What is Evidence-Based Practice?

Evidence-Based Practice from a

Nursing Perspective

Cynthia Padula, PhD, RN

Nurse Researcher, The Miriam Hospital
Master’s Program Director, Rhode Island College

Adopted and Compilled by Arwani, SKM, BN. Hons. MN.

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 Objectives

 Describe evidence based practice from a nursing perspective

 Identify challenges to using evidence based practice in
nursing
 Compare and contrast evidence based nursing and medicine
 Recognize the impact of the Magnet movement on evidence
based nursing practice
 Identify resources relevant to nursing

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 Quality PRACTICE is supported by
Evidence-based Health Care

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 Definition

“Process by which nurses make clinical

decisions using best available evidence,
clinical expertise & patient preferences
in the context of available resources”
(DiCenso, 1998)

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 DEFINITION cont’d

 Evidence-based practice (EBP) attempts to

cover gaps in patient care for better outcomes
and a healthier population by blending
clinical experience and evidence

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 EBP

 Evidence-based practice involves collecting,

evaluating and implementing evidence to improve
patient care and outcomes
 Clinicians rely on experience and expertise to
evaluate research findings that can benefit patients
 Evidence-based practice respects the patient unique
situation, preferences and values

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 THE BENEFITS OF EBP

 The advantages of evidence-based practice include

better patient outcomes, increased patient safety and
improved quality of life
 In the past, patients simply received healthcare
 Today, patients are healthcare consumers
 They demand improved treatments and increased
safety
 EBP strives to standardize practices, which can deliver
more predictable outcomes
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What is Evidence-Based Nursing
Practice

 Builds on process of research use, but more

encompassing
 More specific than term ‘best practices’
 Does not foster rigid adherence to
standardized guidelines [Tidak menumbuhkan kepatuhan yang kaku
terhadap standar]

 Recognizes the role of clinical expertise

 EB nursing practice is a state of mind!
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Why Evidence-Based Practice in
Nursing
 Potential to improve quality, reduce variations in care
 Focus on practices that result in best possible outcomes at
possibly lower cost
 Provides a way to keep pace with advances
 Potential to narrow the ‘research-practice gap’: adoption of
research findings into practice can take as long as 17 years
(Balas & Boren)
 Impacted by perception that published research is not relevant
to practice
 Provides a means to answer problematic clinical practice issues
 Potential to improve individual bedside practice;
supports/improves clinical decision-making skills

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 Traditional Basis for Nursing
Practice (Stetler, 1998)

 Rituals, unverified rules

 Anecdotes, isolated experiences
 Customs, opinions, unit cultures
 Physicians’ authority

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 Reference: Haynes (1998). Barriers and bridges to evidence-based
clinical practice. BMJ, 317:273-276.
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 Q S

P A
Raise Questions (dimensions
and definitions)
Searching for evidence
Appraising the evidence
Getting Research into Practice
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 Levels of Evidence Hierarchy
(Stetler et al., 1998)*
 Level I : Meta-analysis of multiple RCTs (‘gold standard’)
 Level II : Individual RCTs
 Level III: Quasi-experimental
 Level IV: Non-experimental; qualitative
 Level V : Program evaluation; case reports
 Level VI: Opinion of respected authorities

*modified slightly by Padula

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 The quality of Nursing CARE

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 Evidence Based Practice
Process
 Identify a practice issue
 Formulate an answerable question
 Search for best evidence
 Critically evaluate the evidence and clinical
relevance
 Make recommendations
 Apply to clinical practice
 Evaluate impact/effectiveness/ outcomes

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 FIVE STEPS OF EVIDENCE-BASED PRACTICE

• Ask the burning clinical question (Picot format)

• Search for and collect the most relevant and best
evidence
• Critically appraise the evidence
• Integrate all evidence with one’s clinical expertise,
patient preferences and values in making a practice
decision or change
• Evaluate the practice decision or change
• (Disseminate)
Unlike research utilization (info from a single study), EBP - takes into account expertise of the
practitioner and patient preferences / values
Melnyk & Fineout-Overholt 2005

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 Readiness of US Nurses for EBP
(Pravikoff et al., 2005)
• Purpose  to examine nurses’ perceptions of
their skills in obtaining evidence and their
access to tools with which to do so.
• Sample  stratified random sample of 3,000
RNs across the US; 1,097 responded
• Measurement  93 item measure; content
validity established; varying response format

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 Sample Characteristics
(Pravikoff et al.)

