Discuss evidence based practice

Swamped with your writing assignments? We'll take the academic weight off your shoulders. We complete all our papers from scratch. You can get a plagiarism report upon request just to confirm.

Order a Similar Paper Order a Different Paper

 Please discuss how you can link evidence based nursing practice and patient centered care based on patient preferences? 

NRG 5005 Evidence-based Practice for Advanced Practice Nurses

Pulling It All Together

Evidence-Based Practice

How do you know that your practice

is a “best practice” (that it is safe

and efficient) and that you get the

best outcomes possible?”

Evidence-based Clinical Decision Making

What works best, for whom,

and under what circumstances?

Research utilization is using knowledge gained from a research study.

Evidence-based practice is a synthesis of evidence from multiple studies

Barriers to Research Utilization

Typical source of information: colleague

58% had never used research articles to support clinical practice

18% had never used a library

Pravikoff, D.S., Tanner, A.B., & Pierce, S.T. (2005). Readiness of US nurses for evidence-based practice. American Journal of Nursing, 105(9), 40-51.

Barriers to Research Utilization

Perceived value of research

Resistant to change

Lack of time and resources

Communication gap between researchers and clinicians

Organizational culture

Inability to evaluate research

Sources of Evidence

Sources of information informing practice currently:



Trial and error

Personal experience


Borrowed evidence

Scientific research

Why are vital signs taken routinely every four hours on patients who are clinically stable?

Result of trial and error:

Settling on one approach that is more often than not effective

Personal experiences:

Frequently based on tradition, authority, and trial and error

What is Evidence-based Practice?

Evidence-based Practice

“The conscientious, explicit, and judicious use of theory-derived, research-based, information in making decisions about care delivery… in consideration of individual [patient] needs and preferences.”

Ingersoll, G.L. (2000). Evidence-based nursing: What it is and what it isn’t. Nursing Outlook, 48, 151-152.

Evidence-based Clinical Decision Making

Uses evidence from:


Clinical judgment (the ability to think about, understand, and use research evidence; the ability to assess a patient’s condition through history, examination, and lab reports)

Opinion leaders

Expert panels

Clinical expertise (evidence from outcomes management, quality improvement projects)

Patient preferences and values

Evidence-based Practice

The examination and application of research findings or other reliable evidence

Use of critical thinking skills to review research publications and other sources of information

Assessment of patient needs, culture, and preferences

Use of clinical decision-making skills to apply evidence to patient care


Dr. Archie Cochrane (British epidemiologist) in 1971:

individuals should pay only for health care based on scientific evidence

Rigorous, systematic research should inform practice and policy development

Cochrane Center established (http://www.cochrane.org/)


During this time, nursing involved in applying research findings to practice (research utilization).

By 2000, realization that practice should not be changed from one study, and clinical judgment involved as well as patient preferences.

Using EBP as an
Advanced Practice Nurse

Assessing patients

Deciding when to change practice

Evaluating patient outcomes

Using EBP as an Advanced Practice Nurse

Use rates to assess patient needs

Compare the prevalence of disease with larger populations (state, national) to detect issues within the community

Use rates to determine causes of disease within the community and to target interventions to those who need them the most

Assessing Patients

Your patient population has Lyme’s disease at a rate of 0.06 per 1,000. If the county’s rate is 0.003 per 1,000 and the state’s rate is 0.059 per 1,000, does your patient population have a problem with Lyme’s disease?

Assessing Patients

Your patient population has respiratory disease at a rate of 0.067 per 1,000. Is this a concern if the county rate is 0.080 per 1,000 and the state rate is 0.053 per 1,000?

Assessing Patients

Your patient population has diabetes mellitus at a rate of 0.04 per 10,000 people. Are you concerned, given that the state rate is 0.06 and the national rate is 0.05?

Assessing Patients

Use the evidence pyramid to determine strength of evidence

Analyze existing evidence for credibility

Analyze relevance for your group of patients

Analyze the strength of the collective group of studies

Determine next steps

Evidence is not strong enough to support change in practice

Evidence shows promise but more research needed

Evidence is strong enough to support change in practice

Deciding When to Change Practice

You want to develop a protocol using a new hypothermia blanket for patients pre and post surgery. You search the literature and find 4 studies that support the use of the new hypothermia blanket to increase patient satisfaction, reduce nausea and vomiting, and reducing the pain medication required after in the recovery room. Two of the studies are correlational studies, one is a descriptive study, and one is a quasi-experimental study conducted on 40 patients. The quasi-experimental study was conducted by the manufacturer of the hypothermia blanket. How strong is the evidence of the outcomes of using the new blanket?

Deciding When to Change Practice

Is the evidence credible?

Is the evidence relevant?

How strong is the evidence?

Determine next steps

Is the evidence strong enough to support change in practice?

Does the evidence show promise but more research is needed?

Deciding When to Change Practice

Measuring Patient Outcomes

The success of evidence-based changes must be measured in patient outcomes

Evaluating Patient Outcomes

Patient Outcomes are the focus of evidence-based practice!

