1. Evidence-Based Nursing Practice
The Center for Nursing Research
Ochsner Medical Center
December 2015

2. Why were you assigned this lesson?
Multiple Ochsner facilities are renewing or pursuing initial Magnet designation from ANCC, and a commitment to increase nursing staff’s knowledge about evidence-based practice and research is a requirement for that designation.

3. How long will this lesson take?
This lesson addresses should only take you 10 minutes to complete.

4. Objectives
Following completion of the module, the nurse will be able to:
Define evidence-based nursing (EBN)
Provide examples of unit specific EBN influencing patient outcomes
Discuss the difference between research and EBN
Discuss the difference between performance improvement and research

5. Evidence-Based Nursing (EBN)
The four elements in the EBN process guide best practices to drive quality outcomes:
Best available scientific evidence- current scientific literature, data about patient outcomes, best practices from national sources
Nurses clinical expertise- expert opinion of nursing staff & expert clinicians, individual and collective experience of nurses
Patient/family preferences- ethnicity, gender, age, psychosocial, ethical influences
Context of evidence- the setting (individual units, hospital, patient populations) where practice is translated
EBN

6. Important definitions
Clinical decision-making
Drawing conclusions based on EBN, clinical expertise, patient preference, and other factors such as cost-benefit analysis and availability of alternatives
Clinical practice guideline (CPG)
Clinical guidelines briefly identify, summarize and evaluate the best evidence and most current data about best practices that are associated with optimal patient outcomes
Experimental studies
The researcher has full control over the subjects, the setting, and the research procedures as in studies completed in a laboratory
Literature review
Scholarly analysis of a body of research about a specific issue or topic
Meta-analysis
Merged statistical results from a number of related studies which combines various research studies with the goal of discovering consistencies and differences between studies
Quasi-experimental studies
The researcher does not have full control over all of the aspects of the investigation. (Most healthcare research is of this type.)

7. How does research guide EBN?
EBN uses research findings to adopt & implement current clinical practice(s)
Research is a structured method of scientific study that tests or evaluates new nursing practices or reviews existing practices for clinical meaning
The purpose of research is to create or discover new nursing knowledge

8. Examples of research guiding practice
What are examples
of research
guiding practice
in your unit?
Ventilator associated pneumonia (VAP) prevention bundle
Pain scales to help patients accurately report their pain to the nurse
Standardized central line dressing changes
Hand hygiene
Fall prevention strategies
Structured hourly rounding

9. Performance improvement is not the same as research
Performance Improvement (PI) is:
A process using rapid cycles of change in practice to improve patient outcomes or systems within an organization
The results of PI:
Identify gaps between desired and actual performance
Identify root causes
Facilitate the selection of best practices to close performance gaps
Measure changes in performance because of process change(s)

10. Examples of performance improvement
The use of Alaris Guard Rails to increase patient safety
The use of 2 patient identifiers on all laboratory specimens to prevent missed/lost labs or inaccurate reporting of results
The use of the insulin check sheet for insulin drips to decrease errors in administration
What are examples of
PI in your unit?

11. How can you participate in EBN?
Follow the steps of the IOWA model
Identify the burning issue on your unit: Is it a patient outcome or staff knowledge deficit?
Find and analyze the current evidence in the literature
Meet with unit leadership to align potential project with unit priorities
Use current evidence from the literature to implement practice change
If there is not sufficient evidence in the literature, consult the Center for Nursing Research to discuss potential research questions

12. OMC Uses the Iowa Model of EBP to develop EBN
Start Here
Is there a problem with
patient outcomes?
Is there new
knowledge that
we are not using?
Find & Analyze
Relevant Evidence
Pilot EBP Change OR
Research
Does it match Unit
Priority &
Nursing Research
Center
Approval ? NO
YES
*Sufficient scientific evidence 12

13. Example of Evidence-Based Nursing:
Development of Standardized
Care to Minimize Hospital Acquired Pressure Ulcers
Clinical Practice Guideline (CPG)
(4-prong process)
Gathering
Unit/Hospital
Information to
Address a
Specific Issue –
Hospital Acquired
Pressure Ulcers
(HAPU)
Reviewing Recommendations for Central Line Management –Published evidence & current CPG exist
Making Nursing
Decisions
Based on the
Information &
Patient Preferences –
Assessment strategies
and interventions to
minimize HAPU are
evidence-based
Considering
the Setting (unit)
& Available
Resources –
Integration of
EBN into
acute care
nursing
practice

14. EBN Step 1 - Developing a clear question
Example:
What was the problem that triggered the question regarding Hospital Acquired Pressure Ulcers (HAPU)?
Use baseline data to identify the issue
Performance improvement data reports the number of HAPU on your unit
Patient complaints surrounding HAPU
Primary question - What nursing practices are associated with a reduction in HAPU?

