Welcome

Dear members and delegates

of the Bahrain Nursing Society
 Nursing Research
Reading, Using & Creating Evidence:
Call to Action

Dr. Nandini Mannadath,

M.Sc (N), RN RM, Ph.D.
Assistant Professor
Dept, of Nursing
College of Health and Sport Sciences
University of Bahrain
 Objectives of the Webinar
The delegates will be able to,
1. Define Evidence-Based Practice (EBP) and understands its importance in the
clinical setting
2. Describe the steps of the EBP process
3. Understand the search engines of EBP.
4. Create a well build clinical question using PICO and SPIDER acronym
5. Know the pyramid of evidence from strongest to weakest.
6. Identify the barriers to the adoption of the EBP
7. Pinpoint the strategies to overcome the barrier.
8. Enlist all types of models in EBP
9. Embrace the idea of mentoring the concept of EBP
A voice from the Nurse
A voice from the Nurse…Cont..,

Source: Janet Houser, Regis University, Denver

 Introduction
 All healthcare consumers expect quality health/nursing service from
all healthcare professionals, especially from Nurses.
 The care should be built on the use of best evidence.
 The practice of nursing is deeply rooted in nursing knowledge and
nursing knowledge is generated and disseminated through reading,
using, and creating nursing research.
 It would seem a foregone conclusion that effective nursing practice
is based on the best possible, rigorously tested evidence.
 It is only in the past two decades that an emphasis on evidence as a
basis for practice has reached the forefront of professional Nursing.
 The need for a paradigm shift in the orientation to care given
necessitated an appraisal of how a nurse should generate evidence
for her practice.
 Definition of EBP
Evidence: It is something that furnishes proof or
testimony or something legally submitted to ascertain in
the truth of matter.

Evidence-based Nursing(EBN): according to the

International Council of Nurses, is defined as ‘a
problem-solving approach to clinical decision making
that incorporates a search for the best and latest
evidence, clinical expertise, assessment, and patient
preference values within the context of caring’
 What is

EBP is defined as the conscientious, explicit, and judicious use of

the integration of current best evidence, clinical expertise, and
patient values into the decision-making process for patient care.
(Duke University, 2016; Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996;
Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000).

• Conscientious: Being cautious and thorough in the selection and review of all evidence.
• Explicit: Being open and transparent regarding the detection of flaws and gaps in the evidence.
• Judicious: Using logic and sound judgment to build compelling cases for practice changes.
• Current best evidence: “Best” implies a ranking. Typically, nurses engaged in EBP use
quantitative or qualitative research from the highest order or level, and that possesses the
utmost quality as evidence.
• Clinical expertise: The nurse’s cumulative experience in clinical practice, education,
administration, and informatics.
• Patient values: The patient’s preferences, individual concerns, and expectations related to
quality care.
 Difference between research utilization
and EBP
Research utilization Evidenced Based Practice
Use of knowledge based on a EBP takes into consideration the findings
single study based on a series of studies and the expertise
of practitioner as well as patient preferences
and values
We use the results of studies More rigorous
often conveniently selected as - Nurse selects all research that has been in
supported for nursing care. an area
- Results are analysed and synthesized
- Results are put in the context of clinical
expertise and value system of the patient.
Protocols for best practice is developed.
Findings are usually applied at Findings are usually applied in the bed side
the organizational level. and are tailored to individual patient care
needs.
 The theory-practice gap
Limited time
Access and ability
Personal opinion
Lack of authority
Components of EBP
 Pioneers of EBP

Dr Gordon Guyatt Dr David Sackett

(1953 – till date) (1934 - 2015)

Archie Cochrane
(1909 – 1988) Florence Nightingale
(1820 – 1910)
 Proposed that researchers should
collaborate internationally to
systematically review all the best
clinical trials

One of the most influential

sources of systematically
reviewed evidence today.
Collection of subscription-
based database that contains
high-quality independent
evidence to inform healthcare
decision-making.

www.cochranelibrary.com
 Concept of improving patient outcomes through
sound evidence
 Critically examined the relation between
unsanitary conditions and patient health
 Noted that hot water with soap removed the
most dirt
 Recorded medical statistics using patient
demographics
 “Notes on Nursing” – Best practice guidelines
at that time.
 Environmental theory
 EBP is NOT……,
Focussed only on
Focused on
randomized
statistics
controlled trials