Patient Outcomes

Measure how well current policies and practices are working

Focus on groups of patients, not individual patients

Indicate need for change

Indicate feasibility of policies and practices

Patient Outcomes

Medical outcomes measures

Quality of care

Patient-centered care

Other outcome measures

Efficiency of processes

Environmental changes

Professional expertise

Patient Outcomes Include…

Are quantifiable and community-focused or organization-focused

Used to evaluate changes in clinical practice and establish new policies or guidelines

Examples: health status, disability, iatrogenic effects of treatment, health behaviors, & economic impact of therapy and illness management

Medical Outcomes

Measures the effectiveness of symptoms management

Examples: pain, fatigue, nausea & vomiting, sleep disturbances, appetite changes, depression

Quality of Care

Measures how well the patient is viewed as an equal partner in health care.

Examples: adequate communication with patients, unhurried interactions, participation in decision-making, education regarding illness, consideration of culture and beliefs, respect, empathy patience, and caring attitude.

Patient-centered Care

Measures how well care is delivered efficiently and effectively

Examples: appropriate timing of interventions, effective discharge planning, efficient use of hospital beds

Efficiency of Processes

Measures the degree to which there is a culture of EBP throughout the organization

Examples: evaluation of policy, policy adherence, resource availability, supplies and materials necessary for EBP

Environmental Changes

Measures the ability of providers to meet accepted standards of care essential for best practice.

Examples: knowledge and competence with EBP, ability to measure patient outcomes, commitment to guide practice based on most up-to-date evidence and patient outcomes

Professional Expertise

Changing Practice Based on

Empirical Research

General Process of Changing Practice based on Empirical Research

Select a topic

Problem focused

Knowledge focused

Evidence retrieval

Types of reviews

Appraisal of strength and level of evidence

Synthesis of research

Decide whether to change practice

Selection of Topic


recurring clinical problems

discrepancies in procedures

quality improvement


new information

new equipment, drugs or treatments

Sources of Evidence

Preferred sources of evidence:

Primary sources

Peer reviewed sources

Journals (not magazines)

Integrated reviews


Systematic reviews

Popular vs Scholarly Sources

Popular vs. Scholarly Sources

Does the Study Provide Good Evidence?

Five Step Approach

Ask (Identify the research question. Determine if the question is well constructed to elicit a response or solution.)

Acquire (Search the literature for pre-appraised evidence or research. Secure that best evidence that is available.)

Appraise (Conduct a critical appraisal of the literature and studies. Evaluate for validity and determine the applicability in practice.)

Apply (Institute recommendations and findings and apply them to nursing practice.) (Evaluate the application of the findings, outcomes, and relevance to nursing practice.)

Judging Credible Sources

Is it absolutely clear which company or organization is responsible for the information on the site?

Is there a link to a page describing what the company or organization does and the people who are involved (an “About Us” page)?

Is there a valid way of making sure the company or organization is legit – meaning, is this a real place that has real contact information (email only is not enough)?

Judging Credible Sources

Can I easily figure out who wrote the information?

Are all factual claims clearly substantiated, that is, are there cited (linked) sources?

Are there any glaring grammatical and spelling errors? This could indicate that the content is not credible.

How long ago was the page updated? Is there a date stamp on the article somewhere? You’ll need this especially if you’re using MLA-style citation.

Can you verify the expertise of the author? Are the writer’s qualifications clearly stated somewhere on the site?

Judging Credible Sources

Is there an overwhelming bias in the information? Does the writing seem fair and balanced? Or is the writing overly slanted towards a particular point of view?

Is the URL appropriate to the content? You should be able to figure out from the site address who the site belongs to, since most organizations and businesses put their name in the URL. This is a good way to determine quickly if the site is legit for your purposes; for example, if you’re researching mad cow disease you probably don’t want to get information from the Beef Farmers of America.

Are the ads clearly separated from the content?

Which of the following are credible web sites?


New York Times online


Society of Thoracic Surgeons

ObamaCare 101

Americans for Tax Reform

RN Journal

Sources of Evidence

Electronic indices

Used to be called index, now called databases

Examples: Cumulative Index to Nursing and Allied Health Literature (CINAHL)

OVID (physician)

Pub Med (US National Library of Medicine)




Thomson Gale

EBN Online (

Cochrane Collaboration and Library (http://www.cochrane

Sources of Evidence

Electronic indices (cont.):

TRIP database (Centre for Evidence-based Medicine)

Virginia Henderson International Nursing Library (STTI)

Evidence-based Practice (AHRQ)

National Guidelines Clearinghouse (

National Institute of Nursing Research (NINH)

EMBASE (pharmaceutical and biomedical)

Clinical Trials.gov (

American Factfinder (

PsycINFO (http://www.apa.org/psyinfo/)

Sources of Evidence

Electronic indices (cont.):

ERIC (Educational Resources Information Center) (http//www.eric.ed.gov)

