DR.

D Y PATIL COLLAGE OF NURSING

SEMINAR
Roll of nurse in Evidence based nursing
practice
SUB- ADVANCE NURSING PRACTICE

Submitted to submitted by
DR.Mrs. Kavita Kelkar Srushti M. Patil
Class Co-ordinator Msc 1ST Yr.
DR.D. Y. Patil collage of nursing Roll no-
Pimpri pune
DATE –
Name of the student : Srushti Mahadev patil
Name of the guide : Dr. mrs Kavita Kelkar
Name of the course : 1st yr msc nursing sem 1
Name of the subject : Advanced nursing practice
Topic : Roll of nurse in evidence-based
practice
Date : / / 2023
Time
Venue : Dr. D. Y. Patil college of nursing,
Pimpri pune-18
Method of teaching : Lecture cum discussion
A.V. Aids : Charts, PowerPoint
Presentations
General Objective

After completion of this seminar the group will be able to

understand about Evidence Based Nursing Practice and roll of
nurse in evidence-based practice

Specific Objective
To introduce EBP
To define Evidence Based Practice(EBP)
To enlist components of EBP
To explain steps of EBP
To enumerate models and theories of EBP
To enlist need of EBP
To understand barriers of EBP
To describe advantages of EBP
INTRODUCTION
All health care consumers (patients and clients) expect quality
health/ nursing services from all health care professionals
especially Nurses.

The care should be built on the use of best evidence.

International Council of Nursing (ICN) (2010) stated that Nurses
are both responsible and accountable for their nursing practice.

However, nursing is also allied to other health professions

through its collaborating, referring and coordinating activities
and thus has developed a distinct as well as a shared body of
knowledge and practice changed.

DEFINITION
Evidence:
Evidence refers to sources of data relevant to a
particular clinical problem that are used
to facilitate decision making about patients’ care
It is defined as use of current best evidence by clinicians when
making patient care decision, it entails finding the best
evidence, critically evaluating it, integrating it with clinical
expertise and patient preference and applying the results to the
clinical practice.
EVIDENCE BASED PRACTICE
Evidence based practice is the conscious, explicit, and judicious
use of current best evidence in making decision about he
individual patient. The practice of evidence-base means
integrating individual clinical expertise with the best available
clinical evidence from systematic research.

It is a problem solving approach that integrates a

systematic research for and critical appraisal for the most
relevant evidence to answer a burning clinical question.

COMPONENTS OF EVIDENCE BASED PRACTICE

INDIVIDUAL CLINICAL PATIENT VALUES AND

EXPERTIES EXPECTATION

IMPROVE
PATIENT
OUTCOME

BEST AVAILABLE CLINICAL EVIDENCES

During the 1980s, the term "evidence-based medicine" emerged
to describe the approach that used scientific evidence to
determine the best practice. Later, the term shifted to become
"evidence-based practice as clinicians other than physicians
recognized the importance of scientific evidence in clinical
decision-making. Various definitions of evidence-based practice
(EBP) have emerged in the literature, but the most commonly
used definition is, "the conscientious, explicit, and judicious use
of the current best evidence in making decisions about the care
of individual patients"(Sackett, Rosenberg, Gray, Hayes, &
Richardson, 1996).
Subsequently, experts began to talk about evidence-based
healthcare as a process by which research evidence is used in
making decisions about a specific population or group of
patients. Evidence-based practice and evidence-based
healthcare assume that evidence is used in the context of a
particular patient's preferences and desires, the clinical
situation, and the expertise of the clinician. They also expect
that healthcare professionals can read, critique, and synthesize
research findings and interpret existing evidence-based clinical
practice guidelines.

KEY STEPS OF EVIDENCE BASED PRACTICE

Evidence based practice is a thoughtful integration of best
available evidence, coupled with clinical expertise. As such it
enables health practitioner of all varieties to address healthcare
questions with an evaluative and qualitative approach. EBP
allows the practitioner to assess current and past research,
clinical guidelines and other information resources in order to
identify relevant literature while differentiating between high
quality and low quality findings.

STEPS
Step 1: Asking the burning clinical question in the format that
will yield the most relevant and best evidence.

