Nursing Leadership &
Management
Patricia Kelly-Heidenthal
0-7668-2508-6
Delmar Learning
Copyright © 2003 Delmar Learning, a Thomson Learning company
Chapter 3
Evidence-Based Health Care
Delmar Learning
Copyright © 2003 Delmar Learning, a Thomson Learning company
Objectives

Upon completion of this chapter, the reader should be
able to:
• Know the historical context of evolution of evidence-based
care (EBC) in nursing.
• Discuss the importance of EBC to nursing as a profession.
• Identify further potential contributions of nursing leadership
in development and dissemination of an EBC model of care.
• Understand the ongoing stimulus for establishing an EBC
model for health care delivery.
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Objectives
• Recognize the barriers to efficient, effective, and quality
health care delivery by nurses.
• Assess the types of evidence used and required for EBC
processes.
• Understand the role of the Agency for Healthcare Research
and Quality (AHRQ) in the development of EBC.
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Evidence-based Care

Evidence-based care is the process of providing
clinically competent care that is based on the best
scientific evidence available.
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Importance of EBC
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There is a lack of agreed-upon standards or processes
for identifying clinical interventions and outcomes
based on evidence.
EBC attempts to remedy this situation by promoting a
scientific process driven by uniform standards and
practice guidelines, while also emphasizing quality
improvement.
Because of the nurse’s close interaction with the
patient, nursing can have a significant influence upon
and involvement with the EBC process.
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Historical Overview of EBC
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The term evidence-based medicine (EBM) was
developed at McMaster Medical School in Canada in
the 1980s.
D. L. Sackett encouraged EBM as a way to integrate
individual clinical medical experience with external
clinical evidence, using a systematic research
approach.
EBC evolved to include other clinical health care
providers.
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Trends Moving Nursing Toward EBC
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Early initiatives for using EBC in nursing began in
1996.
Since then EBC in nursing has rapidly developed in
the United States, Australia, Canada, and the United
Kingdom.
In the United States, the Agency for Healthcare
Research and Quality (AHRQ) has stimulated the
adoption of EBC. AHRQ established 12 evidencebased practice centers in 1997.
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Establishing the Culture for EBC

In order for innovative change to develop in an
institution, a supportive culture must exist. Creating
such a culture required three major actions:
• Establishing the culture
• Creating a capacity for change
• Using the organizational infrastructure to sustain and
reinforce change
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Evidence: How It Is Developed and
Evaluated
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Analyzing data to determine its credibility as evidence
must be accompanied by the ability to judge its
usefulness in guiding practice.
EBC involves integrating both clinically observed and
research-directed evidence, then applying knowledge
and evidence to a clinical area where outcomes of care
can be evaluated and measured.
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Level and Quality of Evidence
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There are various EBC models, containing up to six
levels of evidence.
• Level and Type of Evidence for Nursing Intervention (based
on Stetler, Morsi, and Rucki)
• Hierarchy of Evidence (Pfizer Pharmaceuticals)
• Evidence-based Levels (Consensus recommendations of the
American College of Cardiology/American Heart
Association Task Force on Practice Guidelines)
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Conducting Evidence Reports in Nursing
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Select topic or identified problem.
Report the evidence.
Identify methods for assigning levels of evidence.
Report findings, including statistical summary if
appropriate.
Give summary of evidence review.
Make recommendations for level of evidence to be
assigned and clinical application potential.
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Barriers to Efficient, Effective, and
Quality Health Care Delivery by Nurses
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The U.S. health care system does not have uniform
definitions of what constitutes efficient, effective,
quality health care.
It is difficult to get all clinical health care providers to
apply EBC processes at the unit level.
EBC processes must be uniform enough to be valid,
but also adaptable to specific needs of institutions.
EBC requires involvement of and collaboration
between clinical practitioners and health care
researchers.
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