A search for cost- ‘Cookbook

effectiveness medicine’

Intended to
restrict the
autonomy of
clinicians
 Benefits of EBP in Nursing

Improve Advance Prioritizes

patient care knowledge in the needs of
outcome health care the patients

Allow the
Save time Multidisciplinary
patient for a
and investigator-
initiated research proactive
resources
role
18
 Why do we need EBP
• EBP helps ensure patients receive nursing care that best addresses their
individual needs and, therefore, leads to improved healthcare outcomes (
Wells, Pesaro, & McCaffery, 2008).
• At the point of care, EBP provides sound rationale for clinical decision
making and conceptually clarifies the rationale (Scott & McSherry, 2008
).
• Because EBP provides a sound basis for individualized care, risk, and
harm are minimized for the patient (Barnsteiner, 2011).
• Nurses engaged in EBP become proficient in evaluating research evidence
and consequently expose gaps and inconsistencies in healthcare
knowledge (Fawcett & Garity, 2009).
• EBP has been associated with lower healthcare-related cost compared
with care that remains founded on tradition and dated policies and
procedures (Sedwick, Lance-Smith, Reeder, & Nardi, 2012).
• EBP has demonstrated a relationship with greater job satisfaction and
Research Evidence for KAP
Ghuloom, S. A., Kumari, G., Isa Helal, S., & Mohamed Bayoumi, M. (2022).
Knowledge, Attitudes, Practices and Related Factors among Nurses
Regarding Evidence-Based Practices in Bahrain. Journal of the Dow
University of Health Sciences (JDUHS), 16(3), 125–130.

A descriptive, cross-sectional study was conducted at Salmaniya Medical

Complex Hospital in Bahrain from 2017 to 2018. Of 404 nurses’ the majority
of nurses were females 369 (91.6%), with a mean age was 37.7 + 7.7 years.
Most of the nurses 313 (77.5%) had a moderate score of knowledge, 312
(77.2%) were moderate implementers for EBP, and 179 (44.3%) had a positive
attitude.
 Five Key Steps of EBP
(Sackett et. al., 2011)

Convert the information need into an

answerable clinical question
Track down best evidence for
answering the question
Critically appraise the evidence for
the validity impact & applicability
Integrate the evidence into your
clinical decision making
Evaluate step 1 to 4 and seek
way to improve next time
Step…..Zero Step….. HAVING A SPIRIT OF INQUIRY
Refers to an attitude in which questions are
encouraged to be asked about existing practices.
Questioning spurs learning, and the exchange of
ideas, and fuels innovation, and performance
improvement.
It builds rapport and trust among team members and
eventually uncovers avoidable pitfalls
Allows health care providers to feel comfortable with
questioning current methods of practice and
challenging these practices to create much-needed
improvements and change.
Step.1. Convert the information needs into an answerable
clinical question
 Asking a focused and relevant question about your client's situation will
inform your search.
 likely to arise in relation to patients receiving care, Clinicians providing care
and managers reviewing healthcare services.
 Straus et al. (2005) suggest that there are ‘background’ and ‘foreground’
queries.
 PICOT Methods
Population or problem Describe the patient or the
relevant group of people

Intervention or treatment Identify the intervention such

as a test, drug, or factor that
might affect a health outcome

Comparison Identify an alternative strategy

if you want to compare one
intervention to another

Outcome State the clinical outcome -

usually what you and the
patient are most concerned
about
Jenni comes to your antenatal clinic. She would like to consider a
waterbirth, but wants to know if being born underwater, compared with
being born on ‘dry land’, would present any additional risks to her baby.

POPULATION
NEW BORN BABIES

INTERVENTION
WATERBIRTH

COMPARISON
‘LAND’ BIRTH

OUTCOMES
NEONATAL MORBIDITY AND MORTALITY

What might your question look like?

QUESTION In newborn babies, does a waterbirth (compared with
being born ‘on dry land’), increase the risk of
morbidity or mortality?
 PICO Question……?
Example PICO
Population Intervention Comparison Outcome Question
Children with Cochlear Hearing aids Speech For children with
severe to implants and severe to profound
profound language hearing loss, what is
hearing loss developme the effect of cochlear
nt implants compared
with hearing aids on
speech and language
development?

