson, 1996, p. 971).

The Quality and Safety Education for Nurses (QSEN) initiative has a mission defined as: “The QSEN
Institute is a collaborative of healthcare professionals focused on education, practice, and scholarship
to improve the quality and safety of healthcare systems” (www.qsen.org/about-qsen/).

The QSEN initiative adapted the definition to include best available evidence and patient
engagement, defining EBP as “… the delivery of optimal healthcare through the integration of best
current evidence, clinical expertise and patient/family values” (QSEN, 2012).
 Evidence-based practice model

• Health care that is evidence-based

and conducted in a caring context
leads to better clinical decisions
and patient outcomes. Gaining
knowledge and skills in the EBP
process provides nurses and other
clinicians the tools needed to take
ownership of their practices and
transform health care.
 KEY COMPONENTS OF EBP

Clinical expertise, Patient values and

Research evidence
judicious use circumstances

Knowledge gained from practice

Randomized controlled trials Unique preferences
over time

Laboratory experiments Clinical trials

Epidemiological research Outcomes Concerns Expectations Financial
Inductive reasoning
resources Social support
research Qualitative research

Expert practice knowledge, inductive

reasoning
WAYS OF ACQUIRING KNOWLEDGE IN
NURSING
Traditions

Borrowing

Trial & Error

Personal Experience

Role Modeling

Intuition

Reasoning

Research
 EBP NURSING

Evidence Based Nursing: “An integration of

the best evidence available, nursing
expertise, and the values and preferences
of the individuals, families, and
communities who are served.
 AIMS OF EVIDENCE BASED PRACTICE

To focus on
To provide
nursing
the high
To advance practice It
quality and To increase It results in It keeps It increases
quality of away from contributes
most cost- satisfaction better practices confidence
care habits and to the
efficient among patient current and in decision-
provided tradition to science of
nursing patients. outcomes. relevant. making.
by nurses. evidence nursing.
care
and
possible.
research.
 FEATURES of EBP

Problem based and within the scope of the practitioners experience.

It brings together the best available evidence and current practice by combining research with
knowledge and theory. So it narrows the research practice gap. It facilitates application of research
into practice by including both primary and secondary research findings.

It concerned with quality of service and is therefore a Quality assurance activity.

EBP projects are team projects and therefore require team support and collaborative action.

It support research projects and outcomes that are cost effective EBP de- emphasizes ritual,
isolated and unsystematic clinical experiences ungrounded opinions and tradition as a basis of
practice. It stresses the use of research findings.
 WHY IS EBP RELEVANT TO THE NURSING
PRACTICE?

There is a gap between what we Research-practice gap: Much of

know and what we do. Nursing what is known from research
practice can and must be has not been applied in
changed from tradition-based to practice. This is known as
science-based: Research-Practice Gap.
 BEST AVAILABLE EVIDENCE

• implies that someone must conduct a thorough search of the

The term “best
literature and then judge the quality of the evidence to determine
available evidence” if it truly is the “best available.”

• means that there is a need to judge the quality and rank the
“Best” evidence.

• means that an exhaustive search for evidence has occurred. This

means that nurses do not use whatever evidence is handy. Rather,
“Available” the nurse must ensure that the evidence is of the highest quality
available. This leads to the question, how do we know what
counts as evidence and how do we know it is of high quality?
SYNTHESIS OF TYPES AND LEVELS OF EVIDENCE RANKED STRONGEST TO
WEAKEST
 Evidence Appraisal
The role of a nurse is to assess the quality and rigor of the evidence available to support changes in patient care practice. Is the evidence
strong enough to support clinical decisions? Can the evidence be applied in the clinical setting? These questions drive the appraisal of
evidence.

