Quality and Safety Evidence Based Nursing

Quality and Safety
Evidence Based
Nursing
Jake S. Moreno, RN, MAN
EVIDENCE BASED- PRACTICE
EBP in nursing is an
• integration of research evidence,
• clinical expertise and a
• patient's preferences.
• This problem-solving approach to
clinical practice encourages nurses
to provide individualized patient
care.
How Is EBP Incorporated
In Nursing?
EBP helps nurses determine an effective course of
action for care delivery. EBP involves the following
5 steps:
1.Form a clinical question to identify a problem.
2.Gather the best evidence.
3.Analyze the evidence.
4.Apply the evidence to clinical practice.
5.Assess the result.
What Kind Of Research
Is Used In EBP?
Research utilized in EBP falls into four categories.
They are:
1.Randomized controlled trials.
2.Evidence gathered from cohort, case-control
analysis or observational studies.
3.Opinions from clinical experts that are
supported by experiences, studies or reports
from committees.
4.Personal experience.
How Does EBP Benefit Nurses
And Patients?
> The inclusion of EBP in nursing provides nurses with the
scientific research to make well-founded decisions. Through EBP,
nurses can stay updated about new medical protocols for patient
care. By searching for documented interventions that fit the profiles of
their patients, nurses can increase their patients' chances for
recovery.
> EBP enables nurses to evaluate research so they understand
the risks or effectiveness of a diagnostic test or treatments. The
application of EBP enables nurses to include patients in their care
plan. This allows patients to have a proactive role in their own
healthcare since they can voice concerns, share their values and
preferences and make suggestions on how they want to
proceed.
What Is The Advantage Of EBP
For Healthcare Organizations?
With the application of EBP comes better patient
outcomes, which can decrease the demand for
healthcare resources. Thus, healthcare
organizations can reduce expenses. For
example, outdated practices may have included
supplies, equipment or products that are no
longer necessary for certain procedures or
techniques.
What Is The History Of EBP?
Florence Nightingale was credited with
improving patient care in the 1800s
when she noted that unsanitary
conditions and restricted ventilation
could adversely affect the health of
patients. She went on to record medical
statistics using patient demographics to
ascertain the number of deaths in
hospitals and the mortality rate
connected to different illnesses and
injuries.
Archie Cochrane introduced the concept of
applying randomized controlled trials (RTC) and other
types of research to the nursing practice in 1972.
Before Cochrane's contribution to healthcare, medical
care centered on unfounded assumptions without
consideration for the individual patient. Cochrane
proposed that healthcare systems have limited
resources so they should only use treatments that
are proven to be effective. He believed that RTCs
were the “most verified form of evidence” and his
assertion created the foundation for the EBP
movement.
In 1996 David Sackett introduced the
term “evidence-based medicine” along
with a definition that is still widely used
today. Unlike Cochrane, Sackett felt that
EBP should not only focus on research
but should >merge evidence<, >clinical
experience< and >patient values<. As
other healthcare professions began
adopting Sackett's concept for patient
care, it was renamed “evidenced-based
practice.”
EBP is an essential component of
safe, quality patient care. Nurses
must be aware of current practices in
order to provide care to patients
with complicated and debilitating
conditions.
If you’re a nurse who wants to make decisions according to
evidence-based practice, use these three components:
1. Best external evidence: Evaluate and implement the most

current, clinically relevant, and scientifically sound
research.
2. Individual clinical expertise: Draw on your personal
experience of what has worked and not worked in your
clinical practice.
3. Patient values and expectations: Consider and value the
preferences of your individual patients.
Quality Care and Patient Safety
Evidence-based practice is established as a

