1. Read textbook chapters 1, 3, 4 and 6 . After reading the assigned chapters and reviewing the posted content for this week, think about the importance of research and evidence based practice to the profession of nursing. Think of your own clinical prac

Evidence-Based

Practice in a Hospital

Environment

Pamela K Ginex EdD, RN, OCN

Nurse Researcher, Center for Evidence-Based Practice and Research

Memorial Sloan-Kettering Cancer Center

Evidence-Based Practice:

What is it?

 The conscientious, explicit, and judicious use of current best evidence in making decisions regarding patient care.

 Practice based on research evidence is more likely to achieve quality patient outcomes.

Why Evidence-Based Practice?

 Despite an aggressive research agenda, the majority

of findings from research are not integrated into

practice.

 It takes approximately 17 years to incorporate

findings from research into practice.

 Without current best evidence, practice becomes

rapidly out-of-date to the detriment of patients

Thinking Outside the Box

 Does what we are doing make theoretical sense?

 Why are we still doing it?

 We work in dichotomous silos

 Discipline-to-discipline

 Department-to-department

 Do not positively impact patient outcomes

What is an Evidence-Based

Culture?

 An EBP culture is

 a practice environment that values and provides high-

level evidence-based care based on an organizational

commitment to evidence-based nursing practice; and

 a practice environment that includes partnerships with

other disciplines, as needed.

 Not a destination, but an ongoing journey

The Nursing Process and

Evidence-Based Practice

 Assessment

 Diagnosis

 Planning

 Implementation

 Evaluation

Assessment

NURSING

PROCESS

ACTIONS EVIDENCE

BASED

PRACTICE

ACTIONS

Assessment Collects patient data Asking the question Clearly identifies

specific patient

problems/needs

NURSING

PROCESS

ACTIONS EVIDENCE

BASED

PRACTICE

ACTIONS

Diagnosis Analyses assessment

data and determines

diagnosis

Search for evidence Collects information

relevant to the

identified problem

Diagnosis

NURSING

PROCESS

ACTIONS EVIDENCE

BASED

PRACTICE

ACTIONS

Planning Develops a plan of

care

Analyzing the

evidence

Critically appraises

the published

literature

Planning

NURSING

PROCESS

ACTIONS EVIDENCE

BASED

PRACTICE

ACTIONS

Implementation Initiates the

interventions

identified in the plan

of care

Applying the

evidence to practice

Integrates evidence

with clinical

expertise

Implementation

NURSING

PROCESS

ACTIONS EVIDENCE

BASED

PRACTICE

ACTIONS

Evaluation Evaluates the

patient’s progress

toward attainment

of outcomes

Evaluating the

effectiveness

Evaluates the

effectiveness of the

integration of

evidence

Evaluation

EBP Process

 Ask the question

 Question, background, objectives

 Search for evidence

 Literature search engines

 Evidence-based practice web sites

 Experts in the field

EBP Process

 Analyze the evidence

 Selection of evidence (critiquing the literature)

 Levels of evidence

 Summary of findings

 Apply the evidence to practice

 Applicability to practice

 Feasibility

 Recommendations for practice

 Evaluate the evidence

Asking the Question

 Frame the question

 Describe the background related to the issue

 What are the specific objectives you want to

accomplish?

Searching the Evidence

 What search strategy should be used to obtain

the information?

 Describe the database/s utilized

 Literature Search Engines

 Evidence-Based Web Sites

 Organization Web Sites

 Electronic Journals

Analyzing the Evidence

 What search criteria were used in the

analysis?

 How were articles selected?

 What was the level of evidence?

 What were the main results?

Providing Research Evidence

for Best Practice

Level Definition

Level I Evidence from a systematic review or meta-

analysis of all relevant randomized control

trials (RCT) or evidence-based clinical

practice guidelines based on systematic

reviews of RCTs

Level II Evidence obtained from at least one well

designed RCT

Level III Evidence obtained from well designed

controlled trials without randomization

Providing Research Evidence

for Best Practice

Level Definition

Level IV Evidence from well designed case control and

cohort studies

Level V Evidence from systematic reviews of

descriptive and qualitative studies

Level VI Evidence from a single descriptive or

qualitative study

Level VII Evidence from the opinion of authorities

and/or reports of expert committees

Applying Evidence to Practice

 What conclusions can be made as the

evidence is applied to nursing practice?

Evaluating Practice

 What recommendations can be made to

evaluate patient outcomes?

 What metrics are necessary to measure patient

outcomes?

 Need to “close the loop” – evaluate patient

outcomes, not just “collect data”

Outcomes of Evidence Based

Practice

 Justification for standards of care

 Evidence of practice standards for

patients, regulatory agencies, third party

payors

 Improved patient outcomes

Moving Toward an Evidence-

Based Approach to Practice

 Practice areas are unique

 Many standards of practice are shared

 There needs to be representation from all areas

 Policy review and all new policies need an evidence-

based approach

 A major organizational commitment and culture

change

Template for EBP presentations

 Use the following slides for your EBP presentation

to your peers

Question

Simply state your question

Specific Objectives

One or two specific objectives

Search Strategies

 (example – describe your specific strategy)

 MEDLINE

 CINAHL

 Cochrane Collaboration

Sources of Evidence from

Literature Search Engines

 ____ studies were chosen for review based on the

research evidence provided

 Briefly describe each study

Summary of Evidence

 Summarize key points from your review