Evidence-Based Practice in Nursing PDF

EVIDENCE-BASED PRACTICE IN NURSING Dr. Serpil Topçu  NURSING KNOWLEDGE Knowledge is an awareness of the reality one acquires through learning or investigation. Every individual collects, organizes, and arranges facts to build a knowledge base relevant to his or her...

EVIDENCE-BASED PRACTICE IN NURSING Dr. Serpil Topçu  NURSING KNOWLEDGE Knowledge is an awareness of the reality one acquires through learning or investigation. Every individual collects, organizes, and arranges facts to build a knowledge base relevant to his or her personal reality Sources of Knowledge 1- Traditional Knowledge Traditional knowledge is that part of nursing practice passed down from generation to generation. When questioned about the origin of such nursing practices, nurses might reply, “We’ve always done it this way.” It is customary in acute care settings to change a patient’s bedclothes daily, whether soiled or not. There are no research data to support this Sources of Knowledge 2- Authoritative Knowledge Authoritative knowledge comes from an expert and is accepted as truth based on the person’s perceived expertise— for example, when a senior staff nurse teaches a new graduate nurse a more efficient method of doing a technical procedure, such as inserting an intravenous catheter.  Sources of Knowledge 3- Scientific Knowledge Scientific knowledge is that knowledge arrived at through the scientific method (implying through research). New ideas are tested and measured systematically using objective criteria.  Introduction to Evidence-Based Practice Evidence-Based Practice (EBP) is an approach to healthcare that integrates clinical expertise, current best evidence, and patient values to provide high-quality care.  Why is EBP Essential in Nursing? - Improves patient safety and outcomes - Encourages use of up-to-date knowledge - Supports professional development - Bridges the gap between research and practice  Historical Development of EBP - Florence Nightingale's use of data during the Crimean War - Evolution in the 1970s with research-based practices - Expansion in nursing education and practice in the 21st century  Steps of Evidence-Based Practice There are six steps of EBP : 1. Ask a clinical question. 2. Collect the most relevant and best evidence. 3. Critically appraise the evidence you gather. 4. Integrate all evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change. 5. Evaluate the practice decision or change. 6. Share the outcomes of EBP changes with others.  Steps of Evidence-Based Practice 1. Ask a clinical question; Always think about your practice when caring for patients. Question what does not make sense to you and what needs to be clarified. How long have you had pain? Can you describe your pain?  Steps of Evidence-Based Practice 1. Ask a clinical question; The more focused a question you ask, the easier it becomes to search for evidence in the scientific literature  Steps of Evidence-Based Practice 2. Collect the Best Evidence When using the scientific literature for evidence, seek the assistance of a medical librarian  Levels Of Evidence Levels of evidence are a system used to assess the reliability and validity of scientific research and information used in clinical practice. These levels are ranked based on the methodological quality of the studies and the accuracy of the findings. The following summarizes the generally accepted levels of evidence:  Steps of Evidence-Based Practice 3. Critically appraise the evidence you gather There are many different sources of information and research in nursing. However, not all of them are accurate, reliable or applicable. Making decisions based on incorrect information can harm patients. Therefore, nurses need to question and evaluate information.  Steps of Evidence-Based Practice 3. Critically appraise the evidence you gather Critical appraisal of evidence involves carefully examining a study or source of information and seeking answers to three questions: Is this information accurate? Is this information reliable? Will this information work for my patient? Remember, not all information is accurate; questioning is your strength!  Steps of Evidence-Based Practice 4. Integrate the Evidence. Once you decide that the evidence is strong and applicable to your patients and clinical situation, incorporate it into practice. Your first step is simply to apply the research in your plan of care for a patient  Steps of Evidence-Based Practice 5. Evaluate the Practice Decision or Change. After applying evidence in your practice, your next step is to evaluate the outcome. How does the intervention work?  Steps of Evidence-Based Practice 6. Share the Outcomes with Others After implementing an EBP change, it is important to communicate the results. Clinicians enjoy and appreciate seeing the results of a practice change. Nurses often communicate the outcomes of EBP changes at professional conferences and meetings. Being involved in professional organizations allows them to present EBP changes in scientific abstracts, poster presentations, or even presentations.  