Evidence Based

Nursing

REVIEW
Essensi Pelayanan Suatu Profesi:
Problem identification
Problem solving

History

Nursing research began to focus on clinical issues in the

mid 80s (Stevens & Cassidy, 1999).
The National Institute for Nursing Research (NINR) (
http://www.nih.gov/ninr/) was formed in 1986, greatly
increasing the visibility and funding opportunities for
nursing research.
Many new journals emphasize nursing research
In recent years the International Society for Nursing
Research, Sigma Theta Tau, has greatly increased its
capacity to support and disseminate nursing
scholarships (http://www.nursingsociety.org/)
McMaster University in Ontario, Canada has developed
extensive resources in teaching and implementing
evidence-based practice in nursing and other disciplines
(http://www.fhs.mcmaster.ca/ceb/acts/ebcp.htm)

Evidence Based Nursing

Proses dimana pengambilan keputusan
keperawatan didasarkan pada hasil-hasil
penelitian yang terbaik, keahlian klinik,
dan harapan serta nilai-nilai yang ada
pada pasien (University of Minesota,
2001).
Tujuan praktek EBN adalah penggunaan
riset-riset keperawatan yang valid ke
dalam praktek keperawatan sehari-hari
(research utilization)

Evidence Based Nursing (EBN)?

Evidence Based Nursing is the process by which nurses

make clinical decisions using the best available research
evidence, their clinical expertise and patient
preferences.
Three areas of research competence are:
interpreting and using research,
evaluating practice, and
conducting research.

These three competencies are important to EBN.

To carry out EBN the following factors must be
considered:
sufficient research must have been published on the
specific topic
the nurse must have skill in accessing and critically
analyzing research
the nurse's practice must allow her/him to implement
changes based on EBN

Proses praktek EBN

Sama dengan proses praktek Evidence
Based Medicine.
mengidentifikasi permasalahan dalam
bidang keperawatan
melakukan pelacakan untuk mencari
penelitian yang dapat digunakan untuk
menjawab permasalahan
melakukan evaluasi dan telaah bukti
ilmiah
mengidentifikasi intervensi yang paling
baik berdasar pada hasil penelitian,
keahlian klinik dan harapan pasien
Melakukan evaluasi hasil guna penerapan
dalam praktek

Lima langkah praktek EBN

1. Mengajukan pertanyaan klinik yang dapat
dijawab (asking answerable question),
2. Melakukan pelacakan pustaka untuk menjawab
pertanyaan klinik,
3. Melakukan telaah kritis terhadap bukti ilmiah,
4. Melakukan integrasi antara bukti ilmiah yang
valid, keahlian klinik, dan nilai serta harapan
yang ada pada pasien
5. Melakukan evaluasi hasil guna penerapan bukti
ilmiah di dalam praktek (Sackett, 2000).

Evidence-based Nursing
Practice
Solves problems encountered by
nurses by carrying out four steps:
1.
2.
3.
4.

Clearly identify the issue or problem

based on accurate analysis of current
nursing knowledge and practice
Search the literature for relevant
research
Evaluate the research evidence using
established criteria regarding scientific
merit
Choose interventions and justify the
selection with the most valid evidence

STEP 1
MENGAJUKAN PERMASALAHAN
KLINIK

Old paradigms in learning

Much learning complete at the end
of formal training
Intuition very powerful
Dominated by knowledge from
experience
Professionals on top

IK IK Syndrome
I Know I Know
To be certain means to close our
minds to learning

New paradigms in learning

Knowing what you dont know (not feeling bad
about it) and knowing how to find out (or help
others to...)
Longlife learner
Learning by questioning
Turning problems into questions and to find,
appraise, store, and act on experience and
evidence to solve them
Complementing experience with knowledge
from research
Professionals on tap

Mengajukan permasalahan klinik

1. Permasalahan klinik dapat muncul dari
aspek paparan faktor risiko, tindakan
prevensi, tindakan diagnosis, terapi atau
intervensi dan prognosis.
2. Pertanyaan klinik yang diajukan
sebaiknya spesifik.
3. Pertanyaan klinik yang baik (foreground
question) akan membantu proses
pelacakan pustaka yang efektif.

Komponen Pertanyaan Klinik

P (populasi/ population/ patient),
I (intervensi/ eksposur/ intervention),
C (comparison)
O (outcome).

Contoh
Kasus anak dengan demam dan nyeri
Pertanyaan klinik dalam bidang terapi
adalah: apakah ibuprofen lebih efektif
dibanding parasetamol untuk mengatasi
nyeri dan demam pada anak-anak?.

