Evidence-Based Nursing

Practice
Mohammad Aloufi
Chapter Objectives
• By the end of this topic and with further reading and
research, you are expected to:

• Discuss Evidence-Based Nursing Practice (EBNP).

• Recognize the advantages of EBP Implementation.
• Identify the hierarchy of evidence in nursing.
• Describe steps of practicing evidence-based nursing.
• Distinguish the major resources to facilitate EBNP.
• Discuss EBNP in the Saudi Arabian context.
2.1. The meaning of Evidence-Based Nursing
Practice (EBNP)
• There are different definitions in the literature
about evidence-based practice (EBP). Most of those
definitions include three areas:
• Research-based information,
• Clinical expertise,
• And patient preferences (Schmidt & Brown, 2017).
2.1. The meaning of Evidence-Based Nursing
Practice (EBNP)
• Sigma Theta Tau International defined EBP in
nursing as an “integration of the best evidence
available, nursing expertise, and the values and
preferences of the individuals, families and
communities who are served”
2.1.2 Background of Evidence-Based Nursing
Practice
• EBP originated from a Medical School in the early
1970s at McMaster University in Ontario, Canada
(Hoffmann et al., 2013). Archie Cochrane, a British
epidemiologist contributed to the development of
the foundation of EBP, and he noted that clinical
decisions should be based on the available
evidence, and randomized controlled trials (RCTs)
are reliable forms of evidence, and systematic
reviews should be conducted and updated regularly
to provide new evidence.
2.1.2 Background of Evidence-Based Nursing
Practice
• During the development of the concept of EBP,
nurses tried to become involved in applying the
research into practice by a process known as
“Research Utilization”.
Research utilization (RU) means applying research
findings to all aspects of nurses’ tasks.
• However, EBP model is a broader and more comprehensive
model than RU because it includes crucial aspects of
evidence such as critical thinking, focusing on patient
preferences (Rycroft-Malone & Bucknall, 2010; Schmidt & Brown, 2017).
2.1.3 EBP From Islamic Perspective
• The concept of evidence-based practice is implemented deeply
into the Islamic culture where people are requested to read
and understand the Holy Quran.
• The hierarchy of evidence in Islam are the Holy Quran, Sunnah
and Imams' consensus. Imams' "Islamic scholars" reach their
decisions " Fatwa" based on evidence from the holy Quran in
terms of the following:
1- Monasabah: in what condition or situation did the Quran verse was
delivered to prophet Mohammad peas-be-upon-him (settings);
2- Daleel: the Quran verse (the evidence);
3- Shahid: the word or phrase of the verse indicating the action, please
view the
2.2 Advantages of the Implementation of EBP

• EBP allows the combination of education with clinical

practice and the use of the most effective available care
(Plastow, 2006; Reavy & Tavernier, 2008)
• EBP can help the clinician to keep their practice up-to-date
and motivate them to explore recent research findings.
• EBP can also help health professionals to use the best
available evidence to make their decisions in clinical practice
• EBP developing confidence in using research findings,
developing their leadership skills, improving critical thinking
skills, and increasing ability to provide safe, cost-effective
and valid practices for patients (Reavy & Tavernier, 2008).
2.3. Hierarchy of evidence in nursing
• Involve ranking evidence sources according to the strength of
evidence they provide
• Ranking may depend on the type of question being asked.
• Within any level, evidence quality can vary considerably
Example of Therapy questions
§ Level I evidence comes from systematic reviews of multiple RCTs
§ Level II evidence: individual Random control Trials (RCTs)
§ level III evidence: quasi-experiment(No randomization)
2.4. Steps of practicing evidence-based
nursing
The evidence-based nursing practice is a
continuous process for ensuring that nurses are
practicing based on updated information and
guidelines. Steps of practicing evidence-based
nursing are varying among nursing bodies,
however, the general idea is similar (Melnyk et al., 2010).
Seven steps of melnyk et al.’S approach (2010)
Step Zero: Cultivate a spirit of inquiry:

• In this step, nurses start to think, inquire, compare

and question daily nursing practices and their effect
towards patients' outcomes.
• For example, nurses may start to think about their
chronic diseases' self-care teaching methods and
how they improve patients' outcome.
Step 1: Ask clinical questions in PICOT format:

This format stands for

• Patient population of interest (P),
• Intervention (I),
• Comparison intervention/ group (C),
• Outcome (O),
• And time (T)

In _____ (population), what is the effect of ________

(intervention), in comparison to _______
(comparison), on __________(outcome)?
Step 2: Search for the best evidence:

In this step, nurses start to enter the PICOT question

keywords into search engines and databases.
Search a process should combine all keywords.
To narrow the search result, choose "English"
publications and other options that may satisfy your
search needs.
• Databases such as:
• PubMed, Medline and CINAHL
• Saudi Digital library
• ‫ﻋﻣ ﺎد ة ﺷؤن ا ﻟ ﻣ ﻛ ﺗ ﺑ ﺎت‬
Step 3: Critically appraise the evidence:

• once articles are defined at the end of search

processes, nurses are required to appraise the
evidence or the research reports.
• Appraising is a process where the researcher reads
the research report and check its strengths and
weaknesses.
Step 4: Integrate the evidence with clinical
expertise and patient preferences and values
• Nurses need to present their evidence and
negotiate with other nurses and healthcare team
members and patients to apply the new practice or
the new evidence.
Step 5: Evaluate the outcomes of the practice
decisions or changes based on evidence.
"If You Can't Measure It, You Can't Improve It".
Once the evidence is implemented or adapted,
responsible teams are required to measure the new
evidence impact and make sure it improved patients
and/or organizational outcomes.
Step 6: Disseminate EBP results.

Sharing the outcome with other parties including

nursing colleagues, healthcare teams, hospital
administration decreases the impact of the new
evidence as a new approach of improving patients'
outcomes.
2.5. Evidence-based nursing resources
Database Brief description Website

Cochrane Database of It is the gold standard of https://www.cochran

Systematic Reviews systematic reviews. elibrary.com/
Joanna Briggs Institute It has systematic https://joannabriggs.o
EBP Database reviews, evidence rg/
summaries, and best
practice information
sheets.
The Cumulative Index to It has broad content https://www.ebscoho
Nursing and Allied coverage including all st.com/nursing/produ
Health Literature nursing specialties. cts/cinahl-
(CINHAL) databases/cinahl-
complete
2.6. EBNP in Saudi Arabia

• The development of EBP in Saudi Arabia is not well

documented in the literature and it may indicate an
infancy stage of adopting EBP.
• A studies argue that there are factors at different
levels (e.g. individual and organization) that
contribute to the blocking of the integration of
evidence into clinical practice. (Hamaideh, 2016;
Omer, 2012).
Group Exercise
• Please follow the instructions below:
1. Place yourself in a group of 4-6 students.
2. Identify a clinical challenge that you want to address or a problem
that need to be solved.
3. Your goal is to identify how to overcome the identified clinical
challenge using Evidence-Based Nursing Practice steps (researching
the literature, speaking to “expert” etc).
4. Please utilize the reading materials to support your work.
5. Each group should address the identified challenge successfully
using the most appropriate research material by the end of this
chapter.
6. Once everyone in the team are satisfied with the intervention,
approach, or methodology, the team leader must summarize the
materials used and present this to the whole class for discussion and
critique.