Created by Terran Mathers, PhD, RN
There is no conflict of interest in the creation of this education program.
Objectives
 Explain the importance of Evidence Based
Practice (EBP) in nephrology nursing.
 List the steps of EBP.
 Identify four internet resources/databases
where previous research or guidelines
may be located.
 Recognize potential barriers to EBP within
an organization so that strategies may be
planned to overcome them.
Introduction
Historical Background of EBP
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1837: Pierre Louis
1970’s: Cochran Collaboration
1972: Briggs Report (DHSS)
2004: ANNA Nursing Research
Committee Survey
What is
Evidence-Based Research?
 EBR defined: Clinically relevant research
based on medical science; this research is
patient-centered.
 Research Utilization: Use of the
knowledge found from research,
usually based on a single study.
 Cochrane Center (meta-analysis reviews)
(Melnyk & Fineout-Overholt, 2005; Sackett et al, 2000)
What Is
Evidence-Based Practice?
Assessment
Clinical Experience
And Expertise
Search and Appraisal
Of Evidence
Patient Preferences
& Values
Evidence Based Practice
**
Clinical Decision Making
Sackett et al, 2000; Melnyk & Fineout-Overholt, 2005
Why Evidence-Based Practice?
Quality Care
Cost
Containment
Positive
Patient
Outcomes
Enhance
Professional
Environment
Centers for
Evidence-Based Practice
www.ahrq.gov/clinic/epc/epcenters.htm
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Blue Cross and Blue Shield Association
Duke University
ECRI
John Hopkins University
McMaster University
Oregon Health & Science University
RTI International – University of North Carolina
Southern California
Stanford University – University of California, San
Francisco
Tufts University – New England Medical Center
University of Alberta, Edmonton, Alberta, Canada
University of Minnesota, Minneapolis, MN
University of Ottawa, Ottawa, Canada
Steps of
Evidence-Based Practice
Step 1:
What is the
clinical question?
Melnyk & Fineout-Overholt, 2005
Ask the clinical question
in the “PICO” format
P=
I =
C=
O=
Patient Population / Disorder
Intervention or Interest Area
Comparison
Outcome
PICO
Example:
P = Elderly nephrology patients
I = Psychosocial issues
C = Effect on compliance
O = Patient will be able to adapt to
changes related to diagnosis
and treatment
Steps of
Evidenced-Based Practice
Step 2:
Find the best evidence to
answer the question
 Systematic review of the literature
 Meta-analysis or clinical practice
guidelines
 Rigorous process
 Preset criteria
 Overcomes bias
 Valid / credible results
Guideline Databases
 National Guideline Clearinghouse (NGC)
http://www.guideline.gov
 National Institute for Clinical Excellence (NICE)
http://www.nice.org.uk/catcg2.asp?c=20034
 National Kidney Foundation K/DOQI Guidelines:
http://www.kidney.org/professionals/doqi/guidelineindex.cfm
Steps of
Evidence-Based Practice
Step 3:
Appraise the evidence
Critical Questions to Ask:
1. What were the results of the study?
2. Are the results valid?
3. Will the results facilitate patient care?
Steps of
Evidence-Based Practice
Step 4:
Integrate the evidence,
patient assessment
information, clinical
expertise, patient
preferences and values.
Steps of
Evidence-Based Practice
Step 5:
Evaluate the change
in the clinical area.
Implementing EBP:
The Barriers
 Translating the meaning and
relevance of EBP
 Knowledge deficit
 Being overwhelmed by the
evidence
 The need for dedicated time
 Negative views about research
 Organizational constraints
VanBuskirk, 2005; Melnyk & Fineout-Overholt, 2005
Facilitation of EBP
Promote Acceptance
 Access with surveys; focus
groups
 Identify baseline knowledge
 Identify real case scenarios
 Analyze the culture of the
environment
Facilitation of EBP
Correct Misperceptions
 Have key leaders attend nursing
centers
 Teach the basics of EBP (Online
Tutorials)
 Expose to useful databases
EBP Online Tutorials
 Evidence-Based Clinical Practice Tutorial
http://www.urmc.rochester.edu/hslt/miner/digital_library/eviden
ce_based_resources.cfm
 Texas Health Science Center: Academic
Center for Evidence-Based Nursing
http://www.acestar.uthscsa.edu/
 Evidence-Based Nursing
http://www.hsl.unc.edu/Services/Tutorials/EBN/index.htm
Facilitation of EBP
Question Clinical Practices
 Prioritize problems
 Utilize clinical practice
guidelines and research
 Promote a culture of
organizational acceptance
for EBP
References
 Honor Society of Nursing, Sigma Theta Tau
International (2005). Honor Society of Nursing, Sigma
Theta Tau International: Position statement on
evidence-based nursing. Indianapolis: Sigma Theta
Tau International.
 Cowan, P. (2004). Advancing evidence-based practice
through meta-analysis. Nephrology Nursing Journal,
31(3), 343-345.
 Gagan, M., & Hewitt-Taylor, J. (2004). The issues for
nurses involved in implementing evidence in practice.
British Journal of Nursing, 13(20), 1216-1220.
References
 Gillis, A., & Jackson, W. (2002). Research for nurses:
Methods and interpretation. Philadelphia: F.A. Davis.
 Larrabee, J. (2004). Advancing quality improvement
through using the best evidence to change practice.
Journal of Nursing Care Quality, 19(1). 10-14.
 Malloch, K., & Porter-O’Grady, T. (2006). Introduction
to evidence-based practice in nursing and health care.
Boston: Jones and Bartlett.
 Melnyk, B. M., & Fineout-Overholt, E. (2005).
Evidence-based practice in nursing and healthcare: A
guide to best practice. Philadelphia: Lippincott,
Williams, & Wilkins.
References
 Pape, T. (2003). Evidence-based nursing practice:
To infinity and beyond. The Journal of Continuing
Education in Nursing, 34(4), 154-164.
 Paramonczyk, A. (2005). Barriers to implementing
research in clinical practice. The Canadian Nurse,
101(3), 12-18.
 Portney, L. (2004). Evidence-based practice and
clinical decision making: It’s not just the research
course anymore. Journal of Physical Therapy
Education, 18(3), 46-51.
References
 Tod, A., Palfreyman, S., & Burke, L. (2004). Evidencebased practice is a time of opportunity for nursing.
British Journal of Nursing, 13(4), 211-216.
 VanBuskirk, S. (2005). The value of evidence-based
practice in nephrology nursing. Nephrology Nursing
Journal, 32(2), 134-135.
 Sackett, D. L., Straus, S. E., Richardson, W. S. et al.
(2000). Evidence-based medicine: how to practice
and teach EBM. London: Churchill, Livingstone.