Populasi: anak-anak,
Intervensi yang ditelaah adalah
ibuprofen,
Pembanding paracetamol or plasebo,
outcome yang dinilai adalah bebas
demam/ nyeri.

Contoh
Tn. B, 48 th, sebelumnya tidak mengeluhkan
sesuatu, ketika sedang kerja bakti mengeluh
nyeri dada bagian tengah. Nyeri hilang
setelah istirahat 2-3 menit. Setelah kejadian
tersebut Tn. B sering mengeluh nyeri dada
baik pada waktu melakukan kegiatan seperti
olah raga, maupun pada saat istirahat. Tn. B
adalah perokok, 1 bungkus setiap hari. Hasil
pemeriksaan EKG normal, TD 150/96 mmHg.

Pertanyaan Pasien
Apakah saya sakit?
Bukti apa yang menunjukkan bahwa
saya sakit?
Kalau sakit apa penyebabnya?
Apa yang akan dilakukan untuk
mengatasi sakit saya?

Pertanyaan Klinisi
Apkah keadaan Tn. B berbahaya?
Apakah perlu pengobatan lanjut atau hanya
dengan penjelasan saja?
Bagaimana dengan hasil EKG yang normal?
Sejauhmana EKG bisa memastikan adanya PJK?

Apakah berhenti merokok bisa mengurangi

Risiko penyakit?

STEP 2
MENCARI DAN MENEMUKAN BUKTI
ILMIAH TERBAIK

Menemukan Bukti Ilmiah

Tahapan paling penting dan mendasar
Menemukan hasil penelitian yang
valid dan reliable.
Hasil penelitian yang dipilih adalah
penelitian yang memiliki kualitas yang
baik, sesuai dengan hirarki bukti
ilmiah

Derajat Evidence
Derajat

Jenis Evidence

Ia

Meta-analisis dari RCT

Ib

RCT (uji klinis acak terkendali)

IIa

Uji klinik dengan pembanding,

tanpa randomisasi

IIb

Penelitian quasi-eksperimental

III

Penelitian deskriptif: studi komparasi,

studi korelasi, studi kasus
Laporan komisi ahli, opini, pengalaman
klinik ahli yang diakui

IV

REKOMENDASI
Tingkat

Rekomendasi

A (Evidence Memerlukan paling sedikit satu hasi

Levels Ia, Ib)RCT sebagai bagian utama kepustakaan
B (Evidence Memerlukan minimal hasil uji klinis
tanpa randomisasi
Levels IIa, IIb,
III)
C (Evidence Memerlukan bukti dari laporan
suatu
Level IV)
komite ahli atau opini atau
pengalaman klinik ahli yang diakui

STEP 3
Telaah Kritis

TELAAH KRITIS
Telaah kritis dilakukan dengan mengajukan 3
pertanyaan utama, yaitu:
1. Apakah penelitian ini valid?
2. Apakah hasilnya penting?
3. Apakah penelitian yang valid dan penting ini berguna
bagi tatalaksana pasien-pasien saya?

Pertanyaan validitas dan akurasi suatu artikel

bertujuan untuk mempertimbangkan apakah efek
yang dilaporkan benar-benar menunjukkan arah
dan besar efek yang sesungguhnya.

STEP 4
INTEGRASI DALAM PELAYANAN

Integrasi Bukti Ilmiah Dalam

Pelayanan
Memungkinkan untuk diterapkan
Bukti ilmiah yang ada harus bisa
diintegrasikan dan menyatu dengan
pelayanan sehari-hari
Misalkan dalam clinical care pathway

STEP 5
EVALUASI HASIL GUNA

Evaluasi Hasil Guna

Self-evaluation
Dapat menggunakan indikator outcome
pelayanan
Misal:
Dekubitus
Plebitis
ISK
dll

Critical appraisal check list

Judul:...........................................................................................
Penulis:.........................................................................................
Critical
appraisal
Judul