Young adult Cognitive rehab Not applicable Return to What is the effect of
with a stroke work cognitive
rehabilitation on
vocational outcomes
in individuals who
experience a stroke?
 SPIDER Methods
The SPIDER tool can be used when dealing with qualitative research questions
-
S Sample The group of participants in qualitative
research

PI Phenomenon of The how and why of behaviours and

Interest experiences

D Design How the study was devised and

conducted

E Evaluation The measurement of outcome might be

subjective and not necessarily empirical

R Research Type Qualitative, or quantitative, or mixed?

 SPIDER Example
"What are the experiences of first-year university students
in using their library?"
S First-year university students
PI Library use
D Survey
E Experiences (of using the Library)
R Qualitative
Step.2. Track down best evidence for answering the
question
 Internal Evidence
Data may include subjective observations of your client as well
as objective performance data

 External Evidence
Scientific literature—particularly the results, data, statistical
analysis, and conclusions of a study

 Develop a list of search terms

 Set parameters for your search

 Stay organized.
 Sources of EBP
What Useful for Limitations

Websites Current information from various May not be well-designed,

sources; often have specialised focus reliable, objective and
authoritative in terms of
evidence.

Journal articles The most recently published research It can be hard to find the most
findings relevant articles among the large
number published. Require
critical appraisal.

Systematic reviews Synthesized summary of all/most There may not be one that applies
available evidence within a structured to your question.
framework. More reliable than the
findings from one study

Books Background reading and established Not always the most up to date
knowledge information.
Research in The most recent research and emerging Quality of the research is often
progress or findings. Access to less well known and unknown at this stage. Research
unpublished well-funded research. May be useful to reports can be difficult to find
see research trends and/or access, e.g. conference
proceedings.
 Sources of EBP….Cont….,
Protocols and Officially endorsed procedures and May not be appropriate to or
guidelines practices available for your context.
Need to ensure currency.

Colleagues Quick, convenient answers to May not be consistent with

specific questions at a local level the best available evidence.
May be biased.

Statistics Determining trends and patterns in Provides information on the

a population effect, but not the cause.

Government Finding out what action the May be out of date.

reports authority has taken on an issue.

Newspapers Public opinion Details may be inaccurate

and/or guided by opinion or
commercial/political interest.

Social media Individual responses about No quality control.

particular issues; trends in
thinking; active discussions
 Search Engines for EBP
Filtered sources. (Secondary evidence, pre-appraised)
Evidence that is assimilated or put together from a number
of quality primary studies on a topic. It includes systematic
reviews, meta-analyses &
evidence summaries.

Unfiltered Sources,(Primary evidence)

The body of evidence consists of original studies individual
studies such as controlled trials, cohort studies & case
studies.
 Sources of Search Engines for EBP
1. General EBP Resources
 The Cochrane Library
The biggest and best-known EBP resource consists of several databases. The main
databases are:
o Cochrane Database of Systematic Reviews (CDSR)
o Cochrane Central Register of Controlled Trials (CENTRAL)
o Database of Abstracts of Reviews of Effects (DARE)

 TRIP: Turning Research Into Practice

A free clinical search engine for finding high-quality research evidence.
 Evidence Alerts
A searchable database of the best health-care evidence, where articles are pre-
appraised for quality and clinical relevance. Free, but registration is required.
 Sources of Search Engines for EBP…cont…,
2. Journal Databases - for a range of materials including
systematic reviews and randomized controlled trials:
 MEDLINE
Recognized as the premier international index of the biomedical literature,
and available here on the Ovid platform..
 PubMed
Effectively the public equivalent of MEDLINE, and free to all users.
 CINAHL Plus with Full Text
CINAHL stands for Cumulative Index to Nursing and Allied Health Literature.
It is available to Charles Sturt users in the EBSCOhost platform.
 PsycINFO
Produced by the American Psychological Association and available on
the Ovid platform.
 Sources of Search Engines for EBP…cont…,
3. Abstraction Journals - contain summaries of
systematic reviews or of single studies:
 EBM Reviews - ACP Journal Club
ACP Journal Club and Evidence-Based Medicine. Each record in the
database is an abstract and commentary on an individual study or review.
The abstract and commentary are available in full text, with a citation for the
original item.

