Evidence

Based Nursing Practice

BY
SUMMAIRA NASIR
SENIOR LECTURER
Objectives
By the end of this session, the students will be able to:
•Define evidence-based practice and research utilization
•Identify the difference between evidence-based practice
and research utilization.
•Discuss the importance of EBP.
•Identify the barriers to EBP
•Discuss the evidence hierarchies
•Discuss the steps in using research in EBP.
•Discuss strategies to promote EBP
Evidence Based Practice
•EBP is a problem-solving approach to clinical
decision making that integrates the best evidence
from well-designed studies with a clinician’s
expertise along with patients’ preferences and
values
(Melnyk et al., 2012, as cited in Brown, 2014, p. 157)
Evidence-Based Practice (EBP)
•Is the integration of best research evidence with
clinical expertise and patients’ values.
(David Sackett)
•“Using the best available research findings to make
clinical decisions that are most effective and
beneficial for patients.”
(Chitty, 2005)
Evidence based practice
Research Utilization
•Use of the findings from a disciplined study or set
of studies in a practical application .
Types of Research Utilization
•Estabrooks (1999) Canada. three distinct types of
research utilization:
Indirect research utilization, involving changes in nurses’
thinking
Direct research utilization, involving the direct use of
findings in giving patient care
Persuasive utilization, involving the use of findings to
persuade others to make changes in policies or practices
relevant to nursing care-decision makers
Difference
RESEARCH EBP
UTILIZATION
Start with the Start with a clinical
research itself question
How can I put this What does the
new knowledge to evidence say is the
best approach to
good use in my solving this clinical
clinical setting? problem?
Importance of EBP to Nurses
•Improves patients’ safety
•Improves clinical outcomes for patients
•Effectiveness of nursing care and practices
•Crucial step for clinical decision making
•Fills research practice gap
What hinder not to practice
EBP?
Barriers Using EBP
•Time constraint (heavy workload)
•Insufficient academic preparation in EBP and research
utilization
•Lack of awareness of available research literature
•Insufficient authority to change practice
•Lack of funds
•Inadequate skills in critical appraisal and lack of support for
implementation of research findings. 
•Lack of research evidence available regarding the
effectiveness of many nursing interventions (limited RCTs in
Nsg).
(Grove, Burns, & Gray, 2013; Hutchinson & Johnston, 2004)
Nurse-Related Barriers
•Nurses’ attitudes toward research and their motivation to
engage in EBP have repeatedly been identified as potential
barriers.
•People are often resistant to change. Change requires
effort, retraining, and restructuring of work habits.
•Change may also be perceived as threatening (e.g., changes
may be perceived as affecting job security).
•Language barrier
•Constraint of time to practice at bedside
•Complex statistical information barriers to knowledge
diffusion(transmission) to most practicing nurses
Organizational Barriers
•Organizations resist change, unless there is a strong
organizational perception that there is something
fundamentally wrong with the status quo.
•Mostly administrators rewards nurse for
competency in practice, very few rewards are for
critiquing and using nursing research in practice.
•Thus, organizations have failed to motivate or
reward nurses to seek ways to implement
appropriate findings in their practice
 Cont…
•Organizations also may be reluctant to expend
resources for RU/EBP activities or for changing
organizational policy.
•Resources may be required for the use of;
◦ Outside consultants,
◦ Staff release time,
◦ Library materials and Internet access,
◦ Evaluating the effects of an innovation, and so
on.
Steps of Using Research in EBP
Evidence based Nursing Practice solve problems
encountered by nurses by carrying out four steps:
•Clearly identify the issue or problem based on accurate
analysis of current nursing knowledge and practice
•Search the literature for relevant research
•Evaluate the research evidence using established
criteria regarding scientific merit
•Choose interventions and justify the selection with the
most valid evidence
Five Steps of EBP
How do you identify the
problem?
•Why are we doing this?

•Why are we doing it this way?

•Can we produce better outcomes with greater

consistency?
(Wells, 2007, Slide 7)
Literature Search Resources
◦ Nursing Journals (CINAHL/PubMed)
◦ Cochrane Reviews
◦ Agency for Healthcare Research & Quality (AHRQ)
◦ Up-to-date
◦ Joanna Briggs Institute (JBI)
◦ National Guideline Clearinghouse (Guidelines.gov)
Criteria to Evaluate Research
Evidence
•consistent findings exist from numerous studies to support
the change,
•the type and quality of the studies,
• the clinical relevance of the findings,
•the number of studies with similar sample characteristics,
•the feasibility of the findings in practice, and
•the risk-benefit ratio.
If criteria is met, pilot the project, if not then need to
conduct research
(Brown, 2014, p. 158)
Level of Evidence

http://guides.lib.usf.edu/c.php?g=237761&p=1597935
Application to Practice
•Does the research apply to my patient population?

