Evidence Based Practice

Evidence Based Nursing Practice in Nursing

Ð'* "Doing the right things right" (Craig & Smyth, 2002, p.4)

Ð'* Used to improve the experiences associated with health care and illness

Ð'* Early examples

o Infection control (aseptic technique)

o DVT (deep vein thrombosis) prevention

Development of the EBP Concept

Ð'* Began with medicine

o Archie Cochran, a British epidemiologist in 1972 published a book criticizing the medical profession for not reviewing medical research studies

o Believed that the strongest evidence came from RCT (randomized clinical trials). RCT are the most strict kind of research design.

Ð'* A RCT has to have three things:

Ð'* Control group

Ð'* Placebo group

Ð'* Experimental group

o Founded the Cochran Foundation in 1992 after his death

Ð'* Defined as "the conscientious, explicit and judicious use of current best evidence in making decisions about the health care of patients" (Sackett, et al)

Ð'* Focused on findings of randomized clinical trials only

Ð'* New definition: "the integration of best research evidence with clinical expertise and patient values (Sackett, et. al.)

Current Definition in Nursing

Ð'* "Evidence-based practice (EBP) is a problem solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician's expertise as well as patient preferences and values to make decisions about the type of care that is provided" (Melnyk, 2004)

Definition of Terms

Ð'* Best research evidence is patient centered research that is clinically relevant

Ð'* Clinical expertise: the ability to use clinical skills and clinical decision-making to identify patients' health states and risks and benefits of interventions.

Ð'* Patient Values: preferences, concerns and expectations that must be integrated into patients' health care.

Why Evidence-Based Practice?

Ð'* Despite an aggressive research movement, the majority of findings from research often are not integrated into practice.

Ð'* It take approximately 17 hears to translate research findings into practice (if at all)

Ð'* Without current best evidence, practice becomes rapidly out of date to the detriment of patients.

Ð'* In order to keep up with the journals relevant to our practice, we need to review 19 articles a day, 365 days of the year!!!

Ð'* Textbooks may be out of date by the time they are printed

Ð'* Traditional continuing education conferences do not significannot

ly improve clinical practice.

Ð'* To advance our profession and enhance life long learning

Ð'* In the near future, 3rd party payers will only provide reimbursement for healthcare practices that are supported with evidence.

Ð'* Practice routed in tradition are often out dated and does not lead to the best patient outcomes

o Use of soap and water to massage a bony coccyx or reddened heels in bed-ridden patients

 Exacerbated condition

o Daily changing of IV dressings every 24 hours

 Now done every 72 hours

o Perineal shaves before child birth

 Really did nothing

Ð'* Rule 5 of the 10 rules for healthcare in Crossing the Quality Chasm is "evidence-based decision making (IOM, 2001)

Ð'* Competency 3 of the 5 core competencies deemed necessary by the recent Summit on healthcare Professions Education is

o Employ Evidence Based Practice!

What EBP is NOT

Ð'* NOT Cookbook care that has no latitude for clinical judgment

Ð'* NOT Care that excludes patient preferences

Ð'* NOT Care that excludes a clinician's expertise

Ð'* NOT A process that ignores findings from qualitative and descriptive studies

Ð'* NOT Something for academicians

Five Steps of EBP

1. Ask the burning clinical question Ð'- "Why do we do things this way?"

o Give priority to questions that have the most important consequences

o Also give priority to questions that come up more frequently

2. Collect the best evidence

a. Comes from systematic reviews which are also previously called "a meta-analysis"

3. Critically appraise the evidence

o What were the results of the study?

o Are the results valid?

o Will the results help me in caring for my patients?

4. Integrate evidence, clinical expertise, and patient factors/preferences to implement a decision.

5. Evaluate the outcome

Challenges of EBP

Ð'* Gaps in the evidence for what nurses do

Ð'* Rapidly changing evidence bases

Ð'* Life-long