 Evidence-Based Mental Health

This e-Journal contains commentaries on articles of clinical relevance to
psychiatrists and psychologists.

 Evidence-Based Nursing
This e-Journal contains commentaries on articles of relevance to best
nursing practice.
 Sources of Search Engines for EBP…cont…,
4. Clinical Practice Guidelines
 Guidelines
Access to clinical practice guidelines produced for Australian practice
by the Australian National Health and Medical Research Council
(NHMRC).
 Medical Journal of Australia Guidelines
From the website of the Medical Journal of Australia.
 Guidance
Evidence-based recommendations from the (UK)
National Institute for Health and Care Excellence (NICE).
 Professional organizations can be a source of practice guidelines.
 Grey literature
 Grey literature "refers to print or electronic literature that is produced
by government, academia, business, and industry, and is not
controlled by commercial publishers ... i.e. where publishing is not the
primary activity of the producing body." (ICGL Luxembourg definition,
1997. Expanded in New York, 2004.)
 Grey literature does not form a part of traditional publishing and is not
widely disseminated. It can include a huge range of resources from
theses and dissertations, through conference proceedings,
government documents, and research reports to digital repositories
and registers of clinical trials.
 For more information, see Charles Sturt Library's guide on
Grey Literature.
 Translating a PICO Question Into Search Terms
PICO PICO Element Keywords
P Adult, traumatic brain injury Adult
Traumatic brain injury
TBI
Brain injury

I Cognitive rehabilitation Cognitive rehabilitation

Cognitive training
Cognitive treatment

C Not applicable
O Improved cognition Cognition
Cognitive skills
Memory
Attention
Executive function
Problem solving
Step.3. Critically appraise the evidence for validity,
impact and applicability
Determine the Relevance of Your Question
Appraise the Validity and Trustworthiness of the Evidence
Research Design and Study Quality
Limitations of the Evidence
Review the Results and Conclusions
Statistical Analyses
Direction and Consistency
Applicability and Generalizability
 Critical Appraisal of EBP
Has sufficient research been published on the specific topic ?
Does the nurse have skill in accessing and critically analyzing
research?
Does the nurse’s practice allow him/her to implement changes
based on EBPWhy are we doing this?
Why are we doing it this way?
Can we produce better outcomes with greater consistency?
Does the research apply to my patient population?
Would this practice change improve process of care? Patient
outcomes?
Is there support for this practice change
 Critical appraisal technique - RAMMbo
One way to quickly appraise a study's trustworthiness is to use
the RAMMbo mnemonic….

R Recruitment Were the subjects in the study representative of

the target population? Were there enough
subjects to make the study valid?
A Allocation Were the subjects randomly (and "blindly")
allocated to groups?
M Maintenance Was the status of the study group and the control
group maintained throughout the trial?

Mbo Measurement Were the subjects (and researchers) blinded to

(blinding; objective the intervention and were the outcomes
measures) measured objectively? Was bias eliminated as
much as possible?

Source: Glasziou, P., Del Mar, C., & Salisbury, J. (2007).

Evidence-based practice workbook: Bridging the gap between health care research
and practice
(2nd ed.).
Step.4. Integrate your evidence into your clinical
decision making

D.E.C.I.D.E. Framework
Define
Extrapolate
Consider
Incorporate
Develop
Evaluate
Step.5. Implement the evidence and evaluate the outcome

 Implementing the activity

 Evaluate the outcome of applied evidence ( intervention )

 Outcome measures may be psychosocial (quality of life ,

improved patient care) or physiologic ( improved health ,

reduced complication ) and functional improvement
 Evaluation may be through audit , self reflection

 Compare out come with national , international or regional

level
 Self-evaluation and evaluation of the EBP process
 Did I ask a well-formulated clinical question?
 Did I consider the best sources of evidence for the type of clinical question?
 Have I searched the databases efficiently?
 Did I use the hierarchy of evidence as my guide for the type of evidence that I
should be searching for?
 Where possible, did I search for and use information that is higher up in the
pyramid of levels of organization of evidence (for example, syntheses, synopses,
summaries, and pre-appraised original studies)?
 Am I integrating critical appraisal into my clinical practice?
 Can I clearly explain what the evidence means to my patients and involve them
in shared decision-making where appropriate?
 Am I proactively monitoring for newly emerging evidence in my field of
practice?
Hoffmann, T., Bennett, S., & Del Mar, C. (2013). Evidence-based practice across the health professions (2nd ed.).
Elsevier Australia.
 1)Assess

