EVIDENCE BASED

PRACTICE
OBJECTIVES
1. Discuss what evidence is
2. Discuss the eight areas that inform our
knowledge base
3. Defining Evidence Based practice EBP
4. Discuss the origins of EBP
5. Discuss some examples of EBP in nursing
6. Identify possible areas that still require EBP
7. Discuss the advantages of EBP
8. Discuss how we search for Evidence
9. Discuss sources of Evidence
What is Evidence?
First, it is important to understand what we
mean by evidence. The noun evidence
means ‘the available body of facts or
information indicating whether a belief or
proposition is true or valid’. (Oxford
Dictionary)
It refers to information that is used to
‘support particular beliefs, decisions and
actions’ (Ellis, 2019)
Eight areas that inform our
knowledge base
1. Tradition
2. Authority
3. Borrowing
4. Trial and error
5. Personal Experience
6. Role modeling and Mentorship
7. Intuition and Reasoning
8. Nursing Research
What is Evidence-Based Practice in
Nursing
EBP is the use of the best available
research data from well-designed studies,
together with experential knowledge and
patient preferences in clinical practice in
order to support clinical decision making
(Melnyk, 2005)
‘EBP is the use of best evidence in making
patient care decisions. Such evidence
typically comes from research conducted by
nurses and other health care professionals’.
(Polit & Beck, 2017)
What is EBP cont…
EBP is a problem solving approach to patient care
that aids nurses in making clinical decisions.
It allows nurses to provide quality patient care
based on research and knowledge rather than
based on traditions, myths, hunches, advise from
colleagues or out-dated textbooks.
It considers internal and external influences on
practice and encourages critical thinking in the
judicious application of such evidence to the care
of individual patient’s, a patient population or a
system.
Goal of EBP

To improve health and safety of patients

while also providing care in a cost effective
manner to improve the outcomes for both
the patient and the health care system.
History of EBN

Florence Nightingale was the first nurse to use

EBP
During the 1850’s she studied hospital designs, the
battlefield of the Crimean war and patient outcomes
in England, Germany and France. She documented
her findings in her 1859 book “notes on hospitals”
Her book notes on nursing detailed her observations
and conclusions on the impact of light, ventilation,
hygiene, diet and cleanliness on patient’s health.
 
INTRODUCTION OF MODERN
DAY EBP
Modern EBP was introduced by David L. Sackett
a physician and professor who with a group of
clinical epidemiologists started the EB medicine
movement in 1981.
He believed that healthcare professionals should
be aware of changes in medicine to provide
optimal care.
He defined EBM as the conscientious explicit and
judicious use of current best evidence in making
decisions about the care of individual patient’s
EXAMPLES OF EBP IN
NURSING
1. Infection Control
Nurses play a key role in helping to
prevent illness before it happens by
adhering to evidence-based infection-
control policies.
This includes keeping the healthcare
environment clean, wearing personal
protective clothing, using barrier
precautions and practicing hand hygiene.
2. Oxygen Use in Patients with
COPD
Despite the belief by some that providing oxygen
to these patients can create serious issues such as
hypercarbia, acidosis or even death, the evidence-
based protocol is to provide oxygen to COPD
patients.
This practice can help prevent hypoxia and organ
failure.
Giving oxygen, which is the correct treatment
based on the evidence, can enhance COPD
patients’ quality of life and help them live longer.
3. Intravenous Catheter Size and
Blood Administration
Nurses should follow EBP when using
intravenous catheters to administer blood
for packed red blood cell transfusions
(PRBC).
The protocol indicates that nurses should
use a smaller-gauge catheter, which
increases patient comfort.
 
Activity Time!