•Would this practice change improve process of

care? Patient outcomes?

•Is there support for this practice change?

(Wells, 2007, Slide 15)
PICOT Method
PICO (alternately known as PICOT) is a mnemonic
 used to describe the four elements of a good
clinical question. It stands for:
P – Patient/Problem/Disease
I – Intervention/Variable of interest
C – Comparison/Control
O – Outcome
T – Time (The time it takes to demonstrate an outcome)
(http://libguides.sonoma.edu/ld.php?content_id=7671313)
Example 1 (Intervention)
In adult patients with total hip replacements, how effective
is patient controlled analgesia (PCA) pain medication
compared to prn IM pain medication in controlling
postoperative pain during the perioperative and recovery
time?
P – Adult patients with total hip replacement
I – Patient Controlled Analgesia
C – IM pain medication
O – Postoperative pain
T – Perioperative and recovery time
Example 2 (non-
intervention)
What is the duration of recovery for patients with total hip
replacement who developed a postoperative infection as
opposed to those who did not within the first 6 weeks of
recovery?
P – Patients with total hip replacement
I – developed postoperative infection
C – those who did not develop post-operative infection
O – duration of recovery
T – First six weeks of recovery
Example 3 (Etiology)
Are children with obese adoptive parents at increased risk for obesity
compared with children without obese adoptive parents between the
ages of 5 and 18?
P–
I–
C–
O–
T–
Example 4 (Prevention)
P – Nurses doing a 5-minute scrub
I – Artificial nails
C – Natural polished nails and nail beds
O – Presence and types of microbes
T – Time of surgery
Question
In OR, nurses doing a 5-minute scrub, what are the differences in the
presence and types of microbes found on natural polished nails and nail
beds versus artificial nails at the time of surgery?
Example 5 (Meaning)
P – Pregnant women
I – Newly diagnosed with diabetes
C – ???
O – Perceive reporting their blood sugar levels
T – During pregnancy and 6 weeks’ postpartum
Question
How do pregnant women (P) newly diagnosed with diabetes (I) perceive
reporting their blood sugar levels (O) to their healthcare providers during
their pregnancy and 6 weeks’ postpartum (T)?
Asking well worded clinical question
Foreground question-that can be answered based on current best
research evidence on diagnosing/assessing , treating/intervention
Prognosis, causation/harm or on understanding the meaning or process
of health problem
Strategies
•Nurse should read journals and research reports relating to their
specialty.
•Attend professional conferences. Many nursing conferences include
presentations of studies that have clinical relevance.
•Become involved in a journal club to review research articles that have
potential relevance to practice.
•Participate in RU/EBP projects.
•Sometimes ideas for RU or EBP projects come from staff nurses (e.g.,
ideas may emerge within a journal club).
•Several studies have found that nurses who are involved in research-
related activities (e.g., a utilization project or data collection activities)
develop more positive attitudes toward research and better research
skills.
Acknowledgement

Acknowledgement
Dr Khairunissaa Dhamani
Mr. Muhammad Ishtiaq
Reference
Brown, C. G. (2014). Clinical Journal of Oncology Nursing, 18(2): 157-159.
Bussières, A. E., Zoubi, F. A., Stuber, K., French, S. D., Boruff, J., Corrigan, J.,
& Thomas, A. (2016).
Evidence-based practice, research utilization, and knowledge translation in c
hiropractic: a scoping review
. BMC Complement Alternative Medicine,16. Doi: 10.1186/s12906-016-
1175-0
 Grove, S. K., Burns, N. and Gray, J. (2013). The practice of nursing research:
Appraisal, synthesis, and generation of evidence (7th ed.). St. Louis, Mo:
Elsevier/Saunders.
Hutchinson, A. M. and Johnston, L. (2004). Bridging the divide: a survey of
nurses’ opinions regarding barriers to, and facilitators of, research utilization
in the practice setting. Journal of Clinical Nursing, 13, 304–315.
doi:10.1046/j.1365-2702.2003.00865.x
References
McNeill, L. (2017). Back to Basics: How Evidence-Based Nursing Practice
Can Prevent Catheter-Associated Urinary Tract Infections. Urologic
Nursing, 37(4), 204-206. doi:10.7257/1053-816X.2017.37.4.204
Melnyk B., & Fineout-Overholt E. (2010). Evidence-based practice in
nursing & healthcare. New York: Lippincott Williams & Wilkins.
Rajamani, S. (March, 22, 2012). Evidence Based Practice. Power Point
Slide Presentation. Retrieved from
https://www.slideshare.net/mhnsathish/evidence-based-practice-
12124528.
Wells, N. (October, 2007). Evidence-based Practice What Does it Mean
for Nursing? Vanderbilt Medical Center. Retrieved from
https://www.mc.vanderbilt.edu/root/sitebuilder/mcweb/nursing/.../eb
p-octoberfest.ppt