5)Apply 2)Ask

EBP BEGINS AND END WITH

PATIENT THE PATIENT

4)Appraise 3)Acquire
 Implementing EBP: A Conceptual Framework

Kitson et al (1998) have argued that implementing research into

practice may be expressed in this equation:

SI = f (E, C,F)
 SI stands for successful implementation
 E stands for evidence
 C stands for context
 F stands for facilitation
 f stands for function
 Key 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.
 Levels of Evidence

Systematic
Reviews
ce Filtered
Critically-appraised Information
n
ide

topics (Evidence
ev

synthesis)
of
ty

Critically-appraised individual
a li

articles(Article Synopses)
Qu

Randomized Controlled
Trials (RCTs)
Unfiltered
Cohort Studies Information
Case-Controlled Studies
Case Series/Reports

Background Information/Expert Opinion

 Types of Research
RCT Randomised Controlled Trial: a carefully planned experiment that studies the effect
of therapy on real patients. Includes techniques (randomisation and blinding) that
reduce bias. Can provide sound evidence for cause and effect.

Cohort Study Follows patients who have a particular condition or receive a particular treatment
over time, and compares them with another group who have not been affected by the
condition or treatment being studied. Not as reliable as an RCT since the two groups
might differ in ways other than the variable being studied.

Case Control A study in which people who already have a condition are compared with those who
do not. The researcher looks back over time to identify factors that might be
Study associated with the condition. Often relies on medical data or patient recall, and is
less reliable than an RCT or cohort study because cause and effect is not necessarily
established.

Cross Sectional A study where a disease or condition and other related factors are measured at a
specific point in time for a given population. Often referred to as a "snapshot" of the
Study frequency and characteristics of a condition.

Case Report / A report on the treatment of an individual patient. Because there is no control group
for comparison, there is no statistical validity. Where there are a number of case
Case Study reports, this is known as a case series.
 PICO Question and table……,
Preferred Study Study
Type of Question Example Design(s) Design(s)
Screening/Diagnosis Is an auditory brainstem response Prospective, blind Cross-sectional
Accuracy in differentiating screening more accurate than an comparison to reference
clients with or without a otoacoustic emissions screening in standard
condition identifying newborns with hearing
loss?

Treatment/Service What is the most effective treatment Randomized, controlled Controlled trial;
Delivery to improve cognition in adults with trial experimental design
Efficacy of an intervention traumatic brain injury?

Etiology What are the risk factors for speech Cohort Case control;
Identify causes or risk factors and language disorders? case series
of a condition
Quality of Life/Perspective How do parents feel about Qualitative studies (e.g., Ethnographic
Understand the opinions, implementing parent-mediated case study, case series) interviews or surveys
experiences, and perspectives interventions? of the opinions,
of clients, caregivers, and perspectives, and
other relevant individuals experiences of
clients, their
caregivers, and other
relevant individuals
 Models of EBP
 Nurses and other healthcare professionals have developed several evidence-based practices
(EBP) models that aid in the implementation of EBP.

 These models serve as organizing guides that integrate the most current research to create the
best patient care practices.

 Help nurses to integrate credible evidence into practice, EBP models help assure the complete
implementation of EBP projects and optimize the use of nurses’ time and healthcare resources.

 No single EBP model can meet the needs of every organization and every patient situation. But
you would identify the EBP model that best fits your current, specific EBP needs.

The main models are

 JOHN HOPKINS MODELS

 STETLER MODELS

 CURN

 IOWA of evidence-based practice

IOWA Model
ACE Star Model
 Overview of EBP Models
Model Definition Essential Steps Salient Points to
Consider

Iowa Model of EBP ( 1. Identify either a “problem- • Recommended for use at

Titler et al., 2001). The focused trigger” or the level of the
Iowa Model focuses on “knowledge-focused trigger. organizational system
the entire healthcare 2. Determine whether the • Uses a pragmatic
system (e.g., patient, “trigger” is a healthcare problem-solving approach
practitioner, organization priority. to EBP implementation
infrastructure) to 3. Reflect a team’s topic of • Clearly identified
implement and guide interest decision points and
practice decisions 4. Evaluate the availability feedback loops
based on best available and merit throughout the model
research and evidence. 5. Appraise the pilot for its • Designed for
level of success. If the pilot is interprofessional
successful, disseminate collaboration
findings within the • Has sustained test of
organization and implement time
recommended change into
practice.
 Overview of EBP Models
Model Definition Essential Steps Salient Points to
Consider

