Evidence

Based
Practice
Overview
Introduction

• EBP involves the use of the best research evidence to support clinical
decisions in practice.
• Best research evidence was previously defined as a summary of the highest
quality, current, empirical knowledge in a specific area of health care that
has been developed from a synthesis of quality studies (quantitative,
qualitative, and outcomes) in that area.
• As a nurse, you make numerous clinical decisions each day that affect the
health outcomes of your patients. By using the best research
WHAT IS EVIDENCE-BASED PRACTICE?

• The goal of nursing is an evidence-based practice that promotes quality, safe, and cost-effective
outcomes for patients, families, healthcare providers, and for the healthcare
• Evidence-based practice (EBP) evolves from the integration of the best research evidence with
clinical expertise and patients’ needs and values.
• The best research evidence is the empirical knowledge generated from the synthesis of quality
study findings to address a practice problem.
• A team of expert researchers, healthcare professionals, and sometimes policy makers and
consumers will synthesize the best research evidence to develop standardized guidelines for
clinical practice
• Clinical expertise is the knowledge and skills of the healthcare professional who is
providing care. The clinical expertise of a nurse depends on his or her years of clinical
experience, current knowledge of the research and clinical literature, and educational
preparation.
• The stronger the nurse’s clinical expertise, the better is his or her clinical judgment in
using the best research evidence in practice
• EBP also incorporates the needs and values of the patient .The patient’s need(s) might
focus on health promotion, illness prevention, acute or chronic illness management,
rehabilitation, and/or a peaceful death.
• In addition, patients bring values or unique preferences, expectations, concerns, and
cultural beliefs to the clinical encounter. With EBP, patients and their families are
encouraged to take an active role in the management of their health.
• It is the unique combination of the best research evidence being applied by expert
nurse clinicians in providing quality, safe, and cost-effective care to a patient and
family with specific health needs and values that results in EBP.
• Extensive research is needed to develop sound empirical knowledge for synthesis into
the best research evidence needed for practice.
• Findings from a single study are not enough evidence for determining the effectiveness
of an intervention in practice. Research evidence from multiple studies are synthesized
to develop guidelines, standards, protocols, algorithms (clinical decision trees), or
policies to direct the implementation of a variety of nursing interventions
 Examples of Evidence-Based Practice in Nursing

• 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 catheters
to improve patient comfort.
• Valuing the role of family members: Knowing that the recognition of family involvement may lead to
more efficient and effective care, as family members may significantly influence how a patient presents
symptoms to healthcare providers.
• Improving infection control practices: Understanding that wearing personal protective clothing and
practicing handwashing are key to infection control.
• Recognizing alarm fatigue: By reflecting 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.
STEPS of EBP

DISCUSSION
 Strategies Used to Synthesize Research Evidence

• The synthesis of study findings is a complex, highly structured process that is best
conducted by at least two or even a team of expert researchers and healthcare
providers.
• There are various types of research synthesis, and the type of synthesis conducted
varies based on the quality and types of research evidence available.
• The quality of the research evidence available in an area is dependent on the number
and validity or credibility of the studies that have been conducted in an area.
• The types of research commonly conducted in nursing are quantitative, qualitative,
and outcomes.
• The research synthesis processes used to summarize knowledge varies for
quantitative and qualitative research.
 Research evidence in nursing and health care is synthesized by using the
following processes

(1) systematic review; (2) meta-analysis; (3) meta-synthesis; and (4) mixed-methods
systematic review.

Depending on the quantity and strength of the research findings available, nurses
and healthcare professionals use one or more of these four synthesis processes to
determine the current best research evidence in an area.
Process Used to Synthesis Research Evidence
• A systematic review is a structured, comprehensive synthesis of the
research literature to determine the best research evidence available
to address a healthcare question.
• A systematic review involves identifying, locating, appraising, and
synthesizing quality research evidence for expert clinicians to use to
promote an EBP (Craig & Smyth, 2012; Higgins & Green, 2008).
• Teams of expert researchers, clinicians, and sometimes students
conduct these reviews to determine the current best knowledge for
use in practice.
• Systematic reviews are also used in the development of national and
international standardized guidelines for managing health problems
such as acute pain, hypertension, and depression. Standardized
guidelines are made available online, published in articles and
books, and presented at conferences and professional meetings.
• A meta-analysis is conducted to combine or pool the results from previous quantitative studies
into a single statistical analysis that provides one of the highest levels of evidence about an
intervention’s effectiveness
• Qualitative studies do not produce statistical findings and cannot be included in a meta-
analysis.
• Some of the strongest evidence for using an intervention in practice is generated from a meta-
analysis of multiple, controlled quasi-experimental and experimental studies.
• In addition, a meta-analysis can be performed on correlational studies to determine the type
(positive or negative) or strength of relationships among selected variables
• It is possible to be objective rather than subjective when synthesizing research evidence.
• Many systematic reviews conducted to generate evidence-based guidelines include meta-
analyses
• Qualitative research synthesis is the process and product of systematically
reviewing and formally integrating the findings from qualitative studies .
• The process for synthesizing qualitative research is still evolving, and a variety of
synthesis methods have appeared in the literature In this text, the concept of meta-
synthesis is used to describe the process for synthesizing qualitative research.
• Meta-synthesis is defined as the systematic compilation and integration of
qualitative study results to expand understanding and develop a unique
interpretation of study findings in a selected area.
• The focus is on interpretation rather than on combining study results, as with
quantitative research synthesis
• Over the last 10 to 15 years, nurse researchers have conducted mixed-methods studies
that include quantitative and qualitative research methods (Creswell, 2014).
• In addition, determining the current research evidence in an area might require
synthesizing quantitative and qualitative studies.
• .Mixed-method systematic reviews might include a variety of study designs, such as
qualitative research and quasi experimental, correlational, and/or descriptive studies
(Higgins & Green, 2008).
• The value of these reviews depends on the standards used to conduct them.
Levels of Research Evidence
Evidence-based guidelines ( EBG)

• EBG are rigorous, explicit clinical guidelines that have been developed based on the
best research evidence available in that area.

• These guidelines are usually developed by a team or panel of expert clinicians

• The expert panel works to achieve consensus on the content of the guideline to
provide clinicians with the best information for making clinical decisions in practice.
Steps of EBP
Discussion
Article