Evidence-Based PracticeIs it an added value to Nursing?
Irene Wong
What is it (and what it isn’t)?
"Evidence-based medicine is the integration of best
research evidence with clinical expertise and
patient values."
(Sackett D et al. Evidence-Based Medicine: How to Practice and Teach
EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1)
Evidence-based practice is an approach to health
care wherein health professions use the best
evidence possible, i.e. the most appropriate
information available, to make clinical decisions for
individual patients. (McKibbon, 1998)
• An integration of:
(a) clinical expertise/expert opinion,
(b) external scientific evidence, and
(c) client/patient/caregiver values to provide
high-quality services reflecting the interests,
values, needs, and choices of the individuals we
serve.
http://www.asha.org/members/ebp/intro/
What is the goal of EBP?
• Goal of EBP is providing optimal clinical
service to that client/patient on an individual
basis.
• Because EBP is a continuing process, it is a
dynamic integration of ever-evolving clinical
expertise and external evidence in day-to-day
practice
EBP in Nursing: Is it important? Why?
1. Evidence-based practice has gained
momentum in nursing (1=Yes, 2=No)
5. Evidence-based practice demands changes in
education of students, more practice-relevant
research, and closer working relationships
between clinicians and researchers. (1=Yes,
2=No)
2. Research findings, knowledge from basic
science, clinical knowledge, and expert opinion
are all considered "evidence“ (1=Yes, 2=No)
6. Evidence-based practice also provides
opportunities for nursing care to be more
individualized, more effective, streamlined, and
dynamic, and to maximize effects of clinical
judgment. (1=Yes, 2=No)
3. Practices based on research findings are more
likely to result in the desired patient outcomes
across various settings and geographic locations.
(1=Yes, 2=No)
7. When evidence is used to define best practices
rather than to support existing practices, nursing
care keeps pace with the latest technological
advances and takes advantage of new knowledge
developments. (1=Yes, 2=No)
4. The impetus for evidence-based practice
comes from payor and healthcare facility
pressures for cost containment, greater
availability of information, and greater consumer
savvy about treatment and care options.
(1=Yes, 2=No)
Youngblut JM1, Brooten D. AACN Clin Issues.
2001 Nov;12(4):468-76.
School of Nursing, Florida International
University, USA
What is professional responsibility in Nursing?
1. Respect the dignity, uniqueness, values, culture and beliefs of patients/clients and their families in the provision of nursing care.
2. Hold in confidence personal information obtained in a professional capacity.
3. Safeguard informed decision-making and the wellbeing of patients/clients in the provision of care.
4. Provide safe and competent nursing care.
5. Maintain the agreed standard of practice.
5.1 The nurse is responsible for ensuring that the standard of nursing practice is
congruent with the agreed standards of the profession.
5.2 The nurse participates in identifying, implementing and evaluating
evidence-based practices.
5.3 The nurse recognizes the need for lifelong learning and participates in
continuing nursing education.
5.4 The nurse is active in updating her knowledge and skills at regular intervals
to enhance professional competence.
5.5 The nurse observes occupational health and safety at work, and observes
the health and safety rules for fostering self and other colleagues’ wellbeing and
safety in practice situations.
6. Foster the trust that is inherent in the privileged relationship between nurses and their patients/clients.
7. Uphold the image of nurses and the profession by refusing advantages.
8. Practise in accordance with laws of Hong Kong relevant to the area of nursing practice.
Code of Professional Conduct and Code of Ethics for Nurses in Hong Kong
• SCOPE OF CORE-COMPETENCIES OF REGISTERED
NURSE
– Competence area 4: Research
• 13b. Ability to collect, analyse, interpret and use research
data to improve nursing and health care practices
– implementing evidence-based practice
• SCOPE OF CORE-COMPETENCIES OF ENROLLED
NURSE
– Competence area 3: Personal and Professional
Attributes
• maintain updated knowledge and skills to enhance effective
and efficient practice.
Code of Professional Conduct and Code of Ethics for Nurses in
Hong Kong
What nurses need to know, do to offer
evidence-based care?