Can you think of possible areas in nursing

where more EBP and research is required is
required?
AREAS WHERE MORE EBP IS
NECESSARY
The following are some areas where nurses
could better adhere to EBP:
Communication involving changes in a
patient’s status.
Soft skills that improve patient
interaction.
Training and orientation of new nurses.
Shift scheduling and the effect on care.
WHAT METHODS DID NURSES
USE BEFORE EBP
 Patient care was not standardised.
Methods lacking research and evidence
were used which produced variations in
care and unpredictable outcomes.
Nurses relied on doing the following:
 Taking advise from nurse supervisors and managers
 Carrying out approaches based on what was traditionally done
 Using personal experiences confirmed by what worked with patient’s
in the past
 Applying knowledge from nursing education that had become out-
dated
ADVANTAGES OF EBP
 Improved patient outcomes
Contribution to the science of nursing
Keeping practice current and relevant
Increase confidence in decision making
Increased Accountability
ADVANTAGES OF EBP cont…
 Decrease costs due to elimination of
unnecessary tests and procedures
 Reduction in the rate of adverse patient
outcomes
 It helps nurses stay current on the latest
innovations and breakthroughs in healthcare
so they can provide quality patient care
EBP helps professionals in the cases of
litigation
BARRIERS TO IMPLEMENTING
EBP
Individual-level constraints & organisational
constraints
Knowledge from research is not seen as
important by everyone
It can be difficult to identify how research
findings can de directly transferred to practice
Research findings can appear to contradict one
another
Lack of support from leadership
Financial constraints
Consequences of not implementing
EBP
Poor decision making
Can have a negative impact on the
professional identity of the nursing
profession
No development of an evidence base
No improvement in care
No accountability
Ethical issues
THE PROCESS FOR CONDUCTING EBN
INCLUDES:
 Form a clinical question to identify a
problem.
 Gather the best evidence.
 Analyse the evidence.
 Apply the evidence to clinical practice.
 Assess the result
Five A’s of EBP
Phases of EBP
PHASES OF EBNP
Practice – develop and refine your
question and your team
Evidence- search, appraise, summarize &
synthesize internal and external sources of
evidence.
Translation- create and implement an
action plan, evaluates outcomes and
disseminate findings.
 Develop an enquiring mind

Continuously question your practice and

acknowledge there may be alternatives
when:
Colleagues have started using a different
approach
Feedback from patients, clinical audits or
new employees
Articles in professional journals
Acceptance of Feelings of
Uncertainty

Not always easy for any professional

person to acknowledge we don’t know
something
It is okay to not always know the
answer or the solution or best way to
approach something
Reflect and Identify the
Knowledge Gap

‘ I am presumed to know, but I am not

the only one in the situation to have
relevant and important knowledge.
My uncertainties may be a source of
knowledge for myself and for them.’

(Schon, 1983)
 Dealing with Uncertainty
Several options for action:
Accept the unease as a positive. Do not
ignore it.
Congratulate yourself for finding a
knowledge gap, rather than feeling ashamed
and hiding it
Reflect on the issue
Start to turn the concern into questions
 Remember the 3 Elements of
EBP
1. Needs and preferences of the patient
2. The best available evidence
3. Expertise, skill and clinical judgment of the
professional

Latter 2 elements, when adapted to suit the

first are true ‘information mastery’

If it does not make a significant

difference, don’t do it!
 The three elements of EBP

https://www.library.ucdavis.edu/guide/ebp-resources/ebm-cbp-venn-diagram_01
EBP Cycle
A Well Built Question
Contains 3-4 parts
1. The Problem – The patient, situation etc
that you have identified
2. The Intervention
3. A Comparison (if applicable) – an
alternative intervention with which you
can compare
4. The Outcome/s

PICO
Activity- Discussion

Consider one of the areas that were

mentioned before that still requires EBP
and more research, how would you go
about searching for evidence using PICO?
 EBP does not Negate Experience
and Intuition

Itenhances our clinical ‘hunches’ and

credibility especially with medical staff who
will often not respond to a ‘hunch’

When we base our practice on evidence we

build a better foundation for collaboration
and respect from our colleagues

We can be more confident about delivering

optimum care to patients
What do you think is the best form
of evidence?

Expert opinion from years of experience

Journal articles
Text books
On line references

NONE OF THEM
The Best Evidence comes from well
Controlled Research

Research is ranked according to the

rigidity of its processes
Generally, if clinical care raises questions
about treatments and possible alternative
interventions, Randomized Controlled
Trials are the best
Features of Randomized Controlled
Trials
Participants are randomly assigned to one of 2
groups (control or experimental) – Why
important?
Control may be no treatment, a different
treatment, or a placebo
Best if ‘double blind’ – What is that and why is
it best?

The researcher and the participants and the

clinicians do not know which intervention the
patient has received
Hierarchy of Evidence
References
 Craig J & Dowding, D. 2019. Evidence-based practice in Nursing.
4th Edition. Elsevier

 Melynk, B et al. 2014. The Establishment of Evidence-Based

Practice Competencies for Practicing Registered Nurses and
Advanced Practice Nurses in Real-World Clinical Settings:
Proficiencies to Improve Healthcare Quality, Reliability, Patient
Outcomes, and cost. Sigma Vol 11 (1):5-15
 Critical Care Nurse: Putting Evidence Into Nursing Practice
 NCBI: The Evidence for Evidence-Based Practice Implementation.
2016
 Questions?

Thank you for your

attention