MedSurg Lecture
practice first-hand
Evidence-based practice
What is evidence?
- A form of material or information that
would support the practice of nursing
- The practice of nursing is founded
on the evidence available and found
in researches
- All rationale, interventions,
and performances are
approved because it has
been TESTED,
RESEARCHED, and HAS
ESTABLISHED EVIDENCES
- Used to arrive at the truth, to prove
or disapprove of the point of the
issue
Evidence-based Practice
- It is the practice of nursing which is
proven by evidence
- Evidence must be consistent with
the practice
- Needed to provide safe and quality
care to patients
- Supports all interventions and
rationale in the nursing practice in
combination with clinical expertise
- Consistent use of evidence in
combination with clinical expertise
and patient preferences/values to
support clinical decision-making
- The main goal is to provide:
- high-quality care
- Cost-effective care
- Accessibility to health
information
- Evidence may consist of portions
- Internal evidence
- Established by nurse
clinicians themselves
- “According to the
DOH, the use of
lagundi for the
alleviation of cough
…”
- Clinicians have
observed and
experienced the
- External evidence
- From journals,
practices of other
countries, research
- “A study from US
school eme, the use
of eme eme is
effective in the
palliative care of eme
eme…”
- The material
indicated may not be
present in the
Philippines or the
Philippine nursing
practice, making it an
external evidence
Evidence can be a policy or a standard
used by a certain population
- A way of providing nursing care that
guided by integration of best
available scientific knowledge and
expertise
- Nurses need to gather and collect
information from other sources to
come up and arrive at a concept of
care
Purposes of EBP
1. To make sure that each client gets
the best possible services (the more
effective, cost-effective for the
patient = MORE EFFECTIVE)
2. Update the knowledge that is
essential for lifelong learning
a. Some practices are not
anymore applied and
effective because of current
evidence and research
3. Provide clinical judgment
4. Improvement of care provided and
saving lives
Goals of EBP
1. Provide practicing nurses the
evidence-based data to deliver
effective care and achieve
excellence in care delivery
 2. Resolve problems in the clinical
setting
3. Reduce variations in nursing care
(effective and efficient)
Importance of EBP
1. Provides the most effective care
that is available with the aim to
improve patient outcomes
a. The more effective the care
is, the more the patients will
benefit
2. It promotes an attitude of inquiry in
health professionals and enhances
decision-making
a. Healthcare professionals
should not just rely on
existing information
b. We should be able to find
and conceptualize new
information to innovate and
increase the effectiveness of
nursing care
3. Plays a role in ensuring that finite
health resources are used wisely
and that relevant evidence is
considered when decisions are
made about funding health services
a. Sometimes, a practice done
in the healthcare setting is
not what is stated in the
books
b. This is where EBP plays a
role in bridging the gaps
between theoretical and
actual practice
c. Improvements in practice are
brought about the consistent
evolution of information
Sources of Evidence
- Research findings (EBP always
starts with research)
- Findings in the are applied
ion the nursing professions
→ turns it to evidence-based
research → appli3ed to
practice =ebp
- Quality improvement data (data
analyses from hospitals)
- Practice management initiatives (in
terms of the management, and
policies of the hospital as evidence)
- Professional organization standards
(standards of WHO, ANA, DOH,
etc.)
Models of EBP
John Hopkins EBP model (John Hopkins
university)
Has 3 phases
1. Identification of answerable question
2. Systematic review and synthesis
(research and nonresearch
evidence)
a. approximately, 100-200
literature are reviewed
b. Analysis is done to draw
conclusions to answer the
question
3. The translation includes
implementation of practice change
as a pilot study, measurement of
outcomes, and dissemination of
findings
a. Trying of the result in the
hospital and measurement of
the outcomes.
IOWA model
- 1994
- Focuses on organization and
collaboration incorporating conduct
and the use of research, along with
other types of evidence
- Focused on research development
for evidence pahhhhroduction
2 star points
1. A knowledge-focus trigger
a. Awareness of innovative
research findings
b. An interest on certain
research outcomes can
trigger to apply it on the
healthcare facility, to test the
effectiveness
2. A Problem-focus trigger
a. Focus on clinical or
organizational problem
 b. If there is an existing problem
in the hospital, this may
trigger research to find
solutions to this.