Barriers to EBP in Nursing Lack of EBP skills or knowledge Misperceptions or negative attitudes about research and EBP Lack of belief that EBP improves outcomes Too much information in journals – information overload Lack of time and resources to search for and appraise evidence Overwhelming patient loads  Barriers to EBP in Nursing Organization constraints and lack of administrative support Lack of EBP mentors Demands from patients for a certain type of treatment Peer pressure to continue to practice steeped in tradition Resistance to change Lack of consequences for not implementing EBP Lack of autonomy over practices and incentives  EBP Case Example Scenario: You are the director of nurses in a large long- term care facility. At the end of each 3 months, a round- table discussion is held about the prevalence of pressure ulcers (bedsores). At the latest meeting, it was noted that the prevalence was higher than it had been the previous two periods of time. A new type of mattress has been suggested by a salesman that is air fluidized and is “more effective in preventing pressure ulcers than the foam mattress overlays now in use.” However, the air-fluidized mattress is more expensive. You wonder if you should recommend buying the new mattresses for the entire facility.  EBP Case Example POPULATION: Adult inpatients at risk for pressure ulcers INTERVENTION: Air-fluidized mattress COMPARISON: Foam-mattress overlays OUTCOME: Pressure ulcer rates TIME: -  EBP Case Example 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: From a MEDLINE search: Reddy, M., Gill, S. S., & Rochon, P. A. (2006). Preventing pressure ulcers: A systematic review. Journal of the American Medical Association, 296(8), 974–984.  EBP Case Example Findings from research studies on pressure ulcer prevention do not suggest that either dynamic mattresses (e.g., dynamic air-fluidized mattresses) or static mattress overlays (e.g., foam mattress overlays) are better mattress choices that prevent pressure ulcers. Strength of Evidence: Level I—Systematic Review Recommendation: You decide not to purchase the more expensive air-fluidized mattresses  Overcoming Barriers to EBP - Providing EBP training programs - Ensuring administrative support - Encouraging a culture of continuous improvement  Future of EBP in Nursing - Integration of Artificial Intelligence in evidence appraisal - Focus on global health challenges - Enhancing patient participation in decision- making  Conclusion Evidence-Based Practice is essential for improving patient care, advancing nursing practice, and ensuring healthcare sustainability. Case: Managing a Feverish Child Patient: An 8-year-old boy is brought to the clinic by his parents with complaints of a high fever (38.8°C) and fatigue. The child is generally healthy but has been experiencing loss of appetite and lethargy for the past two days. Despite receiving paracetamol, the fever continues to rise. Situation: The nursing team needs to decide on the best methods to manage the child’s fever. Currently, they recommend giving the child plenty of fluids and applying cool compresses.  Identify the Problem: Formulate a PICO Question: Search for Evidence: Discuss the Evidence: Simple Discussion Questions: - If you were the nurse, which intervention would you prioritize for this patient? - What are the benefits and limitations of using cool compresses? - Besides paracetamol, what other methods can be used to reduce fever?  Benefits and Limitations of Using Cold Compresses in Children Benefits: - Fever-Reducing Effect: Cold compresses are a supportive method for reducing high fevers in children. Cold applied to the skin surface can help reduce fever by increasing heat loss from the body. - Reducing Pain: Cold compresses provide relief from conditions such as headaches, muscle pain, or teething pain by reducing local inflammation. - Swelling and Inflammation Control: It can be especially effective for relieving swelling and pain following trauma. - Easy and Affordable: Can be easily applied at home and does not require any medication. Limitations: - Temporary Effect: Cold compresses provide only short-term relief and do not offer a permanent solution unless the underlying cause of fever is treated. - Risk of Incorrect Application: Direct application to the skin may cause tissue damage (cold burns). Prolonged use or application over a large area can lead to hypothermia. - Ineffectiveness on Root Cause: Cold compresses do not address the infection or illness causing the fever. - Discomfort for Sensitive Skin: Especially in young children, sensitive skin may become irritated or uncomfortable with cold compresses.  Alternative Methods to Reduce Fever Besides Paracetamol - Lukewarm Bath or Wiping: The child can be wiped with lukewarm (not cold) water or given a lukewarm bath to help reduce body temperature gently. - Maintaining a Cool Environment: Keeping room temperature between 22-24°C can assist in regulating the child’s body temperature. - Ensuring Hydration: Fever increases fluid loss; adequate fluid intake ensures hydration and helps regulate temperature. - Light Clothing: Dress the child in lightweight clothing to avoid trapping excess heat and help with heat dissipation.  Alternative Methods to Reduce Fever Besides Paracetamol -Cold Compress or Damp Cloth: Apply a lukewarm-cold damp cloth to the forehead, underarms, or groin areas to aid in cooling. - Proper Rest in the Right Position: Ensuring the child rests without excessive movement helps prevent additional heat generation. - Herbal Remedies at Home (Consulting a Doctor): Ginger, mint, or linden teas can be soothing, though their effect on fever is limited. Be cautious of potential allergic reactions. - Seeking Medical Advice: If the fever exceeds 39°C, other methods fail, or it persists for more than 24-48 hours, consult a healthcare professional, as it may indicate a serious condition.