1. Evidence-Based Practice (EBP) Joan Pollner, RN, BSN, CHPN October 18, 2006

2. Objectives Define Evidence-based practice (EBP) Define Evidence-based practice (EBP) Identify the goals of EBP Identify the goals of EBP Distinguish between the characteristics of Research Utilization and EBP Distinguish between the characteristics of Research Utilization and EBP Describe the steps in the EBP process Describe the steps in the EBP process Explain the challenges and misconceptions of EBP Explain the challenges and misconceptions of EBP Utilize resources to further knowledge of EBP Utilize resources to further knowledge of EBP

3. Some Definitions Evidence-based practice can be thought of as requiring "the integration of the best research evidence with our clincial expertise and our patient's unique values and circumstances." (Straus, et al., 2005) "Fortunately, evidence-based practice (EBP) is an approach that enables clinicians to provide highest quality of care in meeting the multifaceted needs of their patients and families." (Melnyk & Fineout-Overholt, 2005) (Yale, 2005) Evidence-based practice can be thought of as requiring "the integration of the best research evidence with our clincial expertise and our patient's unique values and circumstances." (Straus, et al., 2005) "Fortunately, evidence-based practice (EBP) is an approach that enables clinicians to provide highest quality of care in meeting the multifaceted needs of their patients and families." (Melnyk & Fineout-Overholt, 2005) (Yale, 2005)

4. Definitions (con ’ t) Integration of the best research evidence with clinical expertise and patient values. (Spector, n.d.). Integration of the best research evidence with clinical expertise and patient values. (Spector, n.d.). “… using the best available research findings “ to make clinical decisions that are most effective and beneficial for patients. ”” (Chitty, 2005). “… using the best available research findings “ to make clinical decisions that are most effective and beneficial for patients. ”” (Chitty, 2005).

5. Goals of EBP Provide practicing nurses with evidence- based data Provide practicing nurses with evidence- based data Resolve problems in the clinical setting Resolve problems in the clinical setting Achieve excellence in care delivery Achieve excellence in care delivery Introduce innovation Introduce innovation Reduce variations in nursing care Reduce variations in nursing care Assists with efficient and effective decision-making Assists with efficient and effective decision-making

6. Goals (con ’ t) Using best evidence to implement the regulation of nurses Using best evidence to implement the regulation of nurses Resolve regulatory problems Resolve regulatory problems Achieve excellence in regulation Achieve excellence in regulation Introduce regulatory innovation Introduce regulatory innovation

7. Research Utilization vs EBP Research Utilization Use results of studies Use results of studies Randomly selected Randomly selected Support nursing care Support nursing care Less systematic Less systematic Evidence-Based Practice Considers all research Considers all research Utilized thorough integrative review Utilized thorough integrative review Context of clinical expertise and value system of the patient Context of clinical expertise and value system of the patient More systematic More systematic

8. EBP is multi-step process Define patient problem Define patient problem Identify information needed to solve problem Identify information needed to solve problem Search of literature Search of literature Critical appraisal of the evidence Critical appraisal of the evidence Extraction of the clinical answer Extraction of the clinical answer Protocol development Protocol development Evaluation Evaluation

9. Steven ’ s ACE Star Model Discovery Discovery Summary Summary Translation Translation Implementation Implementation Evaluation Evaluation

10. Steven ’ s ACE Star Model Discovery Original research Original research Conduct a literature search utilizing recognized techniques Conduct a literature search utilizing recognized techniques

11. Steven ’ s ACE Star Model Summary Synthesize all research into a single meaningful whole Synthesize all research into a single meaningful whole This step differentiates research utilization from Evidence-based practice This step differentiates research utilization from Evidence-based practice Can be called evidence synthesis Can be called evidence synthesis Increase power and effect of data Increase power and effect of data Reduce bias Reduce bias Assess consistencies Assess consistencies Establish generalizability Establish generalizability Reduce data into an manageable form Reduce data into an manageable form