Stetler Model (Ciliska Steps in this model are •Designed to encourage

et al., 2011; Stetler referred to as phases. critical thinking about the
, 2001). The Stetler integration of research
Model enables Phase I. Preparation findings
practitioners to assess • Promotes use of best
how research findings Phase II. Validation evidence as an ongoing
and other pertinent practice
evidence are Phase III. Comparative • Helps lessen errors in
implemented in clinical Evaluation/Decision Making critical decision-making
practice. The model activity
examines how to use Phase • Allows for categorization
evidence to create IV. Translation/Application of evidence as external
change that fosters (e.g., research) or internal
patient-centered care. Phase V. Evaluation (e.g., organization outcome
data).
 Overview of EBP Models
Model Definition Essential Steps Salient Points to
Consider

Johns Hopkins 1.Practice Question: Using a team •Emphasizes individual

Nursing Evidence- approach, the EBP question is use
Based Practice identified.
Model (Newhouse, 2.Evidence: The team searches, •Well-developed tool kit
Dearholt appraises, rates the strength of that provides nurses with
, Poe, Pugh, & Whit evidence, describes quality of a guide for question
e, 2007 evidence, and makes a practice development, evidence-
). recommendation on the strength of rating scale, and
evidence. appraisal guide for
It applies a problem- 3.Translation: In this stage, various forms of
solving approach to feasibility is determined, an action evidence
clinical decision- plan is created, and change is
making. implemented and evaluated.
Findings are presented to the
The model uses a healthcare organization and broader
three-step process nursing community.
referred to as PET
 Overview of EBP Models
Model Definition Essential Steps Salient Points to
Consider

ACE (Academic 1.Five Stages:Discovery: This stage •Focus on promoting use

Center for involves searching for new of EBP for direct care
Evidence-Based knowledge found in traditional nurses
Practice) Star quantitative and qualitative •Includes use of
Model. (Kring methodologies. qualitative evidence
, 2008; Stevens, 2.Evidence Summary: The primary •Primary goal of model is
2004). Aids in task is to synthesize the body of knowledge
systematically research knowledge into a transformation
integrating best meaningful statement of evidence •Does not incorporate
evidence into for a given topic. This is a nonresearch evidence
practice. knowledge-generating stage, which (patient values,
Research moves occurs simultaneously with new practitioner’s
through the cycles to findings that may arise from the experience)
combine with other synthesis. •Identifies factors that
forms of knowledge 3.Translation: The aim of impact adoption of
before integration translation is to provide clinicians innovation
into practice occurs. with a practice document (e.g.,
clinical practice guideline) derived
from the synthesis and summation
of research findings.
4.Integration: Practitioner and
 Scholarly Characteristics of Nurses Engaged in
Evidence-Based Practice (EBP)
EBP Scholarly Definition Demonstrated Behavior
Characteristic
Inquisitive Having a desire to learn more •The nurse wonders if
about patient care and music CDs at bedtime will
healthcare systems promote quality of sleep for
patients on a cardiac surgery
unit.

Challenger A query regarding the truth or •The nurse begins to ask peers
efficacy of healthcare-related if alternative methods of sleep
phenomena promotion have ever been
tried on the unit.

Critical thinker Actively and skillfully •The nurse reviews and

analyzing and synthesizing assesses research literature
information from a variety of regarding music therapy
evidence sources relaxation interventions.

Disruptive Creating or modifying an •The nurse seeks support from

innovator intervention. the health care team.
Change agent Actively engaged in transforming •The nurse develops a plan
patient care by altering current patient to manage and resolve
care standards resistance to change

Communicator Effective use of communication skills •The nurse develops a clear

to convey ideas, innovations, and vision of a plan and clearly
plans regarding evidence-based articulates that plan to
intervention others.

Context oriented Aware of the circumstances that form •The nurse is aware of and
the setting for EBP intervention sensitive to the unit’s
established evening care
routines.

