Taylor, ch 5
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A step-by-step dynamic process used to
solve clinical problems
EBP solves problems by applying best
research data, best clinical judgment and
expertise, and objective and subjective
information from pts
Finding this research involves looking at
previous research studies to see what the
best practice is for a particular condition or
procedure
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The client is the focus of EBP
It is our duty as nurses to make sure the
patient is receiving the best care possible
Nurses need to contribute to the body of
knowledge that makes up best practices by
conducting research of their own
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Directs nurses toward a common goal
Leads to improved patient care
Provides rational and knowledgeable reasons
for nursing actions
Gives nurses knowledge base necessary for
appropriate actions
Helps resolve current nursing issues
Prepares nurses to question assumptions and
values
Serves research, education, and practice
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Traditionally by:
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Tradition
Authority
Borrowing
Trial and error
Personal experience
Intuition
Reasoning
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Nursing research which is:
◦ “A diligent and systematic inquiry to validate and
refine existing knowledge, and generate new
knowledge that influences nursing practice.”
 (Burns & Grove, 2007)
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Improve care of people in clinical settings
Study people and the nursing process
Develop greater autonomy and strength as a
profession
Provide evidence-based nursing practice
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Quantitative—involves concepts of basic and
applied research
Qualitative—gain insight by discovering
meanings. Based on belief that reality is
based on perceptions that differ for each
person and change over time
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State the problem
Define the purpose of the study
Review related literature
Formulate hypothesis and variables
Select research design
Select population and sample
Collect data
Analyze data
Communicate findings and conclusions
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Steps are same until the data collection
process
Data collection involves gathering
information from the same population sample
over a specific time period
It analyzes the effects of a variable on that
group at different phases of the members’
lives
Must know and accept responsibility for:
Asking questions
Reading literature
Understanding
Critical thinking
Synthesizing info
Applying science
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An orderly series of steps that allows a
researcher to find the answer to a question
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Identify the problem
Gather data
Analyze data
Use the findings
Evaluate outcomes
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What do you want to do?
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Improve practice?
Update knowledge?
Validate a policy or procedure?
Plan a new program or intervention?
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P = Patient, population, or problem
I = Intervention being considered
C = Comparison of interest (old or new)
O = Outcome wanted
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“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?
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Run a subject search thru Medline or CINAHL
Consider hospital policies and procedures
Clinical expertise
Cost
Chart reviews
Patient preference
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Which research applies best?
How strong or weak is the research?
Is this research relevant to the clinical
situation?
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Apply what you learned from the evidence
Include clinical experience
Include patient preferences
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Did the application of your evidence improve
the patient outcomes?
If not, go back to one of the earlier parts of
the process and start over, if necessary
Data: 9 randomized controlled clinical trial study
used to address the problem of surgical site
infections, CAUTIs
 PARTICIPANTS: Adults receiving topical antisepsis
prior to surgery, blood cultures, and vascular
catheter insertion
 INTERVENTIONS: Chlorhexidine gluconate
 COMPARISONS: Povidone-iodine
 OUTCOMEzation, catheter-related sepsis
 RESULT: The use of chlorhexidine for skin antisepsis,
instead of povidone-iodine, would result in significant
reductions in hospital-acquired infections
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The positive outcomes from EBR can improve
the overall performance of an institution
The Quality Improvement department of the
institution focuses on the continuing process
of creating positive patient outcomes
Part of the department includes Risk
Management whose efforts are directed
toward preventing errors in patient care
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These reports contain information about
circumstances involving errors in patient care
that either led to or could lead to injury
The report is not to be placed in the patient’s
chart, but does become part of Risk
Management and is used to track and prevent
errors
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Complete name of person and names of
witnesses
Factual account of incident
Date, time, and place of incident
Pertinent characteristics of person involved
Any equipment or resources being used
Any other important variables
Documentation by physician of medical
examination of person involved
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This accrediting agency promotes quality in
institutions by requiring them to meet
Accountability Measures or standards of care
for various patient conditions
Meeting these measures and standards helps
maintain quality of patient care
These measures are based on evidence that
the interventions are effective
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Unexpected occurrence involving death or
serious physical or psychological injury, or
the risk thereof
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Serious injury specifically includes loss of
limb or function
The phrase “or the risk thereof” includes any
process variation for which a recurrence
would carry a significant chance of a serious
adverse outcome.
JCAHO tracks these events in an effort to
maintain quality patient care
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NPSGs have come about based on the types
of sentinel events that have occurred.
The NPSGs are also part of Risk Management
and Quality Improvement
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A process that looks at the reasons that any
error or “near miss” situation occurred
There is usually more than one reason thus
avoiding the “blame game”
Root cause analysis transforms an old culture
that reacts to problems to a new culture that
solves problems before they escalate; thereby
improving institutional and personal
performances.