Sociological Abstracts (http:www.csa.com/factsheets/socioabs-set-c.php)

Social Services Abstracts

ABI/Inform (business database)

UMI Dissertation Publishing (http:www.il.proquest.com/products_umi/dissertations)

Google Scholar (http://scholar.google.com/)

Sources of Evidence

Grey literature

Unpublished reports

Unpublished conference papers

Grant proposals


Electronic Sources

Synthesis of Evidence

Scientific merit of studies

Subjects studied

Relevance of study to research question

Strength of evidence



Significance of results

Levels of Evidence



Case Control


Non-experimental Studies

Case Series


Case Reports

Expert Opinion

Make a Decision of Whether
to Change Practice

Relevance of evidence for practice

Consistency of findings across studies and/or guidelines

Representativeness of the sample to your patient population

Consistency among research evidence and non-research evidence

Feasibility for use in practice

Risk/benefit ratio for the patient

Exercise: Judging Strength of Evidence

National Guidelines Clearinghouse

Models Used for Building an Evidence-based Culture in Organizations

Building Evidence-based Practice

Evidence-based practice shouldn’t

happen in isolation.

Steps of Evidence-based Practice

Cultivate a spirit of inquiry (clinicians must be comfortable with and excited about asking questions about patient care and institutional or unit-based practices)

Steps of Evidence-based Practice

2. Ask clinical questions in PICOT format

P = patient population

I = Intervention or Issue of interest

C = Comparison intervention or group

O = Outcome

T = Time frame

Steps of Evidence-based Practice

Example of PICOT question:

In teenagers (the patient population), how does cognitive-behavioral skills building (the experimental intervention) compared to yoga (comparison intervention) affect anxiety (the outcome) after 6 weeks of treatment (time frame)?

Steps of Evidence-based Practice

3. Search for best evidence (conduct a systematic, integrated review)

Steps of Evidence-based Practice

4. Critical appraisal of evidence

Are the results of the study valid? (Are the results as close to the truth as possible?)

What are the results? (Did the intervention work? How large was the treatment effect? Would replication of the study yield similar results?)

Will the results help me in caring for my patients? (Are the subjects in the studies similar to my patients? Are the benefits greater than the risks? It the treatment feasible? Does the patient desire the treatment?)

Steps of Evidence-based Practice

If the answer to # 4 is yes,

5. Integrate the evidence with clinical expertise and patient preferences to make the best clinical decision.

Steps of Evidence-based Practice

If the answer to # 4 is no,

5. Generate internal evidence through an EBP implementation or outcomes management project or a research study

Steps of Evidence-based Practice

6. Evaluate the outcomes of the practice change based on evidence (Measure patient outcomes or health care quality to determine if this clinical decision was effective.)

Steps of Evidence-based Practice

7. Disseminate the outcomes of the evidence-based practice change. (locally, regionally, nationally)

Barriers to Evidence-based Practice

Staff lack EBP knowledge and skills

Lack of belief that EBP will result in better outcomes than traditional care

Amount of information published

Lack of time to appraise evidence

Overwhelming patient loads

Barriers to Evidence-based Practice

6. Lack of administrative support

7. Peer pressure to “not make waves”

8. Resistance to change

9. Lack of autonomy over practice

10. Lack of consequences for not implementing EBP

Leading Organization-wide Change

Implementing Evidence in Clinical Settings

Develop a vision for change.

Start with small steps. Select a nursing intervention, conduct an intensive literature review, and build awareness among the nursing staff. Stress the need for a change in practice.

Implementing Evidence in Clinical Settings

2. Promote engagement in EBP

Engage key stakeholders. Assess current attitudes toward the practice in question. Have discussions about the issue. Determine who the decision makers are. Enlist staff with expertise in EBP. Gain administrative support for EBP initiative. Assess and eliminate barriers.

Implementing Evidence in Clinical Settings

3. Integrate evidence-based practice

Establish formal integration teams. Build excitement. Disseminate evidence. Show link between proposed change and patient outcomes. Develop clinical tools that are available to staff and easy to use. Pilot test the change, implementing complex change in stages. Establish goals and timelines. Celebrate success.

Implementing Evidence in Clinical Settings

4. Link evidence-based practice to clinical outcomes. Measure outcomes through:

outcome measures (healthcare results that can be measured such as health status, death, health behaviors, economic impact, disability)

Quality care improvement (quantify how interventions impact the quality of lives)

Patient-centered quality care (the patient is an equal partner in their own care)

Efficiency of processes (efficient utilization of resources)

Environmental changes (creation of a culture that promotes EBP)

Professional expertise (creates an expectation of professional competence)





We offer CUSTOM-WRITTEN, CONFIDENTIAL, ORIGINAL, and PRIVATE writing services. Kindly click on the ORDER NOW button to receive an A++ paper from our masters- and PhD writers.

Get a 10% discount on your order using the following coupon code SAVE10

Order a Similar Paper Order a Different Paper