Evaluator An activity to assess the amount or •The nurse creates a plan to

value of EBP implementation evaluate sleep quantity and
quality postintervention.

Knowledge Formation of new ideas •The nurse learns that the

creator regarding EBP implementation music CD relaxation
intervention is efficacious.

Collaborative Working with others to accomplish a •The nurse recognizes the

spirit desired patient outcome contributions of the team
effort and shares outcomes
with the team and others.
EBP BARRIERS 1)EBP SYSTEM

2)ORGANIZATIONAL

3)PERSONAL
 EBP Barriers
• Lack of • Lack of
Knowledge authority
• Over whelming • Lack of time • Status quo
of information
1) EBP SYSTEM

2)Organizational

3)Personal
• Workload Practice
• Resistance to • Demanding
• Conflicting
change workload
literature reports
• Lack of • Conflict in
• Methodological technical skills priority
shortcomings • Lack of ability • Lack of
to read the administrative
• Complex research support
statistical • Lack of • Lack of
information organizational motivational
support incentives
Research Evidence for Barriers
Alqahtani J M et.al., “Barriers to Implementing Evidence-
Based Practice among Primary Healthcare Nurses in
Saudi Arabia: A Cross-Sectional Study”. Nursing Reports
2022 Apr 28;12(2):313-323.

The findings showed that the three top-ranked barriers were:

(1) Results of the studies are not generalizable to nurses’
settings,
(2) Facilities are inadequate, and
(3) Physicians do not cooperate with the implementation.
Research Evidence for Barriers
John Michael Madamba Ferrer, and Joman Baliton, “Evidence-
based Practice among Clinical Nurses in Bahrain: Basis for a
Policy Brief.” American Journal of Nursing Research, vol. 11,
no. 1 (2023): 21-45. doi: 10.12691/ajnr-11-1-3.

The study result shows that nurses somewhat truly believe in

evidence-based practice, have acceptable evidence-based practice
knowledge, probably consider the culture and organizational
readiness, and are interested in implementing specific evidence-
based practice tasks. At the same time, lack of knowledge and
insufficient time were recorded as barriers to implementing
evidence-based practice.
Strategies for Overcoming Barriers to Adopting an EBP
Strategies for Overcoming Barriers to Adopting an
EBP…cont…,
Strategies for Overcoming Barriers to Adopting an
EBP…cont…,
 Advancing EBP through mentoring
Who is an EBP Mentor?
According to the Advancing Research and Clinical Practice through close
Collaboration model, EBP mentors are essential to building and
sustaining a culture of EBP by supporting nurses and clinicians at the
point of care (Breckenridge-Sproat et al., 2015; Melnyk, 2012).

 Mentoring is a powerful experience that influences nursing careers and impacts

patient care outcomes.
 The presence of a knowledgeable and committed evidence-based practice (EBP)
mentor enhances learning the art and science of EBP for the mentee.
 It explores nurses working together in both individual mentoring experiences and as
members of interprofessional collaborative teams to further the implementation of
EBP. Nurses have important roles in advancing EBP as part of interprofessional
collaboration.
 Whether nurses are educators, clinicians, researchers, or administrators, they have
critical responsibilities in contributing to interprofessional collaboration and EBP
responsibilities.
 Research Evidence for EBP Mentoring
 Nurses reported that their EBP practice, skills, and the Work
based on EBPs improved substantially after the education
program. We found that scores on the Work based on EBPs and
the attitudes towards EBP could predict the nurses' overall self-
evaluations of practices, attitudes, and skills.
 EBP education affects positively on implementation of nurses'
practices and skills
 Organizations need to maintain and develop efficient, attractive
EBP educational programs to promote lifelong learning.
(Vaajoki A, et..al., Systematic education has a positive impact on nurses' evidence-based practice: Intervention study
results. Nurse Educ Today. 2023 Jan.)
 EBP Measurement Tools
EBP Belief Scale – EBPB

EBP Implementation Scale

EBP Competencies Scale

EBP Knowledge Tool – EBP-KAQ

Implementation of Self-Efficacy for EBP Scale

EBP Nurse Manager Competency Scale

EBP Mentoring Scale

 CONCLUSION
Evidence-based Nursing should not just
satisfy the urge of conference researchers to
do research, but it should always be directed
to improve the quality of nursing education,
nursing intervention, and administrative
approaches.