12. Steven ’ s ACE Star Model Translation Scientific evidence is considered in the context of clinical expertise and values Scientific evidence is considered in the context of clinical expertise and values Results in clinical practice guidelines, best practices, protocols, standards or clinical pathways Results in clinical practice guidelines, best practices, protocols, standards or clinical pathways

13. Steven ’ s ACE Star Model Implementation Translation of research into practice Translation of research into practice Where changes take place Where changes take place

14. Steven ’ s ACE Star Model Evaluation Impact of the change is measured Impact of the change is measured Assess variables (health outcomes, efficiency, cost or satisfaction) Assess variables (health outcomes, efficiency, cost or satisfaction)

15. Challenges and Misconceptions Merely a collection of statistics? Merely a collection of statistics? Need more qualitative research Need more qualitative research Nurses need to develop good search strategies Nurses need to develop good search strategies Nurses must learn to do critical appraisals Nurses must learn to do critical appraisals Faculty members must embrace and learn EBP Faculty members must embrace and learn EBP

16. Resources Yale University Nursing Library and Information Resources Yale University Nursing Library and Information Resources http://www.med.yale.edu/library/nursing/education/ebhc2.html Oncology Nursing Society Oncology Nursing Society http://onsopcontent.ons.org/toolkits/evidence/ United States Department of Health and Human Services – Agency for Healthcare Research and Quality United States Department of Health and Human Services – Agency for Healthcare Research and Quality http://www.ahrq.gov/clinic/epcix.htm University of Iowa Hospitals and Clinics Nursing Services and Patient Care University of Iowa Hospitals and Clinics Nursing Services and Patient Care http://www.uihealthcare.com/depts/nursing/rqom/evidencebasedpracti ce/index.html http://www.uihealthcare.com/depts/nursing/rqom/evidencebasedpracti ce/index.html

17. Resources (con ’ t) University of Texas Health Science Center at San Antonio – Acedemic Center for Evidence-Based Practice University of Texas Health Science Center at San Antonio – Acedemic Center for Evidence-Based Practice http://www.acestar.uthscsa.edu/About.htm Medical Library Association – Nursing and Allied Health Resources Section Medical Library Association – Nursing and Allied Health Resources Section http://nahrs.library.kent.edu/resource/symposium/ University of Minnesota – Evidence-based Health Care Project University of Minnesota – Evidence-based Health Care Project http://evidence.ahc.umn.edu/ebn.htm

18. References Chitty, K.K. (2005). Professional nursing: Concepts and challenges. 4 th ed. Philadelphia: Saunders. Chitty, K.K. (2005). Professional nursing: Concepts and challenges. 4 th ed. Philadelphia: Saunders. Spector, N. (n.d.). Evidence-Based Health Care in Nursing Regulation. Retrieved on October 8, 2006 from Nation Council of State Boards of Nursing web site on World Wide Web: Spector, N. (n.d.). Evidence-Based Health Care in Nursing Regulation. Retrieved on October 8, 2006 from Nation Council of State Boards of Nursing web site on World Wide Web: http://www.ncsbn.org/pdfs/Evidencebased_NSpector.pdf#search=%22 evidence%20based%20practice%20in%20nursing%22 http://www.ncsbn.org/pdfs/Evidencebased_NSpector.pdf#search=%22 evidence%20based%20practice%20in%20nursing%22 Yale University. (2005). Evidence-Based Practice. Nursing Library and Information Resources. Retrieved on October 8, 2006 from World Wide Web: http://www.med.yale.edu/library/nursing/education/ebhc2.html Yale University. (2005). Evidence-Based Practice. Nursing Library and Information Resources. Retrieved on October 8, 2006 from World Wide Web: http://www.med.yale.edu/library/nursing/education/ebhc2.html http://www.med.yale.edu/library/nursing/education/ebhc2.html