Evidence-Based Practice in Nursing
Define: Evidence-based practice - ANS-Systematic approach to rational decision making that
facilitates achievement of best practices
Six steps to EBP - ANS-1. Ask a clinical question
2. Collect the most relevant and best evidence
3. Critically appraise the evidence you gather
4. Integrate all evidence with one's clinical expertise and patient preferences and values in
making a practice decision or change
5. Evaluate
6. Share outcomes of EBP changes with others
Ask a clinical question - ANS-• A problem or area of interest that could be performed more
efficiently, consumes healthcare dollars, or does not make sense
• A knowledge focused trigger
• Clinical trends
• Utilization of PICOT format to state your clinical question
Why should I use PICOT format to state my clinical question? - ANS-• The questions you ask
will eventually lead you to the evidence for an answer
• You want to be able to read the BEST four-to-six articles that specifically address your practice
question
• The more focused a question you ask, the easier it becomes to search for evidence in the
scientific literature
PICOT question - ANS-*P* = Patient population of interest
*I* = Intervention of interest
*C* = Comparison of interest
*O* = Outcome
*T* = Time
Collect the best evidence- what kind and includes - ANS-• Search for evidence!
• *Evidence includes but is not limited to*: agency policy and procedure manuals, quality
improvement data, existing clinical practice guidelines, agency experts, staff educators, risk
managers, infection control nurses, and peer reviewed articles (specifically within the most
recent 5 years from the present date)
Critically appraise the evidence you gather - ANS-• The most difficult step in the EBP process
• Involves evaluation, determining if information is valuable and can be easily applied, and if
there is enough evidence for making a nursing practice change
• Thorough review of elements included in evidence-based articles
,Integrate the evidence - ANS-• How will you incorporate the evidence into practice?
• Integrate evidence with use of teaching tools, clinical practice guidelines, policies and
procedures, and new assessment documentation tools
• Consider staff support and available resources
• Conduct a pilot study and attempt to answer your PICOT question
Evaluate and share outcomes - ANS-• Did it work? Is it effective?
• Communicate the results to various groups of nurses or other care providers (facility nursing
practice council or research committee)
PICO four-step process - ANS-*P* - population of interest
*I* - intervention
*C* - comparison
*O* - outcome
Utilization of the research process - ANS-• Identification of a researchable problem
• Review of the literature
• Formulation of the research question or hypothesis
• Design of the study
• Implementation of the study
• Drawing conclusions based on findings
• Discussion of clinical implications
• Dissemination of findings
Identification of a researchable problem - ANS-• Sources:
* clinical situations
* the literature
* theories
• Repeat the study or design a similar one
• Test theoretical models
Review of the literature - ANS-• Comprehensive and covers all relevant research
• Essential to locate similar or related studies that have already been completed and on which a
new study can build
• Answer the question "what have other researchers and theorists written about this problem?"
Two major categories in designing study - ANS-*experimental* (require quantitative
methodology)
*nonexperimental* (can be quantitative or qualitative methodology)
Implementation of the study involves two main task: - ANS-*Data collection* (collected by those
familiar with the study)
*Data analysis* (arrange information into meaningful patterns
, Drawing conclusions based on findings, Answer the question: - ANS-"What do these findings
mean?"
Discussion of clinical implications - ANS-• Suggest actions that can be taken as a result of the
research findings in the future
• Other questions to answer: Will the procedure be effective with patients who have a different
diagnosis? • Will age make a difference? What else do we need to know to improve the care of
patients?
• Also known as the rigor (potential threats to the validity and reliability of the study)
Dissemination of findings two major vehicles: - ANS-• Articles published in professional journals
• Presentations given at conferences
Nursing student role in research - ANS-Learning about research: doing honors projects or
assisting in labs
BSN role in research - ANS-Identifies problems that can be studied; may do data collection for
research studies
MSN role in research - ANS-Replicates earlier research; beginning independent research
Doctorate role in research - ANS-Generate and test theory; establish independent research
career
Academician role in research - ANS-Independent research with external funding (e.g., NIH,
foundation grants)
After formulation of the research question or hypothesis, the next step in the research process is
to:
A. Select the population
B. Review the literature
C. Design the study protocol
D. Discussion and/or clinical implications - ANS-*C. Design the study protocol*
After formulation of the research question or hypothesis, the next step in the research process is
to design the study. The study design will influence the data collection process. Selecting the
population is a component of this phase of the research process. Obtaining necessary
approvals is part of conducting the study, which follows the design phase in the research
process. Identification of the instrument to use for data analysis occurs during the process of
designing the study protocol. This step would occur during the study design phase of the
research process after the problem identification and literature review has taken place.
Research is the same as problem solving. T or F - ANS-*False*
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