Discussion Question
1- Discussion question: Describethe importanceofevidence-basedpractice and describehow and where to search for evidence?
2- 3 paragraphs 3 sentences each.
3- 2 references not older than 2015
4- APA style
Evidence-Based
Professional
Nursing Practice
Chapter 10
Evidence-Based Practice:
What Is It?
Evidence-based practice (EBP) is a
framework used by nurses and other
healthcare professionals to deliver optimal
health care through the integration of best
current evidence, clinical expertise, and
patient/family values
Why Is EBP Relevant in Nursing? (1 of 2)
Helps resolve problems in the clinical setting
Results in effective patient care and better
outcomes
Contributes to the science of nursing through
the introduction of innovation to practice
Keeps practice current and relevant by helping
nurses deliver care based upon current best
research
Why Is EBP Relevant in Nursing? (2 of 2)
Decreases variations in nursing care and
increases confidence in decision making
Supports Joint Commission on Accreditation
of Healthcare Organizations (JCAHO)-
readiness since policies and procedures are
current and include the latest research
Supports high quality patient care and
achievement of Magnet status
Steps in the EBP Process (1 of 2)
Cultivate a spirit of inquiry and culture of EBP
among nurses and within the organization
Identify an issue and ask the question
Search for and collect the most relevant and
best evidence to answer the clinical question
Steps in the EBP Process (2 of 2)
Critically appraise the evidence and synthesize
the evidence
Integrate evidence with clinical expertise and
patient preferences to make the best clinical
decision
Evaluate the outcome of any EBP change
Disseminate the outcomes of the change
Barriers to EBP in Nursing (1 of 3)
Lack of value for research in practice
Difficulty in changing practice
Lack of administrative support
Lack of knowledgeable mentors
Insufficient time
Lack of education about the research process
Lack of awareness about research or EBP
Barriers to EBP in Nursing (2 of 3)
Research reports/articles not readily available
Difficulty accessing research reports and articles
No time on the job to read research
Complexity of research reports
Lack of knowledge about EBP
Lack of knowledge about the critique of articles
Barriers to EBP in Nursing (3 of 3)
Feeling overwhelmed by the process
Lack of sense of control over practice
Lack of confidence to implement change
Lack of leadership, motivation, vision,
strategy, or direction among managers
Promoting EBP: Individual Nurse
Educate yourself about EBP
Conduct face-to-face or online journal clubs,
share new research reports and guidelines with
peers, and provide support to other nurses
Share your results through posters, newsletters,
unit meetings, or a published article
Adopt a reflective and inquiring approach to
practice
Strategies to Promote EBP:
Organizations
Specific identification of the facilitators and
barriers to EBP
Education and training to improve
knowledge and strengthen beliefs related to
the benefits of EBP
Creation of an environment that encourages
an inquisitive approach to patient care
PICO(T)
P: Patient, population, or problem
I: Intervention, exposure, or topic of
interest
C: Comparison or alternate intervention
O: Outcome
(T): Time or timeframe
PICO(T) Questions
In (patient or population), what is the effect
of (intervention or exposure) on (outcome)
compared with (comparison or alternate
intervention)?
For (patient or population), does the
introduction of (intervention or exposure)
reduce the risk of (outcome) compared with
(comparison or alternate intervention)?
Electronic Resources
National Library of Medicine
Cochrane Library
National Guideline Clearinghouse
Joanna Briggs Institute
Agency for Healthcare Research and Quality
Centre for Health Evidence
Registered Nurses Association of Ontario
Evaluation of Evidence
What is the source of the information?
When was it developed?
How was it developed?
Does it fit the current clinical environment?
Does it fit the current situation?
Levels of Evidence
Meta-analysis or systematic reviews of multiple well-
designed controlled studies
Well-designed randomized controlled trials
Well-designed nonrandomized controlled trials
Observational studies with controls
Systematic review of descriptive and qualitative studies
Single descriptive or qualitative study
Opinions of authorities and/or reports of expert
committees
Appraisal of Research Using the
Critical Appraisal Skills Programme
(CASP)
Checklists provide tools to interpret
research evidence
Checklists are specific to types of research
Checklists provide frameworks to determine
strength and reliability of research reports
Institute of Medicine (IOM)
Standards for Clinical Practice
Guideline Development
STANDARD 1: Establishing
STANDARD 2: Management of conflict of interest
STANDARD 3: Guideline development group composition
STANDARD 4: Use of systematic reviews
STANDARD 5: Establishing evidence and strength of
recommendations
STANDARD 6: Articulation of recommendations
STANDARD 7: External review
STANDARD 8: Updating
Appraisal of Guidelines for Research and
Evaluation (AGREE II)
Scope and purpose
Stakeholder involvement
Rigor of development
Clarity and presentation
Application
Editorial independence
AGREE II Category #1
Scope and purpose
Overall objectives of the guideline are
specifically described
The health questions covered by the guideline
are specifically described
The population to whom the guideline is meant
to apply are specifically described
AGREE II Category #2
Stakeholder involvement
Guideline development group includes
individuals from all relevant professions
The views and preferences of the target
population have been sought
Target users of the guideline are clearly defined
AGREE II Category #3 (1 of 2)
Rigor of development
Systematic methods were used to search for
evidence
The criteria for selecting the evidence are clearly
described
The strengths and limitations of the body of
evidence are clearly described
The methods used for formulating the
recommendations are clearly described
AGREE II Category #3 (2 of 2)
Rigor of development (cont.)
The health benefits, side effects, and risks have
been considered in formulating recommendations
There is an explicit link between the
recommendations and the supporting evidence
The guideline has been externally reviewed by
experts prior to publication
A procedure for updating the guideline is provided
AGREE II Category #4
Clarity and presentation
Recommendations are specific and
unambiguous
Different options for management of the
condition or health issue are clearly presented
Key recommendations are easily identifiable
AGREE II Category #5
Application
The guideline describes facilitators and barriers to
its application
The guideline provides advice and/or tools on how
the recommendations can be put into practice
The potential resource implications of applying the
recommendations have been considered
Guideline presents monitoring and/or auditing
criteria
AGREE II Category #6
Editorial independence
The views of the funding body have not
influenced the content of the guideline
Competing interests of guideline development
group members have been recorded and
addressed
Implementation Models for EBP
Center for Advancing Clinical Evidence (ACE)
Star Model of Knowledge Transformation
The Iowa Model of Evidence-Based Practice
Agency for Healthcare Research and Quality
Model
Johns Hopkins Nursing Evidence-Based Practice
Model
Diffusion of Innovation Framework