The Appraisal of Guidelines for

Tools to Appraise Evidence From The Critical Appraisal Skills
Research and Evaluation II
the Literature Program
Instrument

•Appraising research can be • Scope and purpose • The Critical Appraisal Skills Program
intimidating, particularly to the (CASP, 2010) is another available free
• Stakeholder involvement resource
newto-practice nurse. Tools exist to
• Rigor of development • that provides the nurse with tools to judge
aid the inter-professional team in the quality of various types of research
judging the quality of the evidence. • Clarity of presentation • evidence. In contrast to the AGREE II tool
The following are tools to assist both for appraising clinical practice guidelines,
• Applicability
novice and expert nurses and the • CASP has different appraisal tools for
interprofessional team to appraise • Editorial independence (The different types of evidence (see Table 11.3).
different types of evidence. AGREE II Next Steps • CASP provides checklists specific to types of
Consortium, 2009) research including RCTs, SRs, cohort
• studies, case-control studies, and qualitative
research studies
 RESEARCH TERMINOLOGY
Case-control study
•A study comparing cases of two study participants in order to identify causes of what makes them different.

Clinical practice guidelines (or practice guidelines)

•Statements with recommendations to assist healthcare professionals regarding most appropriate treatment for specific clinical situations.

Cohort study
•A prospective study of two groups conducted over time in order to collect and analyze data in comparison to one another.

Integrative review
•An analysis of the literature on a specific topic or concept leading to implications for practice

Meta-analysis
•A comprehensive and systematic approach using statistical methods to pool the results of independent studies on a topic that leads to inferences or
conclusions about that topic

Mixed methods
•A study that uses both quantitative and qualitative study designs

Non-experimental research
•A study in which the researcher collects and analyzes data based on what is observed about a phenomenon without using a comparison
 RESEARCH TERMINOLOGY
Outcomes research
•A study conducted to measure the effectiveness of an intervention.

Prospective study
•A non-experimental study that begins with an examination of assumed causes (e.g., high-fat diet), which then goes forward in time to the presumed effect
(e.g., obesity)

Qualitative research
•A study that examines a phenomenon with words and descriptions rather than statistics or numbers in order to determine underlying elements and patterns
within relationships

Quantitative research
•A study that examines a phenomenon with numeric data and statistics rather than words or descriptions in order to determine the magnitude and reliability
of relationships between variables or concepts

Randomized controlled trial (RCT)

•A study that uses a true experimental design (research that provides an intervention or treatment to research participants who have been randomly chosen
to be either in the experimental group receiving a treatment or in the control group where they receive no intervention or treatment)

Systematic review (SR) of the literature

•A study that uses an exhaustive and transparent systematic approach to searching all the literature on a topic and then critically examines and synthesizes all
the evidence on that specific topic

Text and expert opinion

•Opinions from experts or committees; literature reviews, Non-research articles and editorials are some types of expert opinions
 Clinical expertise
Clinical expertise
• develops as the nurse tests and refines both theoretical and practical knowledge in actual
clinical situations (Benner, 1984).
• must be explicit, or clearly visible to others, so that it can be subjected to analysis and
critique. Nurses demonstrate clinical expertise when they assess their patient and the
patient’s family, consider the setting of the provision of care, make clinical decisions that
place the patient’s values at the center of care, and coordinate patient care based on
available resources.

Patient Preferences
• refer to the involvement of the patient and family with a consideration of their values and
beliefs in clinical shared decisions (Hopp & Rittenmeyer, 2012).
• When patients are included in their healthcare decisions there is an improvement in
cognitive (e.g., ability to retain education, memory recall) and behavioral (e.g., the ability
to adhere to a prescribed regimen) outcomes (Shay & Lafata, 2015).
Shared decision
• making is an approach that involves both clinicians and patients in considering the best
available evidence to make healthcare decisions. Patients are empowered, engaged, and
supported to make autonomous decisions about healthcare (Truglio-Londrigan, Slyer,
Singleton, & Worral, 2014). responsibilities required of the healthcare provider and
essential skills needed for shared decision making, as follows:
Involve the patients Describe treatment
Explore ideas, fears, and Identify the patient’s
either implicitly or options with
expectations of the preferred format for
explicitly in the consideration for
problem and possible education and provide
decision-making equilibrium and
treatments. tailor-made information.
process. balance.

Include the patient to

Check the patient’s Discuss the options and
the extent he or she
understanding of either make or defer the
desires to be involved in
information and healthcare decision.
the decision-making
reactions. (Elwyn et al., 2012)
process.
THANK
YOU
Mohammed Hamoud Alsaadi
Master of Science in Nursing

aaa77gg@gmail.com

20190380