proven intervention. This has been a growing trend over
the past few decades; as more research reveals proven
practices, nurses are relying more upon such proven
methods. This is driven by the growing demand for the
provision of higher quality of care and patent safety,
reduced costs, and greater efficiency.
Patient Advocacy
The nursing role is one of patient advocate. An
advocate is one who defends or promotes the rights of
others (in this case, patients). In the process of patient
care, nurses learn about their patients and know their
needs. Nurses act as advocates and liaisons
between the patient and the doctor, the family and doctor, or the
patient and family and the health care system
Empowerment
Empowerment is a large part of patient
advocacy. This includes “allowing patients and their
families” to make their own health care decisions.
Patient empowerment may threaten some health
care providers. Nurses need to be open to empowering
their patients and decrease any potential threat to the
provider-patient relationship. Patient advocacy
through empowerment begins with patient education.
Providing Quality Nursing
Care with other providers to deliver care based on evidence is
Collaborating
the foundation of quality care. Once care is based on evidence, the nurse
begins to look at practice differently, realizing that measurable outcomes
are what truly drive every decision. Measurable outcomes empower
nurses to advocate for the best possible care for their patient. This
approach also allows the nurse to use measurable outcomes (evidence)
to change policy, whether in their own unit, hospital, or even nationally.
With the help of local and national nursing organizations, nurses can
continue to drive change and improve the care and lives of all patients
What Types of Research Are Used in Evidence-
Based Practice?
Levels of evidence in research can be grouped into four

categories according to how credible the information
is.These four categories, ranging from the most credible
to least, include:
1.Randomized controlled trials
2.Evidence from cohort, case-control, or observational
studies
3.Expert opinions that are supported by experience,
studies, or reports
4.Personal experience
What Are the 5 Steps of Evidence-Based Practice?
According to the Cleveland Clinic, there are five steps in the process of implementing
evidence-based practice. Also known as the “five A’s of evidence-based practice,”
these steps include:
1.Ask: Formulate answerable clinical questions about a patient,
problem, intervention, or outcome.
2.Acquire: Search for relevant evidence to answer questions.
3.Appraise: Determine whether or not the evidence is high-
quality and valuable.
4.Apply: Make clinical decisions utilizing the best available
evidence.
5.Assess: Evaluate the outcome of applying the evidence to the
patient’s situation.
When evaluating EBP nursing research studies,
focus on these four criteria:
1. validity—the legitimacy, accuracy, and
soundness of all aspects of the study
2. reliability—the extent to which a
measurement's result is consistent
3. relevance—the logical connection between
two ideas, tasks, or events
4. outcome—the conclusions reached through
the process of research.
The dynamic duo
* Quantitative and qualitative research are the two types of EBP
research that nurses perform, evaluate, and utilize to guide nursing
interventions and improve patient care (see Quantitative versus
qualitative research). Research can be specifically quantitative or
qualitative, or a combination of both. When a research project utilized
both quantitative and qualitative data, it's commonly called a mixed–
methods research study.
Examples of Evidence-Based Practice in Nursing
Through evidence-based practice, nurses have improved the care they deliver to patients.
Key examples of evidence-based practice in nursing include:
•Giving oxygen to patients with COPD: Drawing on evidence to

understand how to properly give oxygen to patients with chronic
obstructive pulmonary disease (COPD).
•Measuring blood pressure noninvasively in children: Using
the auscultatory method and then comparing the measurement
against data obtained with the oscillometric method as suggested
by evidence.
•Using the correct intravenous catheter size: Recognizing the

benefits of using smaller gauge catheter to improve patient
comfort.
•Improving infection control practices: Understanding
that wearing personal protective clothing and practicing
handwashing are key to infection control.
•Recognizing alarm fatigue: By reflection on current

practices, nursing staff can create effective protocols
ensuring that nurses who are desensitized to sound due
to alarm fatigue are monitoring patients correctly.
When you apply scientific evidence to your nursing practice,
it helps you deliver high-quality, safe care—and it improves
outcomes for patients, your workplace, and your own career.
If you are studying to become a nurse or a nurse practitioner,
you can expect to learn how to evaluate research, make
informed decisions, and deliver the best care you can.

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Quality and Safety

1. Best external evidence: Evaluate and implement the most

Evidence-based practice is established as a

Levels of evidence in research can be grouped into four

•Giving oxygen to patients with COPD: Drawing on evidence to

•Using the correct intravenous catheter size: Recognizing the

•Recognizing alarm fatigue: By reflection on current

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