Introduction To Evidence Based Nursing By Dr. Hanan Said Ali

Objectives Define evidence – informed nursing Identify the main imperative for evidence – informed nursing. List the requirement of evidence – informed nursing. Identify how does it relate to clinical effectiveness and evidence – based practice Discuss how to Implement evidence – informed prac tice. Determine the Strengths of evidence.

What is evidence – informed nursing We use the term ( evidence – informed nursing ) in preference to evidence – based nursing in order to recognizes that nurses are critical practitioners. The nurse made a decision for actions which can be justified from knowledge base.

The main imperative for evidence – informed nursing Proper use of evidence supports nurses in accounting for what they do. Providing clinically effective patient care and being able to justify the procedures used, the care plan devised or the services provided by reference to authoritative evidence.

The main imperative for evidence – informed nursing Making of decision about the care of individual patients and families, on the basis of the best available evidence Integration of professional judgement and research evidence about effectiveness of interventions.

What it requires is that all nurses have An understanding of the importance of practice being based on the most appropriate evidence on effectiveness. Access to and the ability to use research findings. The ability to evaluate research. The ability to implement research finding in their own practice.

Evidence – informed nursing requires The formulation of answerable questions that arise from practice- Reflection, The searching of the literature or other relevant evidence sources – Information, The evaluation of the evidence for validity, generalisability, and transferability - appraisal

Evidence – informed nursing requires Cont. The use of the best available evidence alongside clinical expertise and patient preferences in planning care - implementation, The evaluation by practitioners of their own professional practice – evaluation.

The evidence – informed nursing cycle Reflection Decision - making Research awareness Information gathering & Critical appraisal Implementation Evaluation

How does it relate to clinical effectiveness and evidence – based practice They refer, at least in part, to using research to inform practice and to ensure efficient and effective practice. It refers to clinical effectiveness as : applying the best available knowledge, derived from research, clinical expertise and patient preferences, to achieve the optimum processes and outcomes of care for patients.

How does it relate to clinical effectiveness and evidence – based practice It is doing the right thing in the right way for the right patient at the right time. There is a dissonance between the core beliefs of nursing and clinical effectiveness. Nurses are committed to providing holistic care as opposed to care based on the biomedical model.

How does it relate to clinical effectiveness and evidence – based practice Nurses are committed to treat patients as whole people and work with them rather on them. Furthermore, effectiveness is only one element of the decision – making process –in deciding on the therapeutic intervention others include safety, acceptability, cost – effectiveness and appropriateness.

Example: If he was diagnosed with cancer today and was faced with the decision about which type of chemotherapy to choose, would he want to know the evidence regarding the risks and benefits of each therapeutic agent as generated from prior clinical trials with other similar cancer clients?

Implementing evidence – informed prac tice To achieve evidence – informed nursing a nurse needs to have: The research awareness skills and the knowledge and competence to interpret research material and to use it to inform their clinical decision- making. A managerial and organisational culture that facilitate the implementation of research into clinical practice.

To implement evidence- informed practice the nurse needs: 1Clinical Expertise 2 A Knowledge of research evidence 3 An understanding of patients preferences 4 Access to adequate resources

1. Clinical expertise Nurses are professionally accountable for the effectiveness of the care they provide and imposes on them a duty to monitor and improve their knowledge and competence

1. Clinical expertise Cont. The nurses have began to recognise the importance of evidence- informed practice and the need to have the skills to assess the research literature and implement findings in their own day – to –day practice.

2. Knowledge of research evidence There is increased emphasis on using the latest and highest- quality evidence to inform clinical practice and service delivery to improve health outcomes for individuals and the population as a whole.

2. Knowledge of research evidence Cont. Evidence –informed nursing is a systematic approach to providing nursing care that requires critical appraisal skills. While research evidence is at the centre of it, it does not require all nurses to be researcher

3. An understanding of patient preference and choice Patients and their families place their trust in nurses. The nurse needs to assess the patient’s knowledge and understanding of their condition and involve them in the decision – making process regarding their care.

3. An understanding of patient preference and choice Cont. The nurse needs to be able to access and critically appraise the evidence in relation to the care needs of each patient and communicate this information in a style most appropriate to the individual patient.

4. Access to adequate resources For nursing to be evidence- informed, research needs to be accessible to nurses who understand the need to base their practice on research and who have the critical appraisal skills necessary to evaluate it.,time to access it and skills to implement it.

Strengths of evidence Evidence is categorized according to the overall research studies design in preventing bias from influencing the research finding. What needs to be emphasised here is the value of the research in answering the proposed question.

The Five Strengths of Evidence Class Strength of evidence I Strong evidence from at least one systematic review of multiple well- designed randomised controlled trials II Strong evidence from at least one properly designed randomised controlled trial of appropriate size. III Evidence from well- designed trials without randomisation, single group pre- post, cohort, time series or matched case – control studies.

The Five Strengths of Evidence Cont. ClassStrength of evidence IV Evidence from well- designed non – experimental studies from more than one centre or research group. V Opinions of respected authorities based on clinical evidence, descriptive studies or reports of expert committees.

Best Evidence Define the best research evidence? Is define as: Clinically relevant research, often from the basic sciences of medicine, but especially from patient centered clinical research. Without current best evidence, practice is rapidly outdated

Best Evidence Example: For years, pediatrics primary care providers advised parents to place their infant in prone position while sleeping, this is beast position to prevent aspiration of vomiting. With evidence indicating that prone positioning increase risk of sudden infant death syndrome, the American academic of pediatrics released the clinical practice guideline recommending a supine position for infant sleep.

Common Terminology in EBN Patient value The unique preferences, concerns and expectations each client brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient.

Common Terminology in EBN Cont. Systematic review A summary of the medical literature that uses explicit methods to perform a comprehensive literature search and critical appraisal of individual studies and that uses appropriate statistical techniques to combine these valid studies. Cochrane collaboration A worldwide association of groups who create and maintain systematic reviews of the literature for specific topic areas.

Common Terminology in EBN Cont. Case-control study A study which involves identifying patients who have the outcome of interest (cases) and patients without the same outcome (controls), and looking back to see if they had the exposure of interest. Cohort Study Involves identification of two groups (cohorts) of patients, one which received the exposure of interest, and one which did not, and following these cohorts forward for the outcome of interest

Common Terminology in EBN Cont. Cross-sectional study The observation of a defined population at a single point in time or time interval. Exposure and outcome are determined s imultaneously. Meta-analysis A systematic review that uses quantitative methods to synthesize and summarize the results.

Common Terminology in EBN Cont. Randomization (or random allocation) Method analogous to tossing a coin to assign patients to treatment groups (the experimental treatment is assigned if the coin lands “heads” and a conventional, “control” or “placebo” treatment is given if the coin lands “tails”). Randomized control clinical trial (RCT) Participants are randomly allocated into an experimental group or a control group and followed over time for the variables/outcomes of interest

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