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Evidence Based Nursing
Date of last revision: September 18, 2013

Introduction

  • Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. (Fineout-Overholt E, 2010)

  • Health care that is evidence-based and conducted in a caring context leads to better clinical decisions and patient outcomes. Gaining knowledge and skills in the EBP process provides nurses and other clinicians the tools needed to take ownership of their practices and transform health care. Key elements of a best practice culture are EBP mentors, partnerships between academic and clinical settings, EBP champions, clearly written research, time and resources, and administrative support. (Fineout-Overholt E, 2005)

Definition

  • Nursing Research: "A scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice."

  • Evidence Based Nursing/Practice: 'An integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served."

  • "Evidence-based decision-making is a continuous interactive process involving the explicit, conscientious and judicious consideration of the best available evidence to provide care."-Position Statement by Canadian Nurses' Association

  • In increasing numbers, nurses as members of interdisciplinary and transdisciplinary teams are implementing evidence-based practice (EBP) changes. ( Worral PS, 2009)

Purpose and Objectives

Evidence based practice seeks to replace practice as usual, with practice guided by rigorous outcome-oriented research, ideally randomized controlled trials. It also seeks to make practice a less subjective enterprise, and to raise it to a higher level of accountability. It is associated with efforts to identify best practices in nursing and other disciplines. (Baumann SL, 2010)

Evidence based nursing aims:

  •  to provide the highest quality and most cost-efficient nursing care possible. 

  • to advance quality of care provided by nurses.

  • to increases satisfaction of patients

  • to focus on nursing practice away from habits and tradition to evidence and research.

Components of Evidence-Based Nursing Practice

  • Key elements of a best practice culture are EBP mentors, partnerships between academic and clinical settings, EBP champions, clearly written research, time and resources, and administrative support. (Fineout-Overholt E, 2005)

  • When delivered in a context of caring and in a supportive organizational culture, evidence based practice can help to achieve the highest quality of care and best patient outcomes. ( Baumann SL, 2010)

Ways of Acquiring Knowledge in Nursing

  • Traditions

  • Authority

  • Borrowing

  • Trial & Error

  • Personal Experience

  • Role Modeling

  • Intuition

  • Reasoning

  • Research

Phases of the Research Process

  • Stating the Study Problem

  • Defining the Purpose of the Research

  • Reviewing the Literature to Develop a Theoretical Framework

  • Selecting the Research Design

  • Selecting the Population and Sample

  • Conducting a Pilot Study

  • Collecting the Data

  • Analyzing the Data

  • Communicating Findings and Recommendations

Rating system for levels of evidence

Best evidence includes empirical evidence from randomized controlled trials; evidence from other scientific methods such as descriptive and qualitative research; as well as use of information from case reports, scientific principles, and expert opinion.

Level Definition
I

Systematic review of all relevant RCT

II

At least 1 RCT

III 1

CT without randomization

III 2

Cohort or case control analytic studies

III 3

Multiple time series with/out intervention

IV

Opinion of respected authorities, based on clinical experience, descriptive studies or reports of expert committees

EBN Process

  • Asking a clinical question.

  • Searching the literature for relevant research.

  • Critically appraising what has been found. If change is warranted, following steps occur.

  • Implementing a practice change.

  • Evaluating the change in practice.

Steps in EBN

  • Select a topic

  • Collect appropriate and accurate data to generate evidence for nursing practice.

  • Analyze data from clinical practice.

  • Design interventions based on evidence.

  • Predict and analyze outcomes.

  • Examine patterns of behavior and outcomes.

  • Identify gaps in evidence for practice.

  • Evaluate project to determine and implement best practices.

Sources of Evidence-Based Nursing Information

  • Systematic reviews

    • Cochrane Collaboration (www.cochrane.org)

    • Evidence-Based Journals

  • Evidence-based practice guidelines

    • National Guidelines clearinghouse (www.guidelines.gov)

Limitations

  • Resistant to changes in nursing practice.

  • Ability to critically appraise research findings.

  • Time, workload pressures, and competing priorities.

  • Lack of continuing education programs.

  • Fear of "stepping on one's toes"

  • Poor administrative support .

Conclusion

  • Evidence based nursing started in the 1800s with Florence Nightingale.

  • EBN is a problem solving approach to clinical decision making.
  • EBN integrates providers' clinical expertise with the best external clinical evidence.
  • EBN is the process of integrating
    • Clinical knowledge
    • Judgment
    • Proficiency skills
    • with the best available clinical evidence, such as nursing practice in to patient care.

References

  1. Fineout-Overholt E, Melnyk BM, Stillwell SB, Williamson KM. Evidence-based practice step by step: Critical appraisal of the evidence: part I. Am J Nurs. 2010 Jul;110(7):47-52

  2. Fineout-Overholt E, Melnyk BM, Schultz A. Transforming health care from the inside out: advancing evidence-based practice in the 21st century. J Prof Nurs. 2005 Nov-Dec;21(6):335-44

  3. Worral PS, Documenting an EBP project: guidelines for what to include and why. J N Y State Nurses Assoc. 2009 Fall-2010 Winter;40(2):12-9.

  4. Baumann SL.The limitations of evidenced-based practice.Nurs Sci Q. 2010 Jul;23(3):226-30.

  5. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nurseshdbk/

  6. Evidence-Based Decision Making and Nursing Practice: Position Statement by canadian Nurses assiciation


 

 

   
 
 
     
 
           
 

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