Foundations in Evidence Based PracticeB71P02

Session Outcomes

At the end of this session you will be able to:

Define Evidence Based Practice Identify reasons for Promoting

Evidence Based Practice Identify nursing practice that might

benefit from the use of evidence Appreciate different forms of

evidence

Definitions of EBPSackett et al (1996) define EBP as ‘ the conscientious, explicit and judicious use of current best evidence in making nursing decisions about the care of individual patients’

Carnwell defines EBP as ‘[the] systematic search for, and appraisal of, best evidence in order to make clinical decisions that might require changes in current practice, while taking into account the individual needs of the patient.’

She adds:‘Best evidence might be defined as that which is valid and relevant to the patient.’ (Carnwell, 2001)

Definitions of EBP

‘Clinical decisions should […] be informed by up-to-date, relevant and robust evidence rather than outdated primary training or over interpretation of individual patient experiences (Donald & Greenhalgh, 2000; Sackett et al, 2000)

Use of best evidence is thus important.

Relevance of EBP to nursing practice

What areas of nursing practice might we want to ask EBP questions about? Discuss this with a partner.

Relevance of EBP to nursing practiceYou might ask questions about a range of categories of practice:1. Assessment – how to properly gather and interpret findings?2. Causes of the problem – how to identify them?3. Deciding what the problem is – where the symptoms/signs indicate a

range of possible problems how do you decide which is most likely? 4. How to select and interpret tests used to identify problems and to

monitor patient progress?5. How to estimate the likely clinical progression of a condition/illness

and any likely complications?6. How to select interventions that do more good than harm and that are

worth the effort and cost of doing them?7. How to reduce the chance of the problem reoccurring or how to

promote health?8. How to keep up to date; improve your skills; and run a more

effective/efficient nursing team?9. How best to understand the perceptions of individuals and groups e.g.

service users and carers

Adapted from Sackett et al (1997) (http://www.mdx.ac.uk/www/rctsh/ebp/question.htm - Accessed 22/11/07)

With a partner make a list of reasons why we should use evidence to underpin nursing care

Why is best evidence and evidence based nursing important?

Ensures patient/clients receive the care that fits their needs

Facilitates sound decision making and makes it more explicit

Minimises risk to the patient/client so that benefits outweigh harm

Provides the nurse with the skills and knowledge to evaluate healthcare literature and practice

Exposes gaps in knowledge and conflicts in evidence

What is Evidence?

In the context of evidence based practice this is research published in professional and academic journals and systematic reviews of research found in databases of evidence (such as Cochrane).

‘ Knowledge derived from a variety of sources that has been found to be credible’ (Higgs & Jones 2000)

Evidence Classified by Level:

At least one systematic review of multiple, well designed randomised controlled trials (RCT’s)

At least one properly designed RCT of appropriate size

Well designed trials without randomisation, single group pre-post, cohort, or matched case controlled studies

Well designed, non-experimental studies from more than one centre or research group

Opinions of respected authorities, based on clinical evidence, descriptive studies or reports of expert committees

(Source: Muir Gray, 1997)

Other Forms of Evidence

Evidence based on experiences (professional or personal)

Evidence gathered from patients/clients and/or carers.

Evidence based theory that is not research based.Le May (1999) ‘Evidence-based practice’

Nursing Times, Monographs, 1;2.

What EBP is not

EBP is not cook-book practice evidence needs extrapolation to the

patient’s unique biology and values EBP is not cost-cutting practice

when efficacy for the patient is paramount, costs may rise, not fall

The Evidence Quiz

1. Evidence is important to nurses because:

a) It minimises the risks to patientsb) You don’t need to think about your

actions anymore because the evidence does that for you

c) It ensure that patients receive care based on robust research

d) It ensures that research journals stay in business

The Evidence Quiz

2. Evidence may help to answer questions about:

a) Methods of nursing assessmentb) What time the evening meal arrives on

the wardc) Whether it is tasteful for Mr James to

wear a thong on a mixed sex wardd) How to select interventions that do

more good than harm

The Evidence Quiz

3. Robust Evidence may be obtained from:

a) Googleb) Heat magazinec) The Cochrane libraryd) Wikipediae) CINAHLf) Nursing Times

The Evidence Quiz

4. The strongest forms of evidence may be obtained from:

a) The Times newspaperb) Systematic Reviewsc) The bloke at the chippyd) Randomised Controlled Trials (RCT’s)

References Carnwell, R. (2001) ‘Essential differences between research and

evidence-based practice’, Nurse Researcher, Vol.8, No.2, pp.55-68. DoH (1997) The New NHS: Modern, Dependable, London, The

Stationary Office. DoH (1999) Making a Difference: Strengthening the nursing,

midwifery and health visiting contribution to health and healthcare, London, Department of Health.

Donald, A. and Greenhalgh, T. (2000) A Hands-on Guide to Evidence Based Healthcare: Practice and Implementation, Blackwell Science, Oxford.

Le May, A. (1999) Evidence-base practice, London, Nursing Times Books.

Muir Gray, J.A. (1997) Evidence-based Health Care. How to make Health Policy and Management Decisions, Edinburgh, Churchill Livingstone.

Sackett, D.L., Rosenberg, W.M., Gray, J.A., Haynes, R.B. and Richardson, W.S. (1996) ‘Evidence based medicine: What it is and what it isn’t’, British Medical Journal, 312, 7023, pp. 71-72.

Sackett, D.L., Strauss, S.E., Richardson, W.S., Rosenberg, W. and Haynes, R.B. (2000) Evidence Based Medicine: How to Practice and Teach EBM, 2nd edn, Edinburgh, Churchill Livingstone.