Nursing role and scope

Evidence-Based Practice:

What Is It?

• Evidence-based practice (EBP) is a

framework used by nurses and other

healthcare professionals to deliver optimal

health care through the integration of best

current evidence, clinical expertise, and

patient/family values

Why Is EBP Relevant in Nursing? (1 of 2)

• Helps resolve problems in the clinical setting

• Results in effective patient care and better


• Contributes to the science of nursing through

the introduction of innovation to practice

• Keeps practice current and relevant by helping

nurses deliver care based upon current best


Why Is EBP Relevant in Nursing? (2 of 2)

• Decreases variations in nursing care and

increases confidence in decision making

• Supports Joint Commission on Accreditation

of Healthcare Organizations (JCAHO)-

readiness since policies and procedures are

current and include the latest research

• Supports high quality patient care and

achievement of Magnet status

Steps in the EBP Process (1 of 2)

• Cultivate a spirit of inquiry and culture of EBP

among nurses and within the organization

• Identify an issue and ask the question

• Search for and collect the most relevant and

best evidence to answer the clinical question

Steps in the EBP Process (2 of 2)

• Critically appraise the evidence and synthesize

the evidence

• Integrate evidence with clinical expertise and

patient preferences to make the best clinical


• Evaluate the outcome of any EBP change

• Disseminate the outcomes of the change

Barriers to EBP in Nursing (1 of 3)

• Lack of value for research in practice

• Difficulty in changing practice

• Lack of administrative support

• Lack of knowledgeable mentors

• Insufficient time

• Lack of education about the research process

• Lack of awareness about research or EBP

Barriers to EBP in Nursing (2 of 3)

• Research reports/articles not readily available

• Difficulty accessing research reports and articles

• No time on the job to read research

• Complexity of research reports

• Lack of knowledge about EBP

• Lack of knowledge about the critique of articles

Barriers to EBP in Nursing (3 of 3)

• Feeling overwhelmed by the process

• Lack of sense of control over practice

• Lack of confidence to implement change

• Lack of leadership, motivation, vision,

strategy, or direction among managers

Promoting EBP: Individual Nurse

• Educate yourself about EBP

• Conduct face-to-face or online journal clubs,

share new research reports and guidelines with

peers, and provide support to other nurses

• Share your results through posters, newsletters,

unit meetings, or a published article

• Adopt a reflective and inquiring approach to


Strategies to Promote EBP:


• Specific identification of the facilitators and

barriers to EBP

• Education and training to improve

knowledge and strengthen beliefs related to

the benefits of EBP

• Creation of an environment that encourages

an inquisitive approach to patient care


• P: Patient, population, or problem

• I: Intervention, exposure, or topic of


• C: Comparison or alternate intervention

• O: Outcome

• (T): Time or timeframe

PICO(T) Questions

• In (patient or population), what is the effect

of (intervention or exposure) on (outcome)

compared with (comparison or alternate


• For (patient or population), does the

introduction of (intervention or exposure)

reduce the risk of (outcome) compared with

(comparison or alternate intervention)?

Electronic Resources

• National Library of Medicine

• Cochrane Library

• National Guideline Clearinghouse

• Joanna Briggs Institute

• Agency for Healthcare Research and Quality

• Centre for Health Evidence

• Registered Nurses’ Association of Ontario

Evaluation of Evidence

• What is the source of the information?

• When was it developed?

• How was it developed?

• Does it fit the current clinical environment?

• Does it fit the current situation?

Levels of Evidence

• Meta-analysis or systematic reviews of multiple well-

designed controlled studies

• Well-designed randomized controlled trials

• Well-designed nonrandomized controlled trials

• Observational studies with controls

• Systematic review of descriptive and qualitative studies

• Single descriptive or qualitative study

• Opinions of authorities and/or reports of expert


Appraisal of Research Using the

Critical Appraisal Skills Programme


• Checklists provide tools to interpret

research evidence

• Checklists are specific to types of research

• Checklists provide frameworks to determine

strength and reliability of research reports

Institute of Medicine (IOM)

Standards for Clinical Practice

Guideline Development • STANDARD 1: Establishing

• STANDARD 2: Management of conflict of interest

• STANDARD 3: Guideline development group composition

• STANDARD 4: Use of systematic reviews

• STANDARD 5: Establishing evidence and strength of


• STANDARD 6: Articulation of recommendations

• STANDARD 7: External review

• STANDARD 8: Updating

Appraisal of Guidelines for Research and

Evaluation (AGREE II)

• Scope and purpose

• Stakeholder involvement

• Rigor of development

• Clarity and presentation

• Application

• Editorial independence

AGREE II Category #1

• Scope and purpose

– Overall objectives of the guideline are

specifically described

– The health questions covered by the guideline

are specifically described

– The population to whom the guideline is meant

to apply are specifically described

AGREE II Category #2

• Stakeholder involvement

– Guideline development group includes

individuals from all relevant professions

– The views and preferences of the target

population have been sought

– Target users of the guideline are clearly defined

AGREE II Category #3 (1 of 2)

• Rigor of development

– Systematic methods were used to search for


– The criteria for selecting the evidence are clearly


– The strengths and limitations of the body of

evidence are clearly described

– The methods used for formulating the

recommendations are clearly described

AGREE II Category #3 (2 of 2)

• Rigor of development (cont.)

– The health benefits, side effects, and risks have

been considered in formulating recommendations

– There is an explicit link between the

recommendations and the supporting evidence

– The guideline has been externally reviewed by

experts prior to publication

– A procedure for updating the guideline is provided

AGREE II Category #4

• Clarity and presentation

– Recommendations are specific and


– Different options for management of the

condition or health issue are clearly presented

– Key recommendations are easily identifiable

AGREE II Category #5

• Application

– The guideline describes facilitators and barriers to

its application

– The guideline provides advice and/or tools on how

the recommendations can be put into practice

– The potential resource implications of applying the

recommendations have been considered

– Guideline presents monitoring and/or auditing


AGREE II Category #6

• Editorial independence

– The views of the funding body have not

influenced the content of the guideline

– Competing interests of guideline development

group members have been recorded and


Implementation Models for EBP

• Center for Advancing Clinical Evidence (ACE)

Star Model of Knowledge Transformation

• The Iowa Model of Evidence-Based Practice

• Agency for Healthcare Research and Quality


• Johns Hopkins Nursing Evidence-Based Practice


• Diffusion of Innovation Framework