• 91% female
• 79% between >40 years of age
• Educational preparation:
Diploma 17%
AD 34%
BSN 39%
MS 9%
• Employment: 60% in hospitals
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 Subscale: Information Need/Seeking

• How often do you need

• information to support nursing role?
61%: once or twice a week
• How do you find the information
• needed?
67% always or frequently sought a
colleague
58% didn’t use research reports at all
82% had never used a hospital library

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 Subscale: Resource Availability and
Use
• 83%: at least somewhat successful when searching
the Internet
• 19% somewhat confident in ability to search CINAHL;
76% never search CINAHL
• 36% somewhat confident in ability to search
MEDLINE
• 83% rarely or never sought librarian assistance; 82%
didn’t use hospital library

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 Resource Use/Availability (cont.)

• 77% had never received instruction re: electronic

resources
• 36% reported had access to electronic databases;
29% did not know if access was available
• 26% had access to electronic databases on nursing
units
• 49% had access to the Internet on units

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 Subscale: Individual Barriers
(other than time)

 Lack of value for research in practice

 Lack of understanding of electronic databases
 Difficulty accessing materials
 Lack of computer skills
 Difficulty understanding articles
 Lack of: access to computer; library access; search
skills; research knowledge; critiquing skills

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 Differing Challenges:
Nursing Medicine
 Varying entry levels  MD degree

 Rapid indoctrination  Internship/residency

 Off unit access difficult  Easier access off unit

 Clinical reality more  Focus on ‘objective’ reality/

‘subjective’/’human response’ treatment effectiveness research

 Most quasi or below; qualitative  More RCTs

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 Using the Magnet Influence
• Administered by the American
Nurses Credentialing Center
http://nursingworld.org.ancc
• Magnet designation recognized
and rewards nursing excellence
• Forces of Magnetism (14)
identified via a landmark study
(McClure & Hindshaw)

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 Take the Magnet Journey!!

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 Resources

 Evidence Based Nursing Journal

 Online Journal of Knowledge Synthesis for
Nursing, Sigma Theta Tau
http://www.nursingsociety.org
 US Preventive Services Task Force
http://www.ahrq.gov/clinic/uspsfact.htm

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 Selected Lifespan Resources

 Direct links to PubMed and Ovid

 Micromedex
 > 3000 journals
 DXplain
 MD consult

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 References

 Baras, E., & Boren, S. (2000). Managing clinical knowledge for

 healthcare improvement (pp. 65-70). Germany: Schattauer
 Publishing.
 Dee, C., & Stanley, e. (2005). Nurses’ information needs: nurses’ and
 hospital librarians’ perspective. J Hosp Librar, 5(2), 1-13.
 Hallyburton, A., & St. John, B. (2009). Partnering with your library to
 strengthen nursing research. J Nsg Educ, 49(3), 164-167.
 McClure, M., & Hinshaw, A. (2002). Magnet hospital revisited.
 Washington DC: ANA.
 Pravikoff, D., Tanner, A., & Pierce, S. (2005). Readiness of US nurses
 for evidence-based practice. AJN, 105(9), 40-51.

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 References (cont.)

 Rourke, D. (2007). The hospital library as a “Magnet Force”…Med Ref

 Svcs Quar, 26(3), 47-54.
Sherwill-Navarro, P., & Roth, K. (2007). Magnet hospital/magnetic
 libraries. J Hosp Librar, 7(3), 21-31
 Stetler C. et al. (1998). Evidence-based practice and the role of nursing
 leadership. JONA, 28(7/8), 45-53.
 Stetler, C. et al. (1998). Utilization-focused integrative reviews. Appl
 Nurs Res, 11(4).

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