Stetler model
- 1992
- “Practitioner-oriented” model
- Deepmphasize unsystematic clinical
experiences and raise awareness
bailout the importance of applying
research findings in nursing practice
- If they desire to improve their current
practicum, they subject it to a period
of review called “evidence-based
research”
5 phases
1. Preparation phase
a. Formulation of the questions,
information, and evidence
2. Validation phase
a. Looking into the information
3. Comparative evaluation/
Decision-making phase
a. Comparative analysis to
arrive at a decision
(experimental change)
4. Translation/ Application Phase
a. Application of the formulated
decision to the healthcare
setting
5. Evaluation phase
a. If positive results, it can now
become a policy with good
foundations of evidence
Rossworm and Larrabee Model
- 1991
- Based on theoretical and research
literature that begins with
assessment of need and integration
of an evidence-based protocol
6 stages
1. Assess the need of the stakeholders
2. Link problem, interventions and
outcomes
3. Synthesize the evidence and
determine relevance
4. Design the practice change
5. Implement and evaluate practice
change
6. Integrate and maintain the practice
change
Cochrane Model
4 phases
1. Record checking
2. Qformulate question
3. Experiment
4. And analyze
This is a cyclical process to improve the
process
EBP in the Clinical Setting
Evidence-based nursing practice in the
clinical setting is always based on:
1. Best research evidence
a. Up-to-date scientific research
into various aspects of
patient care, diagnosis,
treatment, or prevention of
disease
2. Clinical expertise
a. Combination of skills,
knowledge, and professional
experience accumulated over
the course of their careers
(usually more than 5 years of
clinical experience)
3. Patient values and circumstances
a. Unique preference,
concerns, expectations,
beliefs, hopes, strengths,
limitations, and stresses of
each patient
b. We should always interrelate
to the needs of the patients
c. The sole reason for
evidence-based practice is
because there is a presence
of need
Steps of the EBP Process
Key Steps
- Ask the patient: clinical problems
- Method of assessment for
the client's needs
 - If the client asks for a certain
need, we can formulate
questions from that
- Ask the questions: construct a
clinical question from the case
- We must be able to construct
clinical questions based on
the needs and concerns of
the patients
- Acquire evidence: appropriate
resources
- Appraise evidence: validity and
applicability
- Evaluate and make a review
that appraises the evidence
- Apply information: return to patient
and integrate evidence
- Execute a pilot study to test it
- Audit (Self-evaluation): evaluate
performance with patient
- If it produce positive results,
we can now use it as an
evidence-based practice
In-depth discussion of the key steps
1. ASKING A CLINICAL QUESTION
a. Creates a context that is
searchable and answerable
b. We use the PICOT format
i. Patient/population
ii. Intervention
iii. Comparison (of the
intervention)
iv. Outcome
v. Time
example
PICOT format:
“In adult, cardiac surgery patients (P) is
morphine (I) or fentanyl (C) more effective
in reducing pain (O) on the first
postoperative day (T)?”
“For 65 years and older (P), how does the
use of influenza vaccine (I) compared to not
receiving (C) influence the risk of
developing pneumonia (O) during the flu
season (T)?”
2. Search and collection of evidence
a. Search and collect evidences
based on the clinical
question
Databases
- Randomized control Trials (RCT) -
strongest
- Systematic review
- Clinical practice guidelines
- Meta-synthesis of qualitative
evidence
- Expert committees, authority figures
3. Critically appraise and synthesize
the evidence
Critical appraisal: determine the
value and strength of research
evidence to practice
a. What are the results?
b. Are the results valid?
c. Are the findings clinically
relevant to patients?
If all are answered with yes, then we can
proceed to step 4
4. Integration of evidence
- Evidence must be implemented into
practice interventions in combination
with the clinician’s expertise and
patient preference
Example:
Evidence support that morphine is an
effective analgesic but not for patients with
renal failure
Insufficient evidence = conduct research
5. Evaluate the practice decision
- Evaluation of identified measured
outcomes match with clinical project
objective
- Reflect ALL aspects of
implementation
- Interdisciplinary contributions
Implementation of EBP
- Continuously seek scientific
evidence that support patient
outcome
- Healthcare leaders' engagement
(needed to execute ebp)
- Take into account the patient’s
unique circumstances and
preferences
- EBP closes the gap between
research and practice