“KNOWLEDGE IN A VACUUM IS FRUITLESS,WHEREAS KNOWLEDGE

USED TO ENHANCE PRACTICE IS OF THE UTMOST IMPORTANCE”

INTRODUCTION: The vision for nursing in the 21st century is for all nurses to
seek out evidence and apply it in their everyday practice, with an increasing
proportion actively participating in research and development and some
developing into research leaders.

EVIDENCE BASED HEALTH CARE:

What is it and why do we need it?

Evidence based practice has been described as ‘doing the right things right’.
This means not only doing things more efficiently and to the best standard
possible, but also ensuring that which is done is done ‘right’ – so that more
good than harm results.

There are several hurdles on the way to this good, we need the evidence
base to know what it is ‘right’ to do; we have to be clear to whom the
evidence really applies; and we also have to be clear at what stage in a
person’s trajectory of health or illness the evidence based intervention is
indicated. For example, in the 1840’s Semmelweis’s insistence that doctors
performing autopsies should wash their hands before going on to deliver
babies was associated with a dramatic reduction in mortality due to sepsis
from over a fifth to 3%. Similarly, it was careful observation that led John
Snow in the 1840’s to pinpoint the cause of the outbreak of Cholera in
London to a water tap in Broad Street. These two examples from the
nineteenth century encapsulate the breadth of domains of professional
practice in health which can and should be evidence based; but they also
demonstrate powerfully how reflective, questioning and acutely observant
practitioners can uncover evidence within their own everyday practice which,
when acted upon, can improve health, although not all examples will be
quite so dramatic.

DEVELOPMENT OF THE EVIDENCE-BASED CONCEPT:

The first textbook on evidence based medicine (EBM) defined it as ‘the

conscientious, explicit and judicious use of current best evidence in making
decisions about the health care of patients’.

DEFINITIONS OF EVIDENCE-BASED NURSING (EBN):

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EBN is the process of incorporating good quality research findings into
nursing practice/EBN is the process by which nurses make clinical decisions
using the base available research evidence, their clinical expertise and
patient preferences.

Conditions necessary for evidence based nursing:

• The availability of appropriate evidence.

• The critical scrutiny of that evidence for applicability.

• The conversion of that evidence into an applied form.

• The acceptance of the evidence as legitimate and its use as the basis
for changes in managerial or clinical practice.

• The nurse’s practice must allow her/him to implement changes based

on evidence.

SOURCES OF EVIDENCE:

• Research studies.

• Clinical practice guidelines.

• Journal.

• Opinions + Reports of expert authorities.

• Basic sciences.

• Anecdotes, Case histories.

• Speciality organizations.

• Government organizations

• Commercial publications.

• Bibliographic databases.

• Message service.

STEPS OF EVIDENCE BASED NURSING:

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 • Formulation of an answerable question to address a specific patient
problem/situation.

• Systematic searching for the research evidence that could be used to

answer the question.

• Appraisal of the validity.

• Relevance and applicability of the research evidence.

• Integration of the research evidence with other information that might

influence the management of the patient’s problem (clinical expertise,
patient preferences for alternative forms of care and available
resources).

• Implementation of evidence based practice decisions.

MODELS FOR EVIDENCE-BASED NURSING:

• Research, Development and Diffusion model.

• Social interaction and Diffusion model.

• Problem solving (lippit et al 1955) model.

• Linkage model.

Applications of models:

• The Nursing Child Assessment Satellite Training Projects (NCAST)

• The Western Interstate Commission for Higher Education (WICHW)

• The content Utilization of Research in Nursing (CURN) Project

Newer Models:

The John Hopkins Nursing Evidence-Based Practice Model:

Several studies are undertaken nowadays using this model. Three

dimensions of the process are PET-practice question, Evidence and
Translation.

Barriers to Evidence-Based Practice:

• Lack of awareness of EBP

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 • Lack of time/workload/shifting pattern of work

• Research is not considered as source of knowledge

• Lack of authority and co-operation to change patient care procedures

• Lack of access to colleagues with research expertise

• Negative beliefs, attitudes and values of practicing nurses

Resources and Organizational strategies to enhance

Evidence-Based practice:
• Evidence-Based Journal

• Systematic Reviews

• Center for evidence-based nursing

• Evidence-based practice guidelines

• Arrangement for separate budget and natural resources

• Further development of leadership skill amongst nurses

• Development of research team

• Development of research as a component of nurse education

• Autonomy enabling structure

• Emphasis on action research

Values of Evidence-Based Nursing:

• Facilitates the application of research findings

• Reduces gap between education and practice

• Better physiological and psychological outcomes have been observed

in patients receiving evidence-based nursing than those who receive
routine nursing care

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 • Involves exploring the relationship between clinical reasoning and
research evidence

• Enhances the nursing knowledge base improve patient care

Evidence-Based Practice in Midwifery:

Current Scenario

• Every minutes a women dies from complications of pregnancy or

childbirth

• All but 1% of these deaths occur in developing countries

• Most of these deaths could be advised only if appropriate care was

available throughout pregnancy, childbirth and post-natal period

Causes of natural deaths 5,29,000 deaths:

99% in developing countries

Severe bleeding
24%
Infection15%

Eclampsia12%

Obstructedlabour
8%
Unsafe abortion
13%
Other direct
causes8%
Indirect causes
20%

EVIDENCE-BASED MIDWIFERY PRACTICE

 Risk assessment approach: This evidence published in

American Journal of Preventive Medicine on may 2002
by Evelyn P Whitelock, C.Tracy Orleans,Nola Pender,
Janet Allan.
Effective antenatal care can improve the health of the mothers and give her
a chance to deliver a healthy baby. Regular monitoring during pregnancy
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can help detect complications at an early stage before they become life
threatening emergencies. So

o We should recognize that ‘every pregnancy at risk’.

o Ensure that ANC is used as an opportunity to detect and treat

existing problems

o Make sure that services are available to manage obstetric

emergencies when they occur

o Prepare pregnant women and their families for the eventuality of

an emergency

The important components of ANC are discussed below:

 Early registration-timing of the first visit: - The first visit or

registration of a pregnant women for ANC should take place as
soon as the pregnancy is suspected. Ideally, the first visit should
take place in the first trimester (first 3 months of pregnancy),
before or at the 12th week of pregnancy. However, even if a
women comes late in her pregnancy for registration, she should
be registered, and care given to her according to the gestational
age.

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