Evidence-Based Practice

Chapter 5 Evidence-Based Practice

Definitions #1

Variety of definitions, interpretations

Definition according to David Sackett

Definition by Sigma Theta Tau International

Use of the term best practice by industries

Association with “benchmarking”

Now, one of the less scientific forms of evidence used

Definitions #2

Goal: provide optimal patient care

Enhancement of nursing practice

Improvement of patient or system outcomes

Use of Evidence-Based Practice #1

Why?

Control of health care costs: early stimulus

Provision of highest quality patient care: selection of optimal interventions for patients

Patient satisfaction

Use of Evidence-Based Practice #2

When and Where?

Priority across nursing specialties (see Table 5.1)

Valued across nursing roles and responsibilities

Preparation of nurse leaders and administrators

Refinement of nursing curricula

Expectation of staff nurses to participate in or lead initiatives

Use of Evidence-Based Practice #3

Around the World

Worldwide commitment

Australia (the Joanna Briggs Institute)

Canada (Registered Nurses’ Association of Ontario)

United Kingdom

Nursing Knowledge International (NKI): international clearinghouse, facilitator

Question #1

Is the following statement true or false?

The term evidence-based practice was first defined during the time of Florence Nightingale.

Answer to Question #1

False

Evidence-based practice emerged as a term in response to the ongoing expansion and demanding changes in health care.

It evolved when discussions of evidence-based medicine were expanded to include an interdisciplinary audience.

David Sackett, one of the leaders of the movement, defined evidence-based medicine.

Sigma Theta Tau expanded the definition to address nursing.

Determination of Evidence-Based Practice

Questions arising in practice settings

Nurses empowered to ask critical questions (see Box 5.1)

Questions leading to decision making to affect outcomes

Best answers, decisions from informed, evidence-based analysis of each situation

Sources of Evidence #1

Tradition based

Consultation with more experienced, educated, higher-authority-level nurse

Institutional standards, procedure manuals

Coworkers, other health care providers

Sources of Evidence #2

Evidence based

Research

Randomized controlled trial (RCT): considered the gold standard of clinical evidence

Integrative review

Meta-analysis

Additional Sources of Evidence

Benchmarking data

Clinical expertise

Cost-effectiveness analyses

Infection control data

Medical record review data

National standards of care

Pathophysiologic data

Quality improvement data

Patient and family preferences

Question #2

Is the following statement true or false?

Institutional standards are considered evidence based.

Answer to Question #2

False

Institutional standards and procedure manuals are typically considered sources for tradition-based evidence rather than evidence-based information.

Support Mechanisms for Best Evidence

Garner administrative support

Collaborate with research mentor (see Box 5.3)

Seek assistance from professional librarians

Search already reviewed or summarized research (journals, Cochrane Collaboration, AHRQ)

Access resources from professional organizations (AACN, AWHONN, AORN, ONS)

Benchmark with high-performing teams, units, institutions

Mechanisms for Incorporation Into Practice

Development, refinement of research-based policies, procedures

Protocols, algorithms, decision trees, standards of care, critical pathways, care maps, institutional clinical practice guidelines

Consensus of interdisciplinary team

Patient, family support

Challenges to Implementation #1

Accessibility of research findings

Anticipated outcomes of using research

Support from others

Lack of organizational support (Funk et al., 1991)

Spiva and colleagues (2017) used this instrument in the implementation of a mentoring program to promote evidence-based practice

Challenges to Implementation #2

Practicing nurses often feel overwhelmed by the volume of research on their topics of interest

Practicing nurses often lack the time and experience to be able to efficiently read and synthesize the literature

Practicing nurses struggle with the political challenges of attempting to change long-standing policies and procedures in their clinical settings

See Box 5.4

Question #3

Which of the following would a nurse most likely need to address as the greatest obstacle when planning to implement evidence-based practice?

A. Accessibility of research findings

B. Support from others

C. Setting

D. Organizational support

Answer to Question #3

On the basis of research about barriers to implementing evidence-based practice, lack of organizational support was perceived to be the most significant limitation.

End of Presentation

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