Step 2: Collecting the most relevant and best evidence to

answer the clinical question including research for systematic
reviews.

Step 3: Critically appraising the evidence that has been collected

for its validity, relevance and applicability.

-Step 4: Integrating the evidence with one's clinical expertise,

assessment of patient's condition and available health care
resources along with the patient preference and values to
implement a clinical decision.

Step 5: Evaluating the change resulting from implementing the

evidence in practice.
 STEPS OF EBP

Step 1: Ask clinical questions in PICOT format. Inquiries in this

format take into account patient population of interest (P),
intervention or area of interest (1), comparison intervention or
group (C), outcome (O), and time (T). The PICOT format provides
an efficient framework for searching electronic databases, one
designed to retrieve only those articles relevant to the clinical
question.

Step 2: Search for the best evidence. The search for evidence to
inform clinical practice is tremendously streamlined when
questions are asked in PICOT format. If the nurse in the rapid
response scenario had simply typed "What is the impact of
having a rapid response team?" into the search field of the
database, the result would have been hundreds of abstracts,
most of them irrelevant. Using the PICOT format helps to
identify key words or phrases that, when entered successively
and then combined, expedite the location of relevant articles in
massive research databases such as MEDLINE or CINAHL,
Step 3: Critically appraise the evidence. Once articles are
selected for review, they must be rapidly appraised to
determine which are most relevant, valid, reliable, and
applicable to the clinical question. These studies are the "keeper
studies." One reason clinicians worry that they don't have time
to implement EBP is that many have been taught a laborious
critiquing process, including the use of numerous questions
designed to reveal every element of a study.

Step 4: Integrate the evidence with clinical expertise and patient

preferences and values. Research evidence alone is not
sufficient to justify a change in practice. Clinical expertise, based
on patient assessments, laboratory data, and data from
outcomes management programs, as well as patients'
preferences and values are important components of EBP. There
is no magic formula for how to weigh each of these elements;
implementation of EBP is highly influenced by institutional and
clinical variables.

Step 5: Evaluate the outcomes of the practice decisions or

changes based on evidence. After implementing EBP, it's
important to monitor and evaluate any changes in outcomes so
that positive effects can be supported and negative ones
remedied. Just because an intervention was effective in a
rigorously controlled trial doesn't mean it will work exactly the
same way in the clinical setting. Monitoring the effect of an EBP
change on health care quality and outcomes can help clinicians
spot flaws in implementation and identify more precisely which
patients are most likely to benefit. When results differ from
those reported in the research literature, monitoring can help
determine why.
Step 6: Disseminate EBP results. Clinicians can achieve
wonderful outcomes for their patients through EBP, but they
often fail to share their experiences with colleagues and their
own or other health care organizations. This leads to needless
duplication of effort, and perpetuates clinical approaches that
are not evidence based. Among ways to disseminate successful
initiatives are EBP rounds in your institution, presentations at
local, regional, and national conferences, and reports in peer-
reviewed journals, professional newsletters, and publications for
general audiences.

. When health care organizations adopt EBP as the standard for

clinical decision making, the steps outlined in this article
naturally fall into place. The next article in our series will feature
a staff nurse on a medical-surgical unit who approached her
hospital's EBP mentor to learn how to formulate a clinical
question about rapid response teams in PICOT format

Posing the question using PICO

P The patient population or disease of

interest e.g. age, gender, identity, ethnicity
and certain disorders e.g. hepatitis
I Intervention or range of intervention of
interest e.g. exposure to

discase, risk behavior

 C What you want to compare the
intervention against c.g. no disease,
placebo or no intervention/therapy,
absence of risk factors
O Outcomes of interest e.g. risk of disease,
accuracy of diagnosis, rate of occurrence
of adverse outcome death.

