Evidence Based Nursing Practice Nursing is one of the oldest professions dated back to ancient civilizations. From the Middle Ages (where the first hospitals and founding of nursing orders were constructed ) to Florence Nightingale in the 19th century to the middle 20th century (where developments in health care such us intensive care units emergency/trauma units and recovery rooms were first sighted) and today’s facts such us the EBNP we can agree that nursing is a progressive and blooming profession that can substantially improve the well- being of people which is as we all know the purpose of nursing

Definitions of EBP Sackett et al (1996) define EBP as “ the conscientious, explicit and judicious use of current best evidence in making nursing decisions about the care of individual patients” Carnwell defines EBP as “the systematic search for, and appraisal of, best evidence in order to make clinical decisions that might require changes in current practice, while taking into account the individual needs of the patient.” Clinical decisions should be informed by up-to-date, relevant and robust evidence rather than outdated primary training or over interpretation of individual patient experiences (Donald & Greenhalgh, 2000; Sackett et al, 2000)

SO WHAT IS EVIDENCE-BASED PRACTICE Conscientious use of current best evidence to make decisions about patient care A problem-solving approach to clinical practice Based on: 1.systematic search for and appraisal of most relevant evidence to answer questions 2.one’s clinical experience and expertise 3.patient preference and values

Why Evidence-Based Practice in Nursing!! Builds on process of research use, but more encompassing More specific than term ‘best practices’ Recognizes the role of clinical expertise EB nursing practice is a state of mind! Fueled by accrediting bodies, professional organizations, third party payers Potential to improve quality, reduce variations in care Focus on practices that result in best possible outcomes at possibly lower cost Provides a way to keep pace with advances

EBP Improves patient outcomes

Five Key Steps of EBP – Step 1. Formulate the question (PICO). – Step 2. Search for the best evidence. – Step 3. Critically appraise the evidence. – Step 4. Integrate the evidence. – Step 5. Evaluate its effectiveness.

What is the PICO Format Population I Intervention or Interest C Comparison intervention or status O Outcome

LEVELS OF EVIDENCE I Evidence - Systematic reviews, meta-analysis RCTs, EB clinical practice guidelines based on RCTs II Evidence - One well designed RCT III Evidence - CTs without randomization IV Evidence - Well-designed case control or cohort studies V Evidence - Systematic reviews of descriptive or qualitative studies VI Evidence - Single descriptive or qualitative study VII Evidence – Opinions of authorities, reports of experts

Definitions of different types of evidence syntheses (Melnyk & Overholt, 2005) Systematic review: A compilation of like studies to address a specific clinical question using a detailed, comprehensive search strategy and rigorous appraisal methods for the purpose of summarizing and communicating the results and implications of contradictory results or otherwise unmanageable quantities of research Meta-analysis: A statistical approach to synthesizing the results of a number of studies that produces a larger sample size and thus a greater power to determine the true magnitude of an effect. Used to obtain a single- effect measure (i.e. a summary statistic) of the summarized results of all studies included in a review.

Barriers to EBP 1. Lack of knowledge about EBP. 2. Lack of knowledge about library and online resources. 3. Inconvenient/inaccessible library/internet. 4. Misperceptions or negative views of research. 5. Devotion to traditional care 6. Overwhelming patient care load. 7. Voluminous amounts of literature. 8. Difficult patient care situations. 9. Organizational constraints. 10. Inadequate information in nursing program. 11. Laziness/lack of motivation/ burnout.

Conclusion Evidence-based practice encompasses implementing the best-known practices into the clinical setting using a scientific approach. As a result, safe, high-quality, and cost-effective care will be more likely to occur consistently

References 1. Melnyck, B.M. & Fineout-Overholt, E. (2005). Evidence- based practice in healthcare. Philadelphia: Lippincott. 2. Stetler, C.B., Morsi, D., Rucki, S., Broughton, S., Corrigan, B., Fitzgerald, J., et al.(1998). Utilization-focused integrative reviews in a nursing service.Applied Nursing Research, 11, Lori Holder, RN, CPN ‘ Nursing through the generetions’ NS/NURSINGEXCELLENCE8/Pages/NursingThroughGenerations.aspx NS/NURSINGEXCELLENCE8/Pages/NursingThroughGenerations.aspx 4. J Contin Educ Nurs Sep-Oct;34(5):217.’ Evidence- based nursing practice: to infinity and beyond. 5. Carnwell, R. (2001) ‘Essential differences between research and evidence-based practice’, Nurse Researcher, Vol.8, No.2, pp Sackett, D.L., Strauss, S.E., Richardson, W.S., Rosenberg, W. and Haynes, R.B. (2000) Evidence Based Medicine: How to Practice and Teach EBM, 2 nd edn, Edinburgh, Churchill Livingstone.