• Implementation of EBP places additional demands on
nurses to apply credible evidence to individual patient
situations through searching related evidence, using
clinical judgments, and considering patient values and
resources.
• Nurses must have the ability to–
–
–
–
–
Identify knowledge gaps,
Formulate relevant questions,
Conduct an efficient literature search,
Apply rules of evidence to determine the validity of studies,
Apply the literature findings appropriately to the patient’s
problem, and
– Appropriately involve patient in the clinical decision making
Majid et al. (2011). Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and
barriers. J Med Libr Assoc 99(3).
What would help us implement EBP?
Bernadette Melnyk, dean of the Ohio State University
College of Nursing and chief wellness officer for Ohio
State said that:
• EBP is not something that’s just “nice to do” anymore.
This is something that we have got to do to improve
quality and safety in heath care and to improve patient
outcomes.
• We have enough studies to show that evidence-based
care can produce good results, fewer complications
and hospital readmissions and shorter LOS. But we are
talking about behavior change for clinicians, and that’s
not a simple process.
How to implement EBP?
• The following are 4 key steps in the EBP
process:
– Step 1: Framing the Clinical Question
– Step 2: Finding the Evidence
– Step 3: Assessing the Evidence
– Step 4: Making the Decision
Step 1: Framing the Clinical Question
• The first step in applying evidence to a clinical decision is
framing the specific question about which evidence will be
sought.
• One widely-used approach to framing these questions is
known as PICOS, for Population, Intervention, Comparison,
Outcome.
• Ensuring that the clinical question addresses all four of
these areas will help to ensure that the evidence will be
relevant to the particular circumstance faced by the
clinician.
• e.g. "Are patients with aphasia who received speech
therapy services shortly after their stroke more or less likely
to achieve functional communication abilities than stroke
patients who received such treatments later?".
Step 2: Finding the Evidence
• Ideally, evidence-based clinical practice guidelines
relevant to your clinical question will already exist .
When that is not the case, however, the clinician needs
to seek out scientific evidence to help inform the
treatment decision.
• Two major types of evidence may be useful:
– Systematic Reviews
• Cochrane Collaboration, JBI COnNECT+ Reviews, ASHA/N-CEP's
Compendium of Guidelines and Systematic Reviews, Evidencebased Communication Assessment and Intervention (EBCAI)
Journal
– Individual Studies
• Data base: OVID, EBSCO, CINAHL, MEDLINE
• Jounals: JCN, JAN, JWC, JCN, JGN, JNE, JNA, NR, EBN
Step 3: Assessing the Evidence
• Example of a hierarchy of levels of evidence.
Level
Description
Ia
Well-designed meta-analysis
Ib
Well-designed randomized controlled study
IIa
Well-designed controlled study without
randomization
IIb
Well-designed quasi-experimental study
III
Well-designed non-experimental studies, i.e.,
correlational and case studies
IV
Expert committee report, consensus conference,
clinical experience of
respected authorities
• Conduct a research
Adapted from the Scottish Intercollegiate Guidelines Network
Step 4: Making the Decision
• Finally, the time will come to combine clinical
expertise, the patient's perspective, and the available
scientific evidence in making a specific clinical decision
with a specific patient.
• There are at least three important factors to keep in
mind when considering whether and to what extent to
follow the guidance contained in such documents.
– relevance of the guideline to your specific clinical question
– the extent to which clinical practice guidelines are truly
evidenced-based
– who wrote and published the guideline
What is the impact of EBP in Nursing?
• The entry of EBP onto the healthcare
improvement scene constitutes a major
paradigm shifts in the research-to-practice
effort. A new field of science to build the
“evidence of evidence- based practice” (Shojania
& Grimshaw, 2005).
• While nurses had positive attitudes toward
EBP and wished to gain more knowledge and
skills, they still faced significant barriers in
employing it in practice. (Melnyk et al, 2012).
What are the advantages, changes,
and issues in EBP?
?
What can we do?
End