Point critical appraisal

-

Penulis

Bidang ilmu -

Metodologi
penelitian

Hasil
penelitian

Apakah judul memenuhi kaidah

penulisan judul
Apakah penulisan judul
menggunakan tanda tanya (?)
Apakah penulisan judul
menggunakan tanda seru (!)
Apakah nama penulis
dicantumkan?
Apakah asal insitusi penulis
dicantumkan?
Apakah asal institusi penulis
sesuai dengan topik penelitian?
Apakah bidang ilmu yang
tercantum dalam judul
penelitian?
Apakah latar belakang penulis
(institusi tempat bekerja) sesuai
dengan bidang ilmu topik
penulisan ?
Apakah tujuan penelitian
disebutkan?
Apakah desain penelitian yang
digunakan?
Apakah desain penelitian sesuai
dengan tujuan penelitian?
Bagaimana level of evidence dari
desain penelitian?
Bagaimana pemilihan sampel
dalam penelitian tersebut?
Dalam bentuk apa hasil
penelitian disajikan?
Apakah uji statistik yang
digunakan?
Apakah hasil penelitian dapat
diimplementasikan di
keperawatan?
Apakah ada rekomendasi khusus
terkait hasil penelitian?

Ya

Tidak

Keterangan

Current national and

international projects in EBN

Centre for Evidence-Based Nursing (UK

)

Evidence-Based Nursing (0nline Journa

l)

Evidence-Based Nursing and Midwifery

(The Joanna Briggs Institute)

Nurse Prescribing (National Prescribing

Research-based nursing journals

There are a number of journals currently available
which are specific or very relevant to evidencebased nursing. This is a list of such journals. Most
of them can be found either in print and/or online
via MNCAT, the University of Minnesota catalog.NT
Research Biological Research for Nursing
Canadian Journal of Nursing Research
Journal of Nursing Measurement
Western Journal of Nursing Research
Scholarly Inquiry for Nursing Practice
Advances in Nursing Science
Oncology Nursing Forum

Nursing Research
Evidence Based Nursing
Online Journal of Knowledge Synthesis
Clinical Nursing Research
Nurse Researcher
Applied Nursing Research
Research in Nursing and HealthNursing Science
Quarterly
Journal of Nursing Scholarship
Annual Review of Nursing Research

EBN internet resources

Evidence-based Clinical Practice Working Group,

Department of Clinical Epidemiology and
Biostatistics, University of McMaster, Canada.
http://www.fhs.mcmaster.ca/ceb/acts/ebcp.htm
Books related to EBN:
http://www.astuk.com/products-by-keywords/evidenc
e-based-nursing.html
University of Hertfordshire, UK, has a informative
web page to explain evidence-based medicine.
http://www.herts.ac.uk/lis/subjects/health/ebm.htm
A wonderful EBM website from University of Toronto,
Canada, aims to develop, disseminate, and
evaluate resources that can be used to practise and
teach EBM for undergraduate, postgraduate and
continuing education for health care professionals
from a variety of clinical disciplines.
http://www.library.utoronto.ca/medicine/ebm/

 This is a Nursing Resource Collection from University of

Massachusetts Amherst
http://www.library.umass.edu/subject/business/ebn.html
The unit for Evidence Based Nursing at Malm University
the Department of Nursing and Public Health, School of
Health and Society, recently formed a unit for Evidence
Based Nursing.
http://www.hs.mah.se/Research/Evidenseng.htm
Developing Evidence Based Nursing Practice, Health
Care Practice Research and Development Unit (HCPRDU)
University of Salford, UK.
http://www.salford.ac.uk/ihr/hcprdu/complete/ebnp.htm

NHS research and development: center for evidence based

medicine. The Center was established in Oxford University, UK.
Its broad aim is to promote evidence-based health care and
provide support and resources to anyone who wants to make
use of them. http://cebm.jr2.ox.ac.uk/
The Western Australian Centre for Evidence Based Nursing and
Midwifery, School of Nursing, Curtin University of Technology,
AU. http://www.curtin.edu.au/curtin/dept/planstats/wacebnm/
Evidence Based Health Care, Saint Louis University, Saint Louis,
MO. http://www.slu.edu/libraries/hsc/wr_ebhc.html
Evidence-based Practice websites for nurse researchers, by
Mary E. Duffy, the Director of the Center for Nursing Research at
Boston College, School of Nursing
http://www.nursing.uc.edu/nrm/duffy11799.htm

 Techniques for Locating Evidence-Based Practice

Resources, University of Washington Health Sciences
Libraries http://healthlinks.washington.edu/ebp/
Evidence-based Medicine resource and information, Duke
University medical center library.
http://www.mclibrary.duke.edu/respub/guides/ebm/index.
html
Nursing Informatics and Evidence-Based Nursing,
University of Wisconsin Health Science libraries
http://www.medsch.wisc.edu/chslib/ad/docs/nurfmatc.ht
m