Models and theories for EBP

Models that offer a framework for launching an EBP includes the
following:
 Advancing research and Clinical Practice through Close
Collaboration Model 2005
 Centre for advanced nursing practice model 2000
 Diffusion of innovation theory 1995
 Evidence based multidisciplinary practice model 1999
 Iowa model of research in practice 2001
 John Hopkins nursing EBP model 2005
 Ottowa model of research use 1998
 Stelter model of research utilization 2001
 IOWA MODEL

Successfully implanted since 1994 intervention ally. Infuses

research into practice to improve quality of care.
Planned change principles integrated research and practice.
Utilizes a multidisciplinary team approach.

Highlights of the models :-

1.it incorporates the use of research and other forms of
evidence.
2.Interference to support research use might involve every
level of the organization.
3.Evidence based practice is linked to quality assurance.
4. Staff are given recognition for research work.
5.Clinicians are given time and resources for research work.
6.This model explains how organizations changes practice
based on research.
7.It gives a systemic design.
8.It includes both the practitioner and organizational
perceptive.
9.It provides guide for regarding implementation of evidence
based practice.

lOWA MODEL BARRIERS TO USING RESEARCH IN NURSING

 Problem Focused Triggers
 Risk management data process improvement data
internal/external bench making data
 Financial data and identification of clinical problem
  Knowledge Focused Triggers
 New research or other literature national agencies
guidelines standard philosophies of care.
 Questions from institutional standard committees

STELTER MODEL
It was developed as practitioner-oriented model in 1994.
It was revised in 2001 without changes in its focus on critical
thinking.
It raised awareness about the importance of applying research
finding in nursing practice.
Meaning of evidence as per stelter model: -
Evidence is defined as information or facts that are obtained
systematically evidence comes from two different sources
1. External evidence
 Derived from opinions of concepts.
 Comes from the experts own experiences.
2. Internal evidence
 It comes from systematically obtain facts or information at
ground level.
 Phase 1
preparation

Phase 5 Phase 2
evaluation Validation

phase 3
phase 4
comparative
Translation
evaluation
application
decision making

NEED FOR EBP

 For making sure that each client gets the best possible
services.
 Update knowledge and is essential for lifelong learning.
 Provide clinical judgment.
 Improvement care provided and save lives
 To provide framework for understanding the evidence
 based practice process.

BARRIERS TO EBP
 Lack of value for research in practice.
 Difficulty in bringing change.
 Lack of administrative support
 Lack of knowledge.
 Lack of time for research.
  Many nurses have not received any formal instruction in
research and they lack skill to judge the merits of study.
 Unavailability of research reports, which are not easily
gathered.
 Complexity of the research regarding evidence-based
practice.
 Organization have failed to motivate or rewards.
 There is a shortage of role models nurse who can be
evaluated for their success in using or promoting the use of
research in clinical practice.

ADVANTAGES OF EBP

 Information explores
 Provide better patient outcomes.
 Ebp increases the efficiency of nurses.
 Making decision based on knowledge that is backed by
research.
 It keeps nursing practice current to the new trends and
updated guidelines of care.
 It provides variations in practice because it can help
determine high quality cast effective intervention that
actually work.
 It promotes high quality and cost-effective intervention and
treatment.
 Using EBP to provide care to patients increases the nurse’s
confidence.

Summary
Evidence-based practice is a conscientious, problem-solving
approach to clinical practice that incorporates the best evidence
from well-designed studies, patient values and preferences, and
a clinician's expertise in making decisions about a patient's care.
Unfortunately, no standard formula exists for how much these
factors should be weighed in the clinical decision-making
process. However, there are a variety of rating systems and
hierarchies of evidence that grade the strength or quality of
evidence generated from a research study or report. Being
knowledgeable about evidence-based practice and levels of
evidence is important to every clinician as clinicians need to be
confident about how much emphasis they should place on a
study, report, practice alert or clinical practice guideline when
making decisions about a patient's care.

REFERENCES
Brae Kour Navdeep; HC Rawat, textbook of advance nursing
practice first edition. Jaypee publisher; page no 533-541.

Basheer. P, shabeerkhan. Yasmeen S. A concise textbook of

advanced nursing practice first edition; EM-ESS medical
publisher; page no.751-757.

Polit. F. Denise ; back tatano cheryl nursing research;

generating and assessing evidence for nursing practice; tenth
edition, wolters kumars publisher page no 30-41.