Evidence-Based Practice in Nursing

Evidence-Based Practice in Nursing

• Evidence-Based Practice (EBP) is an approach to healthcare integrating clinical expertise, current best evidence, and patient values to provide high-quality care.
• Knowledge is awareness of reality, gained through learning or investigation.
• Individuals collect, organize, and arrange facts to build a knowledge base relevant to their personal reality.

Sources of Nursing Knowledge

• Traditional Knowledge: Information passed down through generations in nursing practice. Nurses often justify actions by saying "we've always done it this way," but there may be no evidence supporting this.
• Authoritative Knowledge: Accepted as truth based on an expert's perceived expertise, often from senior staff nurses teaching new graduates more efficient procedures, like IV catheter insertion.
• Scientific Knowledge: Knowledge derived from the scientific method—implying research. New ideas are tested and measured systematically using objective criteria.

Why EBP is Essential in Nursing

• Improves patient safety and outcomes.
• Encourages the use of up-to-date knowledge, supporting professional development.
• Bridges the gap between research and practice.
• Requires nurses to update their knowledge base.

Historical Development of EBP

• Florence Nightingale's use of data during the Crimean War is an early example of EBP.
• Evolution in the 1970s saw research-based practices become more prominent in nursing.
• 21st-century expansion in nursing education significantly expanded use of EBP.

Steps of Evidence-Based Practice

• 1. Ask a clinical question: Thinking critically about care for patients to clarify unclear or illogical procedures; asking questions like "How long have you had pain?" or "Can you describe your pain?"
• 2. Collect the best evidence: Using scientific literature databases (like CINAHL, MEDLINE, EMBASE, PsycINFO), Cochrane Database of Systematic Reviews, and National Guidelines Clearinghouse to search for evidence, or Google Scholar.
  • Use these databases for studies, summaries, guidelines, and other pertinent information.
• 3. Critically appraise the evidence: Evaluating quality and applicability of gathered information to ensure accuracy, reliability, and relevance for specific patients to avoid harm.
  • Ask critical questions like: "Is this information accurate?", "Is this information reliable?", "Will this work for my patient?"
• 4. Integrate the evidence: Applying the evidence to the patient's specific situation and clinical expertise to make a practice change or decision. Using the research to improve plan of care.
• 5. Evaluate the practice decision/change: Assessing the outcome of the applied evidence to see if it achieves the desired impact; asking "How does the intervention work?"
• 6. Share the outcomes: Communicating EBP changes' outcomes to other colleagues and organizations. Sharing results of the EBP at conferences, or in writing (e.g., abstracts, posters, presentations).

Barriers to Evidence-Based Practice in Nursing

• Lack of skills or knowledge in EBP.
• Misperceptions or negative attitudes toward research.
• Lack of belief that EBP improves outcomes.
• Information overload in journals.
• Lack of time and resources to search for and appraise evidence.
• Overwhelming patient loads.
• Organizational constraints; lack of administrative support.
• Lack of mentors to guide and support EBP.
• Demands from patients or pressure to practice in traditional ways.
• Resistance to change.

Overcoming Barriers to EBP

• Provide training programs in EBP.
• Ensure administrative support and commitment
• Encourage a culture of continuous improvement.

Future of EBP in Nursing

• Integration of artificial intelligence to support evidence appraisal.
• Focus on global health challenges.
• Patient participation in decision-making processes.

Conclusion

• EBP is essential for improving patient care, advancing nursing practice, and sustaining healthcare.

Case: Managing a Feverish Child

• Patient: An 8-year-old boy with a high fever and fatigue.
• Situation: The nursing team needs to decide on the best methods to manage the child's fever, given that existing treatments aren't working.

Simple Discussion Questions

• If you were the nurse, which intervention would you prioritize?
• What are the benefits and limitations of using cool compresses?
• Besides paracetamol, what other methods can be used to help reduce fever?

Benefits and Limitations of Using Cold Compresses

• Benefits: Reducing fever, pain relief, and swelling control, are affordable, and easily applied.
• Limitations: Only temporarily effective, possible risk of incorrect application (causing tissue damage or hypothermia), and ineffective if addressing the underlying cause of the fever.

Alternative Methods to Reduce Fever

• Lukewarm baths or gentle wiping.
• Maintaining a cool environment.
• Ensuring hydration.
• Using light clothing to prevent heat trapping.
• Cold compress or damp cloth; applied to forehead, underarms, or groin.
• Proper rest in proper position.
• Herbal remedies; seeking medical advice if fever exceeds 39°C or symptoms persist.

EBP Case Example

• Population: Adult inpatients at risk for pressure ulcers.
• Intervention: Air-fluidized mattress
• Comparison: Foam-mattress overlays.
• Outcome: Pressure ulcer rates.
• Time: Time to reduce rates of pressure ulcers.
• PICO Question: Is the use of air-fluidized mattresses associated with lesser rates of pressure ulcers than foam-mattress overlays among adult inpatients at risk for pressure ulcers?
• Finding: Systematic review suggests that both mattress types are equally effective in reducing pressure ulcers; air-fluidized mattresses are more expensive.
• Recommendation: Patient in this case wouldn't purchase expensive air-fluidized mattresses based on this information.

This quiz explores the fundamental concepts of Evidence-Based Practice (EBP) in nursing, focusing on sources of knowledge that inform nursing practices. It distinguishes between traditional, authoritative, and scientific knowledge, emphasizing the importance of integrating clinical expertise and research for high-quality patient care.