1. Evidence-based Practice What Does it Mean for Nursing?
Nancy Wells
Vanderbilt Medical Center
October, 2007

2. What is evidence-based practice?

3. Evidence-based Practice
Process by which clinical decisions are made using:
Best available research evidence
Clinical expertise
Patient preference

4. Historical Perspective
Variation in practice leads to:
Variable quality of care
Higher cost of care
Potential for errors that may cause harm

5. Translating research into practice

6. Skills Required for EBP
Clearly identify practice problem or new knowledge ( innovation)
Find research literature
Critically evaluate research findings
Apply to practice through change process

7. Identifying Practice Problem
Why are we doing this?
Why are we doing it this way?
Can we produce better outcomes with greater consistency?

8. Clinical practice problems in your setting?

9. Critically Evaluating Research
Literature review
Integrative literature review
Systematic literature review
Meta-analysis

10. Strength of the Evidence
Level I – systematic review, met-analysis, well-designed RCTs
Level VII - opinion

11. Resources for Reviews Nursing journals Clinical work station sites
Up-to-date
Zynx
Eskind Digital Library
Cochrane Reviews

12. Clinical Practice Guidelines
Agency for Healthcare Research & Quality (AHRQ)
Early examples
Skin integrity
Acute pain guideline
Urinary incontinence

13. AHRQ Evidence-based Reports
Examples of reports available
Cancer symptom management (2002)
Coronary heart disease in women, systematic review (2003)
Mechanical ventilator criteria for weaning (2000)
Wound healing, laser treatment and vitamin-assisted closure (2004)

14. Evidence-based Nursing Practice
AHRQ clinical nursing practice guidelines
To be released in December
Joanna Briggs Institute (JBI)
JBI Connect
National Guideline Clearinghouse
Guidelines.gov

15. Application to Practice
Does the research apply to my patient population?
Would this practice change improve process of care? Patient outcomes?
Is there support for this practice change?

16. EBP Models CURN project  Research utilization
Review, synthesis, application, evaluation
Stettler Model of Research Utilization
Critical thinking & decision making
Iowa Model of Research in Practice
Quality assurance meets research utilization

17. Planned Change Assess current practice (processes and outcomes)
Identify and implement changes to modify processes
Evaluate effects on processes and/or outcomes

18. Evaluation
Processes of care
Outcomes of care

19. Documentation of Groin Sites
Investigators: Stacy Sherrard, Grace Vincente & Felicia Lowe
1 month trial of education and coaching to improve documentation of groin sites post-catheterization

20. Groin Site Documentation

21. Summary Reduce variations in practice
Improve the quality of care provided
Maintain or improve patient outcomes