1. An Introduction to Evidence Based Practice
N T.Shea, RN

2. Evidence Based Practice
Learning Objectives:
1. Define evidence based practice
2. Describe why we use evidence based practice
3. Identify the four elements of a well- formulated clinical question

3. Crossing the Quality Chasm
IOM’s 6 aims to improve the health care system:
Health care must be:
Safe
Effective
Patient-centered
Timely
Efficient
Equitable

4. How Can Nursing Meet Those Aims?
By:
Increasing the body of nursing knowledge by conducting research
Utilizing that research in a clinically relevant manner through evidence based practice

5. What Is Knowledge?
“Knowledge is essential information acquired in a variety of ways, expected to be an accurate reflection of reality, and incorporated and used to direct a person’s actions”
(Burns & Grove, 2007, p.13)

6. How Knowledge is Acquired in Nursing
Traditional Methods
New Methods
Tradition
Authority
Borrowing
Trial and Error
Personal Experience
Intuition
Reasoning
Nursing research:
“A diligent and systematic inquiry to validate and refine existing knowledge ,and generate new knowledge that influences nursing practice,”(Burns & Grove, 2007, p.20).
The application of scientific process to result in evidence based nursing practice

7. Evidence Based Practice
What is
Evidence-Based practice (EBP)?
It is the integration of best research evidence with the clinical problem, clinical expertise, and patient values

8. Why do we care about EBP? .

9. Why Use EBP? Optimal patient outcomes
Information accessibility for clinicians
Evidence-based resources allow clinicians to make research-based decisions in a time-efficient, patient-focused manner
“No unaided human being can read, recall, and act effectively on the volume of clinically relevant scientific literature.” (Institute of Medicine, 2001, p.25)
Image retrieved October 5, 2009 from

10. Nursing Role in Evidence Based Practice
Individual RNs
Must know and accept responsibility for:
Asking questions
Reading literature
Understanding
Critical thinking
Synthesizing info
Applying science
Image retrieved September 21, 2009 from atchealthcare.com/government.html

11. Evidence ‘Pyramid’ EBP journals Cochrane DB Systemic reviews
8/4/2019
Evidence ‘Pyramid’
EBP journals
Cochrane DB
Systemic reviews
Clinical Practice
Guidelines
primary research articles
CINAHL, Medline
Assoc. websites,
textbooks
Google
Adapted from

12. Primary Evidence
Primary evidence includes the original reports of research studies and are included in journal citation databases:
MEDLINE
CINAHL

13. Secondary Evidence Secondary evidence is the analysis
of research studies
Includes practice guidelines and systematic literature reviews
Systematic reviews are known as the highest level of evidence in clinical research
Examples:
Cochrane Database of Systematic Reviews (CDSR)
Database of Abstracts of Reviews of Effects (DARE)
National Guidelines Clearinghouse

14. The National Guidelines Clearinghouse
Includes evidence-based practice guidelines from various health centers and organizations.
It can be searched by disease, treatment or organization.

15. Steps to Evidence Based Practice
An orderly series of steps that allows a researcher to find the answer to a question
Consists of five steps:
Identify problem.
Gather data.
Analyze data.
Use the findings.
Evaluate outcomes.

16. Steps to Evidence Based Practice
1. Identify the problem/question
What do you want to do . . .
Improve practice?
Update knowledge?
Validate a policy or procedure?
Plan a new program/therapy/goal?

17. Steps to Evidence Based Practice
PICO: the Anatomy of the Clinical Question:
Patient characteristics (Who) Intervention being considered (What) Comparison intervention (What else) Outcome of clinical interest (How)

18. Steps to Evidence Based Practice
Four elements of a clinical question
Who is the focus of the question?
What is the intervention being done to the patient/population?
How does the intervention affect the patient/populations?
What could be done instead?

19. Steps to Evidence Based Practice
An example question :
“In a 55-year-old man with a 35-year-old history of chronic smoking, would the administration of bupropion as compared to a nicotine replacement therapy (NRT) be a better therapy in causing long-term abstinence from smoking?”
Can you identify each PICO component?

20. Steps to Evidence Based Practice
2. Gather evidence
Run your subject search
Medline, CINAHL
Locate other sources of information
Consideration of hospital policy & procedures
Clinical expertise
Cost effectiveness
Chart reviews
Patient preferences

21. Steps to Evidence Based Practice
3. Examine the evidence and critically evaluate the literature
Which research applies best ?
How strong or weak is the research?
Is this research relevant to the clinical scenario?
Image retrieved September 21, 2009 from

22. Steps to answering Clinical Questions using the Medical Literature
4. Apply the evidence + clinical experience + the patient's preferences
5. Evaluate patient outcomes

23. What is Evidence Based Practice (EBP)
A step-by-step, dynamic process used to solve clinical problems
EBP solves problems by applying
Best research data
Best clinical judgment and expertise
Clinical history and physical assessment
Patient preferences and values

24. Review with an example: Systematic Meta-analysis for Betadine vs
Review with an example: Systematic Meta-analysis for Betadine vs. Chlorhexidine gluconate (Miller, Rajender, Umscheid, & Williams, 2008).
Result: The use of chlorhexidine for skin antisepsis, instead of povidone-iodine, would result in significant reductions in hospital-acquired infections
Data: 9 randomized controlled clinical trial studies used for meta-analysis
PARTICIPANTS: Adults receiving topical antisepsis prior to surgery, blood cultures, and vascular catheter insertion
INTERVENTIONS: Chlorhexidine gluconate
COMPARISONS: Povidone-iodine
OUTCOMES: Positive surface cultures after skin preparation, surgical site infections, catheter site colonization, catheter-related sepsis

25. Research Tutorials CINAHL Medline EBSCOhost CINAHL.com EBSCOhost
CINAHL.com
Online training
Medline
EBSCOhost
PubMed
Online training

26. References
Burns& Grove (2007) Understanding nursing research: Building an evidence based practice. St.Louis, MO: Saunders.
Institute of Medicine (2001) Crossing the quality chasm: A new healthcare for the 21st century. Washington, DC: National Academies Press.
Miller, J., Rajender, A., R., Umscheid, C.A. & Williams, K. (2008). Chlorhexidine versus povidone-iodine in skin antisepsis: A systematic review and cost analysis to inform initiatives to reduce hospital acquired infections. Retrieved October 5, 2009 from
Sackett D.L., Rosenberg W.M.C., Gray J.A.M., Haynes R.B., & Richardson W.S. (1996). Evidence based medicine: What it is and what it isn’t . British Medical Journal. Jan 13; 312 (7023)