45 Nursing: A Concept-Based Approach to Learning VOLUME TWO | SECOND EDITION 45 MODULE Evidence-Based Practice

A Case for Evidence A problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician’s expertise and patient preferences and values. As the public becomes more computer literate, they have broader access to information regarding health care issues and the incidences of medical errors within health care facilities. Use of evidenced-based practice (EBP) allows nurses to structure how to make accurate, timely, and appropriate clinical decisions. EBP is a problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician’s expertise and patient preferences and values in making decisions about patient care. Without evidence-based practice, nursing would be a practice based solely on tradition. While in practice, you will need an up-to-date textbook, articles from peer-reviewed nursing journals, and nursing research.

Concepts Related to Evidence-Based Practice Clinical Decision Making Advocacy Quality Improvement Accountability Professional Behaviors 3

Benefits of Evidence-Based Practice Nurses using EBP Collaborate with other disciplines Ensure quality communication, continuity Improve client care 4

Ethical and Legal Issues Respect for human dignity Beneficence Justice Informed consent Right to receive full disclosure, information regarding study Right to withdraw from study at any time 5

Steps to Evidence-Based Practice (EBP) Six steps provide a systematic approach to rational clinical decision making: 1. Clinical question 2. Collect evidence 3. Critique the evidence 4. Integrate the evidence 5. Evaluate 6. Share the outcomes Using a step-by-step approach ensures that you will obtain strong evidence to apply in the patient care setting. Table 5-1(on text p. 53) presents various databases available for collecting the best evidence. [Ask students if they are familiar with data bases, especially MEDLINE, CINAHL, or OVID.] Critiquing the evidence oftentimes presents the most difficult step in this process. You want to be able to answer the following questions: Do the articles obtained offer evidence to explain the question? Is the evidence reliable and true? Can the evidence be used in practice? All articles should contain the following information, which will help you to read and understand the content: (1) abstract, (2) introduction, (3) literature review or background, (4) manuscript narrative with purpose of statement and method/design, (5) results or conclusion, and (6) clinical implications.

Evidence-Based Decision Making This model for evidence-based clinical decision making shows how using your clinical expertise and considering patients’ values and preferences ensures that you will apply the evidence in practice both safely and appropriately. [Figure is on p. 51 of text.]

Examples Patient Falls Pressure Ulcer Prevalence Nurse Turnover Nosocomial Infections

Quality and Performance Improvement Every health care organization gathers data on health outcome measures as a way to gauge the quality of care. Examples: medication delivery and using research findings to improve practice. The Joint Commission defines quality improvement as an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others. We often look at fall prevention, medication delivery, decreases in hospital-acquired infection, and pressure ulcers as indicators of overall quality of care. In performance improvement, an organization analyzes and evaluates current performance, using the results to develop focused improvement actions. Remember that evidence-based practice and quality improvement go hand in hand. Combined, they provide the foundation for patient care and outcomes. Table 5-3 (on text p. 61) shows similarities and differences among evidence-based practice, research, and quality improvement.