Fundamentals of Nursing Chapter 5: Evidence-Based Practice

Evidence-Based Practice

• Evidence-based practice (EBP) is a problem-solving approach to clinical practice that combines the best evidence with a clinician's expertise, patient preferences and values, and healthcare resources in making decisions about patient care.
• The best scientific evidence comes from well-designed, systematically conducted research studies found in scientific, peer-reviewed journals.

Steps of Evidence-Based Practice

• Cultivate a spirit of inquiry: constantly questioning current practices leads to consistent use of EBP.
• Ask a clinical question in PICOT format: P = Patient population of interest, I = Intervention of interest, C = Comparison of interest, O = Outcome, T = Time.
• Search for the best evidence: sources include agency policy, procedure manuals, quality improvement data, existing clinical practice guidelines, journal articles, and asking experts for help.
• Critically appraise the evidence: synthesize or combine findings, consider the scientific rigor of the evidence and whether it has application in practice, and use a systematic approach to determine the value, feasibility, and usefulness of evidence.
• Integrate the evidence: apply the research in your plan of care for a patient, use evidence as rationale, educate about the change, and incorporate into policies and procedures.
• Evaluate the outcomes of the practice decision or change: determine if the change was effective, if modifications are needed, and if the change should be discontinued.
• Communicate the outcomes of the evidence-based practice decision: share with clinical staff, nursing practice council, clinicians, and professional conferences and meetings.

The Need for Evidence-Based Practice

• Institutions that demonstrate a culture of EBP encourage nurses to question practices and have a consistent use of EBP.

Scientific Method

• Make an observation, ask questions, gather information, analyze the literature, form a research question or hypothesis, conduct a study using scientific rigor, analyze data, and draw conclusions.
• Types of research studies: quantitative research (experimental research, nonexperimental research, surveys) and qualitative research (inductive reasoning).

Nursing Research

• Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively.
• Many professional and specialty nursing organizations support the conduct of research for advancing nursing science.
• Translation research phases: preclinical and animal studies, phase 1 clinical trials, phase 2 and 3 clinical trials, phase 4 clinical trials and outcomes research, and phase 5 population-level outcomes research.
• Outcomes research helps patients, healthcare providers, and those in healthcare policy make informed decisions based on current evidence.
• Outcomes research focuses on the benefits, risks, costs, and holistic effects of a treatment on patients.

Performance Improvement

• Performance improvement is a formal approach for the analysis of healthcare-related processes that reviews how existing interventions within a process function.
• Performance improvement programs focus on processes or systems that significantly contribute to outcomes.

The Relationship Among EBP, Research, and PI

• EBP uses information from research and other sources to determine safe and effective nursing care with the goal of improving patient care and outcomes.
• Research is a systematic inquiry that answers questions, solves problems, and contributes to the generalizable knowledge base of nursing.
• Performance improvement improves local work processes to improve patient outcomes and health system efficiency, and results are usually not generalizable.