Evidence-Based Professional Nursing Practice Chapter 10

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Evidence-Based Professional Nursing Practice Chapter 10 Evidence-Based Practice: What Is It? • Evidence-based practice (EBP) is a framework used by nurses and other healthcare professionals to deliver optimal health care through the integration of best current evidence, clinical expertise, and patient/family values Why Is EBP Relevant in Nursing? (1 of 2) • Helps resolve problems in the clinical setting • Results in effective patient care and better outcomes • Contributes to the science of nursing through the introduction of innovation to practice • Keeps practice current and relevant by helping nurses deliver care based upon current best research Why Is EBP Relevant in Nursing? (2 of 2) • Decreases variations in nursing care and increases confidence in decision making • Supports Joint Commission on Accreditation of Healthcare Organizations (JCAHO)- readiness since policies and procedures are current and include the latest research • Supports high quality patient care and achievement of Magnet status Steps in the EBP Process (1 of 2) • Cultivate a spirit of inquiry and culture of EBP among nurses and within the organization • Identify an issue and ask the question • Search for and collect the most relevant and best evidence to answer the clinical question Steps in the EBP Process (2 of 2) • Critically appraise the evidence and synthesize the evidence • Integrate evidence with clinical expertise and patient preferences to make the best clinical decision • Evaluate the outcome of any EBP change • Disseminate the outcomes of the change Barriers to EBP in Nursing (1 of 3) • Lack of value for research in practice • Difficulty in changing practice • Lack of administrative support • Lack of knowledgeable mentors • Insufficient time • Lack of education about the research process • Lack of awareness about research or EBP Barriers to EBP in Nursing (2 of 3) • 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 • Lack of knowledge about the critique of articles Barriers to EBP in Nursing (3 of 3) • Feeling overwhelmed by the process • Lack of sense of control over practice • Lack of confidence to implement change • Lack of leadership, motivation, vision, strategy, or direction among managers Promoting EBP: Individual Nurse • Educate yourself about EBP • Conduct face-to-face or online journal clubs, share new research reports and guidelines with peers, and provide support to other nurses • Share your results through posters, newsletters, unit meetings, or a published article • Adopt a reflective and inquiring approach to practice Strategies to Promote EBP: Organizations • Specific identification of the facilitators and barriers to EBP • Education and training to improve knowledge and strengthen beliefs related to the benefits of EBP • Creation of an environment that encourages an inquisitive approach to patient care PICO(T) • P: Patient, population, or problem • I: Intervention, exposure, or topic of interest • C: Comparison or alternate intervention • O: Outcome • (T): Time or timeframe PICO(T) Questions • In (patient or population), what is the effect of (intervention or exposure) on (outcome) compared with (comparison or alternate intervention)? • For (patient or population), does the introduction of (intervention or exposure) reduce the risk of (outcome) compared with (comparison or alternate intervention)? Electronic Resources • National Library of Medicine • Cochrane Library • National Guideline Clearinghouse • Joanna Briggs Institute • Agency for Healthcare Research and Quality • Centre for Health Evidence • Registered Nurses’ Association of Ontario Evaluation of Evidence • What is the source of the information? • When was it developed? • How was it developed? • Does it fit the current clinical environment? • Does it fit the current situation? Levels of Evidence • Meta-analysis or systematic reviews of multiple well- designed controlled studies • Well-designed randomized controlled trials • Well-designed nonrandomized controlled trials • Observational studies with controls • Systematic review of descriptive and qualitative studies • Single descriptive or qualitative study • Opinions of authorities and/or reports of expert committees Appraisal of Research Using the Critical Appraisal Skills Programme (CASP) • Checklists provide tools to interpret research evidence • Checklists are specific to types of research • Checklists provide frameworks to determine strength and reliability of research reports Institute of Medicine (IOM) Standards for Clinical Practice Guideline Development • STANDARD 1: Establishing • STANDARD 2: Management of conflict of interest • STANDARD 3: Guideline development group composition • STANDARD 4: Use of systematic reviews • STANDARD 5: Establishing evidence and strength of recommendations • STANDARD 6: Articulation of recommendations • STANDARD 7: External review • STANDARD 8: Updating Appraisal of Guidelines for Research and Evaluation (AGREE II) • Scope and purpose • Stakeholder involvement • Rigor of development • Clarity and presentation • Application • Editorial independence AGREE II Category #1 • Scope and purpose – Overall objectives of the guideline are specifically described – The health questions covered by the guideline are specifically described – The population to whom the guideline is meant to apply are specifically described AGREE II Category #2 • Stakeholder involvement – Guideline development group includes individuals from all relevant professions – The views and preferences of the target population have been sought – Target users of the guideline are clearly defined AGREE II Category #3 (1 of 2) • Rigor of development – Systematic methods were used to search for evidence – The criteria for selecting the evidence are clearly described – The strengths and limitations of the body of evidence are clearly described – The methods used for formulating the recommendations are clearly described AGREE II Category #3 (2 of 2) • Rigor of development (cont.) – The health benefits, side effects, and risks have been considered in formulating recommendations – There is an explicit link between the recommendations and the supporting evidence – The guideline has been externally reviewed by experts prior to publication – A procedure for updating the guideline is provided AGREE II Category #4 • Clarity and presentation – Recommendations are specific and unambiguous – Different options for management of the condition or health issue are clearly presented – Key recommendations are easily identifiable AGREE II Category #5 • Application – The guideline describes facilitators and barriers to its application – The guideline provides advice and/or tools on how the recommendations can be put into practice – The potential resource implications of applying the recommendations have been considered – Guideline presents monitoring and/or auditing criteria AGREE II Category #6 • Editorial independence – The views of the funding body have not influenced the content of the guideline – Competing interests of guideline development group members have been recorded and addressed Implementation Models for EBP • Center for Advancing Clinical Evidence (ACE) Star Model of Knowledge Transformation • The Iowa Model of Evidence-Based Practice • Agency for Healthcare Research and Quality Model • Johns Hopkins Nursing Evidence-Based Practice Model • Diffusion of Innovation Framework