15. EBN Step 2: Finding and analyzing the evidence
Search for scientific evidence
Databases (PUBMED, CINAHL, MEDLINE, MD Consult, COCHRANE LIBRARY)
National guidelines from professional organizations
Analyze the evidence -
Identify EBN practices in the literature
Consider what EBN practices are relevant to your patient population and unit, using journal clubs or unit meeting discussions
How strong is the evidence?

16. The strength of the evidence
Evidence is categorized using the following levels
Meta-analysis of multiple randomized controlled studies or established clinical practice guideline
Individual randomized control trials
Quasi-experimental studies
Descriptive, comparative, correlational studies, & qualitative work
Program evaluation, quality or performance improvement projects, case reports
Opinions of respected authorities or of an expert committee, including their interpretation of non- research based information
It is desired to have Level I evidence (strongest) to guide
new practice;
however, lower levels of evidence
can be used in combination with clinical expertise
to adopt the best practice.

17. Step 2 in HAPU Prevention Project
Identifying sufficient evidence regarding EBN best practices to reduce HAPU:
Library databases (PUBMED and CINAHL for articles)
Search internet for Clinical Practice Guidelines (ex. Ontario Nurses Association, CPGs from other institutions & WOCN)
Recommendations from the wound care nurses

18. EBN Step 3: Meet with unit leadership to align project with unit goals
Is the EBN practice change congruent with:
Unit goals?
Organizational philosophy?
Patient values?
Can unit leadership support the time needed for:
Project development?
Project implementation?
Data collection and analysis?
Project dissemination?

19. Step 3 in HAPU Prevention Project (where there was sufficient evidence to support practice change)
Nursing leadership approved working on the HAPU prevention project
The Pressure Ulcer Prevention & Management Clinical Practice Guideline was developed using current EBN practice recommendations
The new guideline was approved by the Interdisciplinary Practice Council (IPC) and by nursing leadership

20. Example of Step 3, in a project with INsufficient evidence to support practice change
Does a research question need to be developed?
Based on the gaps in the literature
Does organizational data support that a change is needed
Meet with nursing leadership
Is there sufficient unit support to complete the research project
Consult the Center for Nursing Research
To assist/mentor research proposal development
To present to system nursing research council to determine feasibility
To prepare research proposal for IRB submission

21. EBN Step 4: Implementation of EBN practice change
Identify team members
Identify components of project (education, competency check, compliance to practice change audits, outcome measurements)
Create a timeline
Communicate with the team and unit
Meet often
Listen to the staff! Discuss what works, what does not work, etc.
Provide ongoing data for unit performance and changes in outcomes

22. Step 4 in HAPU Prevention Project
Team members were identified
Team members divided up project responsibilities
Staff were educated on new guideline and practice changes to be implemented
Staff competency check-offs (skills fair)
Compliance audits –share with staff
Track HAPUs – share with staff
Consider team huddles when HAPUs occur to discover barriers to providing best practice

23. What is the value of EBN? Directs quality nursing care
Improves patient outcomes
Results in high quality, cost-effective patient care

24. Summary EBN is a process that guides clinical decision-making using:
The best scientific evidence
Clinical experience & expert opinion
Patient/family preferences
Context of setting to translate practice
EBN is not the same as research
EBN uses research to guide practice, but it also uses other sources of evidence (e.g. published literature, expert opinion)

25. For more information on EBN and nursing research, contact the Center for Nursing Research:
Karen Rice, DNS, APRN, ACNS-BC, ANP (504) or Shelley Thibeau, PhD, RNC-NIC (504)

26. References
Brown, S.J. (2016). Evidence-based nursing: The research-practice connection. 4th edition, Burlington, MA: Jones & Bartlett.

27. Thank you!
This concludes the lesson on Evidence-Based Nursing. Please return to OLN and complete the associated attestation.