Using Evidence in Practice
Christina Ryan, MSN, RN, CPN
Nurse Researcher/Education Coordinator
Children’s Healthcare of Atlanta
Objectives
• At the completion of this presentation, the participant
will:
– Identify differences between EBP and Research
– Identify elements of practice change
– Identify how to develop a EBP culture change
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What is the difference between EBP and
Research?
• Research: Diligent, systematic inquiry or investigation
to validate and refine existing knowledge and
generate new knowledge*
• EBP incorporates theory, clinical decision making,
judgment, and knowledge of research techniques,
followed by application of the best, most effective
and clinically meaningful evidence**
– Must also integrate patient preferences
* Burns & Grove (2004). The Practice of Nursing Research: Conduct, Critique & Utilization
** Melnyk & Fineout-Overholt (2005). Evidenced Based Practice in Nursing and healthcare: A guide to best practice.
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Evidenced Based Practice (EBP)
• Definition:
– A problem solving approach to clinical decision making
within a healthcare organization integrating scientific
evidence with the best available experiential evidence.
• Uses the latest research to produce high quality
healthcare.
• Provides a systematic approach to decision making
that achieves best practices and demonstrates
accountability.
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Key Assumptions of EBP in Nursing
• Nursing is both science and an applied profession;
• Knowledge is important to professional practice, there
are limits to knowledge that must be identified;
• Establishes causality between events or variables;
• Evidenced Based Practice contributes to improved
outcomes
Newhouse et al (2007). Johns Hopkins Nursing Evidenced-Based Practice Model and
Guidelines.Healthcare
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of Atlanta
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How can EBP be used in Nursing?
• Incorporate into every phase of the nursing process:
–
–
–
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Assessment of patient conditions
Diagnosis of patient problems
Planning patient care
Interventions to improve patient’s function, condition or prevent
complications
– Evaluate the patient responses to interventions
• Provides foundations for Policies & Procedures
• Basis for patient care management tools
– Care maps;
– Protocols
– Standard order sets
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Barriers to EBP Implementation
• Lack of EBP knowledge and skills
– Curriculum focuses on research practices not translation
– Care is based on skills learned in academic programs and
outdated policies and procedures
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•
•
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Lack of time
Lack of mentors
Belief that EBP is burdensome
Belief that the organizational culture does not support
EBP
• Collegial resistance to EBP implementation
– Including physicians
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Strategies to overcome barriers
• Self-assessment to identify facilitators and barriers of
EBP practices;
• Education and training to improve knowledge and
increase practioners belief’s and benefits of EBP;
• Create an environment that encourages an inquisitive
approach
– Identify opportunities for best practices
– Create a culture that values support and expects a culture
of EBP
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Unique Elements of EBP success
• Design clinical environments to support best practices
– Provide time
– Educational building sessions
• Focus on how to implement evidence from research
– Resources for implementation: mentors
• Identify organizational priorities for implementation
– Cultivate team of staff nurses with senior executives who
support the project
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Integration of EBP
• Critical to meeting Magnet standards
• 5 Steps*:
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–
–
–
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Establish a foundation for EBP
Identify areas of concern
Create internal expertise
Implement evidence based practice
Contribute to research evidence
• Ongoing, Concrete Support
– Formal systems for finding, prioritizing and answering EBP
* Turkel, M., Reidinger, G., Ferket, K., & Reno, K. (2005). An essential component of the Magnet Journey: Fostering an environment for
evidenced based practice and nursing research. Nursing Administration Quarterly, 29(3), 254-262.
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Examples of EBP outcomes
• Sacred Cow
– Neonate and infants
should sleep in prone
position to prevent
aspiration
– H2O2 is an effective
antibacterial cleaning
agent when applied to
wounds: Bubbling means
bacteria is present
• Evidence Eagles
– Prone sleeping among
blankets and pillows
increased SIDS: supine
position with minimal
contact with blankets and
pillows dressed in warm
sleepwear
– Concentrated H2O2 is
caustic and hinders
neodermal development.
Bubbling occurs when
H2O2 is exposed to air
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References
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Burns, N. & Grove, S. K. (2004) The practice of nursing research: Conduct, critique & utilization
5th Ed. Philadelphia: W.B. Saunders.
Melnyk, B. M & Fineout-Oveholt, E. (2005) Evidenced Based Practice in nursing and healthcare: A
guide to best practice. Philadelphia: Lippincott, Williams & Wilkins.
Melnyk, B. M & Fineout-Oveholt, E.; Gallagher-Ford, L; Kaplan, L. (2012). The state of
evidenced-based practice in US nurses: Critcal implications for nurse leaders and educators. JONA,
42(9): 410-417.
Newhouse, R. P., Dearholt, S. L., Poe, S. S., Pugh, L. C. & White, K. M. (2007). Johns Hopkins
Nursing evidenced based practice model and guidelines. Indianapolis: Sigma Theta Tau
International.
Turkel, M., Reidinger, G., Ferket, K., & Reno, K. (2005). An essential component of the Magnet
Journey: Fostering an environment for evidenced based practice and nursing research. Nursing
Administration Quarterly, 29(3), 254-262.
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