Evidence-Based Professional Nursing Practice
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 on 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 because 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
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
P: Patient, population, or problem
I: Intervention, exposure, or topic of interest
C: Comparison or alternate intervention
(T): Time or timeframe
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)?
National Library of Medicine
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
Rigor of development
Clarity and presentation
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
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
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
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