Implementing Evidence B

ased Practice in ICU

DongOak Debbie Kim, RN, PhD,

Associate Professor, Daejeon
University, Korea
2010. 10. 05 7th. WFCCN, Manila
Basic concept Paradigm shift in
of 21st. C health care services
& edu.
Evidence
Based
Quality
Cost-effective
Improvement of
Nursing
Nursing services
Definition of EBP

 Integration of the best research evid

ence with clinical expertise and pati
ent values (Sackett , 1996)
Definition of EBP
 A process of shared decision making
between practitioner, patient & others
significant to them based on research
evidence, the pt’s experiences & pref
erences, clinical expertise or know-h
ow, & other available robust sources
of information. (Rycroft-Malone et al,
2004; Sackett et al, 2000)
EBP Model
(Satterfield, J.M., et al., 2009)

Environment &
Organizational
context
Decision Making
Components of EBP
 The most relevant evidence to answer a c
linical question
 Clinical expertise
 Patient’s preferences & values
But!!! Implementation be considered in the
context of available resources, organizati
onal policies, & priorities
Cf. Research utilization: The use of knowled
ge typically based on a single study, doe
s not take into account clinical expertise
or pt’s preference/values
Steps of EBP :
Identifying/ Appraising/ Synthesizing

1. Ask : utilize PICO format

2. Acquire : search evidence
3. Appraise : critical appraisal for the validi
ty, relevance, applicability of evidence
4. Apply : Integration of the results of syst
ematic reviews with clinical expertise &
pt’s preferences/values
5. Assess : evaluation for the effectiveness
of results/application
Steps of EBP

Clinical Searching evidences

questions

Application to Practice Critical appraisal

(Demonstration)

Evaluating the Changing &

effectiveness of results disseminating
PICO

 Formulation of the clinical issue into

a searchable and answerable questi
on
– P : Patient population, Problem
– I : Intervention or Interest
– C : Comparison with other treatment, if
applicable
– O : Outcome
 Hierarchy of Evidence

Strong

Weak

Pyramid from: Evidence-Based Practice Tools Summary. University of Washington,

Health Sciences Library
Influencing factors to imple
ment EBP

 Evidence dimension
 Nurse dimension
 Organizational dimension
Process of Implementing E
BP
Change in an
Organization

To
succeed
in implementing EBP
 strong evidence itself can’t lead EBP
 establish strategies considered influencing
factors; evidence, nurse, organization
require multidimensional complex action
Strategies for evidence
 the evidence
– has high priority & consensus among experts
– is strong enough & congruent with pt’s needs
& organizational policies
 the guidelines
– have to be developed multidisciplinary
– are clearly described
– have specific recommendations & user conve
nience.
Strategies for nurse
1. Education & training
 To improve knowledge, skill, attitude & s
elf-confidence about EBP
 Content : 5 EBN competencies (Strauss
et al., 2005)
 describing clinical questions
 searching evidences
 critical appraisal
 integrating the evidences in clinical decision
making,
 evaluating the outcomes.
 Methods
 workshop : interactive education is effective
 Staff nurse internship
Strategies for nurse
2. Mentoring
 Support to learn new knowledge & skill
 Counsel & Support for the process of re
ading research results & translating them
to practice
 During implementing
 Support the fear & skepticism to change
 Solve misconceptions (eg. EBN needs lots o
f time)
 Overcome the resistance against practice ch
ange
Strategies for nurse

3. Encourage to participate in various

projects related to EBP
– Conference…
Strategies for Organizationa
l dimension
Establishing
EBN Culture

Audit & Leadership

Evaluation
Organizational
strategies

Preparing Change
Resources Agent
Establishing EBN Culture
 Organizational mission & vision supporting
EBN
 Evidence-based decision making on every
policy & procedure, & nurse executive’s ad
ministrative decision
 Create clinical inquiry culture
 Operate journal club
 Encourage presentation & publication of re
search
 Sacred cow searching competition
Leadership
 Strong and supportive leadership
 Leader’s participation in whole process of d
eveloping & implementing EBN strategies
 Encourage nurses to share and practice th
e vision
 Support the change agents & responsible p
erson for project
 Develop the EBN model of nursing departm
ent
Leadership -cont’d
-
 Integrate EBN guideline/protocol with
organizational policy & procedure
 Connect EBN to Quality Improvement
activities
 Identify barriers to implementing EBN
& set up the strategies reducing them
 Develop the ownership in whole level
of organization
 …etc.
Change agent, champion
 Roles :
– Facilitate for apply EBN
– Influence to build up EBN culture in unit
– Mentoring to nurses
– Educational outreach visit
 Selection : nursing department, unit
 Developing competencies for change age
nts, opinion leaders, & core groups
Resources

 Administrator has to allocate approp

riate resources for EBN : human res
ources, time, finance, facilities
 Establish EBN communication syste
m
Audit & Evaluation
 Audit
– Utilized as instrument for implement gui
deline recommendations to practice
– Focusing on measuring compliance of
the guideline
– providing productive feedback
– Include the process, outcomes, and ev
aluation plan for continuance of chang
e
Conclusion

 As activating and anchoring the EBP

successfully in icu is the complex pro
cess required organizational changes,
various strategies in terms of evidenc
e, nurse, and organizational dimensio
n are required.
To conduct EBN change is c
hallengeable, but highly com
pensated work.

“Never, never, never, never,

never, never quit”
- Winston Churchill -