Discussion board

Evidence-Based Practice Movement

External Evidence

Internal Evidence

Generated from Clinical Expertise:

Outcomes management projects

Quality improvement projects

Quality improvement data

Patient assessment and evaluation

Patient Values and Preferences

EBP-Impact on Nursing Practice

EBP must be successfully adopted and sustained by all key stakeholders (e.g. system leaders, policy makers, etc.).

EBP must be achieved across the organization culture to eliminate significant barriers EBP must incorporate a strategy application of “Team Strategies and Tools to Enhance Performance and Patient Safety

Nurses must have positive attitudes and desire additional knowledge and skills to face the significant barriers; then effectively demonstrate evidence-based practice interventions.

Magnet Recognition Program – Nurse leaders adopting EBP as a marker of excellence

Building an Evidence-Based Practice

Cultivate a spirit of Inquiry (clinicians must be comfortable with and excited about asking questions about patient care and institutional or unit-based practices

Nurses and health professionals are encouraged to question current practices

Cadre of EBP mentors needed

Infrastructure with tools needed

Administrative support and leadership needed

Steps of Evidence-Based Practice

Ask Clinical questions in PICOT format

Steps of Evidence-Based Practice

In teenagers (the patient population)

How does cognitive-behavioral skills building (the experimental intervention) compared to yoga (comparison intervention) affect anxiety (the outcome) after 6 weeks of treatment (time frame)?

Example of PICOT question:

Steps of Evidence-Based Practice

Search for best evidence (conduct a systemic, integrated review of literature). Look for peer review citations

Steps of Evidence-based Practice

Are the results of the study valid? (Are the results as close to the truth as possible?)

What are the results? (Did the intervention work? How Large was the treatment effect? Would replication of the study yield similar results?)

Will the results help me in caring for my patients? (Are the subjects in the studies similar to my patients? (Are the subjects in the studies similar to my patients? Are the benefits greater than the risks? It the treatment feasible? Does the patient desire the treatment?)

Critical appraisal of evidence found

Steps of Evidence-Based Practice

Integrate the evidence with clinical expertise and patient preferences to make the best clinical decision

Steps of Evidence-based Practice

Generate internal evidence through an EBP implementation or outcomes management project or a research study

Models to Guide Implementation of EBP

The Advancing Research and Clinical practice (ARCC)

Clinical Scholar Model

Iowa Model of Evidence-Based Practice

John Hopkins Nursing of Evidence –Based Practice

The Model for Evidence-Based practice change

The Setler Model

The Promoting Action on Research Implementation in Health Services (PARIHS)

Steps of Evidence-Based Practice

Evaluate the outcomes of the practice change based on evidence (Measure patient outcomes or health care quality to determine if this clinical decision was effective)

Steps of Evidence-based Practice

Disseminate the outcomes of the evidence-based practice change (locally, regionally, nationally)

Barriers to Evidence-based Practice

Staff lack EBP knowledge and skills

Lack of belief that EBP will result in better outcomes that traditional care

Amount of information published

Lack of time to appraise evidence

Overwhelming patient loads

Barriers to Evidence-Based Practice

Lack of administrative support

Peer pressure to “not make waves”

Resistance to change

Lack of autonomy over practice

Lack of consequences for not implementing EBP

References

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Philadelphia: WoltersKluwer/Lippincott Williams & Wilkins.