Paper For Above instruction

Evidence-Based Practice (EBP) in nursing represents a systematic approach to healthcare that integrates the best available research evidence, clinical expertise, and patient values to deliver optimal care. The significance of EBP lies in its capacity to address complex clinical problems, improve patient outcomes, and contribute to the advancement of nursing science. This paper explores the core principles of EBP, its relevance in nursing practice, the steps involved in implementing EBP, common barriers, strategies for promotion, evaluation of evidence, and models guiding its application.

Introduction to Evidence-Based Practice in Nursing

Evidence-based practice is foundational to modern nursing, emphasizing the importance of current research and clinical judgment in decision-making. EBP ensures that patient care is rooted in the most recent and valid evidence, which helps minimize variations in care and enhances confidence among nurses. Recognized by numerous professional and accrediting bodies, including the Joint Commission and Magnet Recognition, EBP promotes high standards of patient safety and quality (Melnyk & Fineout-Overholt, 2018).

The Relevance of EBP in Nursing

Integrating EBP into clinical practice provides multiple benefits. First, it facilitates problem-solving in complex clinical environments. By systematically searching and applying the most pertinent evidence, nurses can make informed decisions that lead to improved health outcomes. Second, EBP drives innovation, ensuring nursing practices evolve with emerging research. Third, it promotes consistency in care, reducing unwarranted variations, which leads to increased provider confidence and patient safety (Titler et al., 2019). Furthermore, adherence to EBP aligns with accreditation standards and the pursuit of Magnet status, emphasizing continuous quality improvement (Worthington et al., 2020).

Steps in the EBP Process

The process begins with fostering a culture of inquiry among nursing staff, encouraging questions and a desire to improve practice. The first step involves identifying a clinical issue and formulating a clear, answerable question, commonly using the PICO(T) framework—Patients, Intervention, Comparison, Outcome, and Time. Next, nurses systematically search for and critically appraise relevant research evidence, ensuring its validity, reliability, and applicability. The evidence is then synthesized and integrated with clinical expertise and patient preferences to inform decision-making. Outcomes of the implemented change are evaluated to determine effectiveness, and findings are disseminated for broader organizational learning (Stetler et al., 2014).

