EVIDENCE BASED

PRACTICE IN
NURSING

Evidence based practice

EBP is the conscientious use of current best evidence in
making clinical decision about patient care.
A basic feature of EBP as a clinical problem solving strategy is
that it de-emphasizes decisions based on custom, authority,
opinion, or ritual.
The emphasis is on identifying the best available research
evidence and integrating it with other factors.

 Evidence based practice do not minimize the

importance of clinical expertise.
It should include best research evidence with clinical
expertise, patient preferences and circumstances and
awareness of the clinical setting and resource
constraints.
Key concept personalise the evidence to fit a specific
patients need and particular clinical situation.

Research utilization and EBP

RU is the use of findings from a disciplined study
or set of studies in a practical application that is
unrelated to the original research.
The emphasis is on translating empirically
derived knowledge into real world applications.
The genesis of the process is a research based
innovation or new knowledge.

 EBP is broader than RU because it incorporates

research findings with other factors as just
noted.
RU begins with research itself
The start point of EBP is a clinical question.

Research utilization 3 types

Indirect research utilization involves
changes in nurses thinking
Direct research utilization involves the
direct use of findings to give patient care
Persuasive utilization involving the use of
findings to persuade others to make
changes in policies and practices relevant
to nursing care.

EBP in Nursing
The EBP movement has given rise to
considerable debate with both logical
advocates and critics.

Overview of the EBP movement

One of the cornerstone of the EBP movement was the Cochrane
Collaboration which was founded in the UK based on the work of
Archie Cochrane.
He called for efforts to make research summaries of clinical trial
available to physicians and other healthcare providers.
This eventually lead to the development of the Cochrane centre in
Oxford & an international collaboration called Cochrane
collaboration.

 A group from McMaster medical school in Canada developed a clinical

strategy they called evidence-based medicine.
The EBM movement has shifted over time to a border conception of
using best evidence by all health care providers.
In the EBP environment, a skilful clinician can no longer rely on a
repository of memorised information, but rather must be adapt in
accessing, evaluating, synthesizing, and using new research
evidence.

Why is EBP important to nursing

practice?
It results in better patient outcomes
It contributes to the science of nursing
It keeps practice current and relevant
It increases confidence in decision-making
Policies and procedures are current and include the
latest research
Integration of EBP into nursing practice is essential for
high-quality patient care and achievement

Factors to be considered to carry out

EBN
-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

Evidence-based Nursing Practice: solves

problems encountered by nurses by carrying
out four steps:
I. Clearly identify the issue or problem based on accurate analysis of
current nursing knowledge and practice
II. Search the literature for relevant research
III. Evaluate the research evidence using established criteria regarding
scientific merit
IV. Choose interventions and justify the selection with the most valid
evidence

Models for research utilization in

nursing to understand evidencebased nursing practice.

The Stetler Model of Research

Utilization
The Stetler Model of Research Utilization applies research findings
at the individual practitioner level. The model has six phases:
(1)preparation,
(2)validation,
(3)comparative evaluation,
(4)decision making,
(5)translation and application, and
(6)evaluation.
Critical thinking and decision making are emphasized.

Iowa Model for Research in

Practice
The Iowa Model of Research in Practice infuses research
into practice to improve the quality of care.
Research utilization is seen as an organizational
process.
Planned change principles are used to integrate
research and practice.
The model integrates evidence-based healthcare
acknowledges and uses a multidisciplinary team
approach.

ACE star model of knowledge transmission

The Star Model of Knowledge Transformation
is a model for understanding the cycles,
nature, and characteristics of knowledge that
are utilized in various aspects of evidencebased practice (EBP). The Star Model
organizes both old and new concepts of
improving care into a whole and provides a
framework with which to organize EBP
processes and approaches.

The Star Model depicts various forms of knowledge in a relative

sequence, as research evidence is moved through several cycles,
combined with other knowledge and integrated into practice.
The ACE Star Model provides a framework for systematically putting
evidence-based practice processes into operation.
STAGES OF KNOWLEDGE TRANSFORMATION
1.

Discovery

2 . Evidence Summary
3. Translation
4. Integration
5. Evaluation

1. Discovery
This is a knowledge generating stage.
In this stage, new knowledge is discovered through the traditional
research methodologies and scientific inquiry.
Research results are generated through the conduct of a single
study.
This may be called a primary research study and research
designs range from descriptive to correlational; and from
randomized control trials to qualitative.
This stage builds the corpus of research about clinical actions.

2. Evidence Summary
Evidence summary is the first unique step in EBPthe task is to synthesize the
corpus of research knowledge into a single, meaningful statement of the state of
the knowledge
This stage is also considered a knowledge generating stage, which occurs

simultaneously with the summarization.

Evidence summary produces new knowledge by combining findings from all

studies to identify bias and limit chance effects in the conclusions.

The systematic methodology also increases reliability and reproducibility of

results

3.Translation
The transformation of evidence summaries into actual practice requires
two stages: translation of evidence into practice recommendations and
integration into practice.
Recommendations are generically termed clinical practice guidelines
(CPGs) and may be represented or embedded in care standards, clinical
pathways, protocols, and algorithms.
Summarized research evidence is interpreted and combined with other
sources of knowledge (such as clinical expertise and theoretical guides)
and then contextualized to the specific client population and setting.

4. Integration
Integration is perhaps the most familiar stage in healthcare because of societys
long-standing expectation that healthcare be based on most current knowledge,
thus, requiring implementation of innovations.
This step involves changing both individual and organizational practices through
formal and informal channels.
Major factors addressed in this stage are those that affect individual and
organizational rate of adoption of innovation and integration of the change into
sustainable systems.

5. Evaluation
The final stage in knowledge transformation is evaluation.
In EBP, a broad array of endpoints and outcomes are evaluated.
These include evaluation of the impact of EBP on patient health
outcomes, provider and patient satisfaction, efficacy, efficiency,
economic analysis, and health status impact.
As new knowledge is transformed through the five stages, the
final outcome is evidence-based quality improvement of health
care.

Barriers to implementing evidencebased practice

Lack of value for research in practice
Difficulty in changing practice
Lack of administrative support
Lack of knowledgeable mentors
Insufficient time to conduct research
Lack of education about the research process

Barriers to implementing evidencebased practice

Lack of awareness about research or evidence-based
practice
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 and critique of articles
Feeling overwhelmed by the process