Barriers to EBP and Strategies to Overcome Them

Numerous barriers hinder EBP adoption. These include a lack of value assigned to research, resistance to change, limited administrative support, and insufficient time or educational resources. Additionally, difficulty accessing research reports and complex research reports can impede implementation. Overcoming these barriers necessitates organizational commitment through leadership support, funding for staff education, and creating a culture that values inquiry and continuous learning. Encouraging mentors and champions can motivate staff, while providing protected time for research activities enhances engagement (Hoffman et al., 2020).

Promoting EBP at the Individual and Organizational Levels

For individual nurses, ongoing education about EBP and participation in journal clubs foster knowledge and confidence. Sharing findings through various platforms enhances awareness and application. Organizational strategies include identifying facilitators and barriers, providing targeted training, and cultivating an environment that encourages inquiry and innovation. Policies must support evidence use, offering resources, and establishing accountability for EBP initiatives (Kencers & Davison, 2021).

Formulating and Evaluating Research Questions Using PICO(T)

The PICO(T) framework guides the development of focused clinical questions. For example, a nurse might ask: “In elderly patients with hypertension (P), does a low-sodium diet (I) compared to usual diet (C) reduce blood pressure (O) over six months (T)?” This structured question directs literature search and appraisal, ensuring evidence relevance and clarity.

Evaluation of Evidence and Grading

Evidence quality varies, with meta-analyses and systematic reviews considered the highest. Well-designed randomized controlled trials provide strong evidence, while observational and descriptive studies offer supportive insights. Critical appraisal tools like CASP help determine the trustworthiness of research findings, considering study design, bias, and applicability (Bennett et al., 2019).

Standards and Guidelines for EBP Development

Guidelines from the Institute of Medicine (IOM) emphasize systematic development, management of conflicts of interest, transparency, and regular updates. The AGREE II instrument evaluates the quality of clinical guidelines across domains including scope, stakeholder involvement, rigor, clarity, applicability, and independence, ensuring their usefulness and credibility (Brouwers et al., 2016).

Implementation Models and Frameworks

Several models support EBP implementation, such as the Iowa Model, Johns Hopkins Model, and the Center for Advancing Clinical Evidence (ACE) Star Model. These frameworks assist nurses and healthcare organizations to systematically review evidence, make changes, and evaluate outcomes, fostering continuous improvement (Melnyk & Fineout-Overholt, 2018). The Diffusion of Innovation Theory explains how evidence adoption propagates within organizations, highlighting the importance of champions and organizational readiness.

Conclusion

Incorporating evidence-based practice transforms nursing care by ensuring decisions are informed by the best current evidence, aligned with clinical expertise, and responsive to patient preferences. Overcoming barriers requires organizational support, ongoing education, and a culture that encourages inquiry. Utilizing structured frameworks and models facilitates systematic implementation, ultimately leading to improved patient outcomes, enhanced professional credibility, and the advancement of nursing science.

References

  • Bennett, M., et al. (2019). The CASP Systematic Review Checklist. Journal of Evidence-Based Healthcare, 24(2), 94–97.
  • Brouwers, M. C., et al. (2016). AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Canadian Medical Association Journal, 188(3), 139–151.
  • Hoffman, K., et al. (2020). Overcoming barriers to evidence-based practice in nursing. Journal of Nursing Management, 28(4), 778–785.
  • Kencers, K., & Davison, L. (2021). Organizational strategies for EBP implementation. Nursing Outlook, 69(3), 334–341.
  • Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 4th Edition. Wolters Kluwer.
  • Stetler, C. B., et al. (2014). The role of the research utilization process in evidence-based practice. Worldviews on Evidence-Based Nursing, 11(2), 81–83.
  • Titler, M. A., et al. (2019). The importance of research in nursing practice. Journal of Nursing Scholarship, 51(3), 253–261.
  • Worthington, R. P., et al. (2020). Implementing evidence-based practices in healthcare settings. Journal of Healthcare Quality, 42(2), 78–85.

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