1. Evidence Based Practice (EBP) PC600 – Health Promotion and Disease Prevention Module 3

2. What is Evidence-Based Practice? The definition of evidence-based practice (EBP) has change over time. You will see with the following definitions that as health care providers gain new insight with regard to the impact of implementing EBP the definition has changed.The definition of evidence-based practice (EBP) has change over time. You will see with the following definitions that as health care providers gain new insight with regard to the impact of implementing EBP the definition has changed.

3. Evidence-Based Practice according to Sackett et al (1996) …is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based Medicine means integrating individual clinical expertise with the best available clinical evidence from systematic research.”

4. Evidence-Based Practice according to Melnyk & Fineout-Overholt (2005) …is “a problem solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician’s expertise as well as patient preferences and values to make decisions about the type of care that is provided.”

5. Evidence-Based Nursing according to Whall, Sinclair, & Parahoo (2006) …is “the conscientious, explicit and judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups of patients and in consideration of individual needs and preferences.”

6. The Core Principles of EBP Evidence-Based Practice InvolvesEvidence-Based Practice Involves Finding the best evidence.Finding the best evidence. Critiquing the evidence using established rating schemas.Critiquing the evidence using established rating schemas. Integrating evidence with the clinician’s expertise and experience.Integrating evidence with the clinician’s expertise and experience. Integrating evidence with the patient’s preferences and values.Integrating evidence with the patient’s preferences and values. Using the evidence to guide professional decision making and practice.Using the evidence to guide professional decision making and practice.

7. A word about patient preference: Nursing has, for some time, recognized the importance of incorporating patient’s preferences and values into the plan of care. Evidence-based practice for nurses then, requires individual nurses to reflect on past experience, both theoretical and experiential, and consider:Nursing has, for some time, recognized the importance of incorporating patient’s preferences and values into the plan of care. Evidence-based practice for nurses then, requires individual nurses to reflect on past experience, both theoretical and experiential, and consider: Patient’s religious and cultural beliefsPatient’s religious and cultural beliefs Patient’s literacy and prior knowledgePatient’s literacy and prior knowledge Anything that makes an individual patient unique. (Melnyk & Fineout-Overholt, 2006)Anything that makes an individual patient unique. (Melnyk & Fineout-Overholt, 2006)

8. Why Are We Teaching Evidence-Based Practice? In 2003, the Institute of Medicine issued a report mandating that “all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics”In 2003, the Institute of Medicine issued a report mandating that “all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics”

9. Why is EBP important for you to understand and implement as an advanced practice nurse? Failure to base nursing practice on the best available evidence can leave your patients vulnerable to poor outcomes.Failure to base nursing practice on the best available evidence can leave your patients vulnerable to poor outcomes. Sole reliance on textbooks and expert faculty knowledge will not prepare you for the fast-paced and ever changing clinical practice you’ll be faced with in this age of the information explosion.Sole reliance on textbooks and expert faculty knowledge will not prepare you for the fast-paced and ever changing clinical practice you’ll be faced with in this age of the information explosion. Evidence-based practice will provide you with a framework to meet the needs of life-long learning that is required when caring for patients.Evidence-based practice will provide you with a framework to meet the needs of life-long learning that is required when caring for patients.

10. What Constitutes “Best Evidence”? (A hot topic of debate) Early definitions of “best evidence” included only randomized controlled trials (RTCs).Early definitions of “best evidence” included only randomized controlled trials (RTCs). Nursing and other health care specialties are currently debating whether or not this is true, or if in fact “evidence” is a broader/more diverse term that includes more than information derived solely from empirical research.Nursing and other health care specialties are currently debating whether or not this is true, or if in fact “evidence” is a broader/more diverse term that includes more than information derived solely from empirical research.

11. What Constitutes “Best Evidence”? (Empirically Speaking) According to Sackett et al (1996), meta- analysis or integrated research reviews offer the strongest levels of evidence.According to Sackett et al (1996), meta- analysis or integrated research reviews offer the strongest levels of evidence. Utilizing randomized controlled trials in integrated reviews is thought to be the “gold standard”.Utilizing randomized controlled trials in integrated reviews is thought to be the “gold standard”. This type of evidence can only be discovered through quantitative research.This type of evidence can only be discovered through quantitative research.

12. What Do Others Think? There are many who believe that experimental, observational, and correlational studies provide sound evidence.There are many who believe that experimental, observational, and correlational studies provide sound evidence. Many of the issues and questions encountered by nurses can not be studied using randomized controlled trials.Many of the issues and questions encountered by nurses can not be studied using randomized controlled trials. Consequently, many nursing scholars believe that the use of experimental, non-experimental, and qualitative research may be appropriate.Consequently, many nursing scholars believe that the use of experimental, non-experimental, and qualitative research may be appropriate. (Rycroft-Malone, Seers, Titchen, Harvey, Kitson, & McCormack, 2004).

13. Some nursing scholars propose that evidence in evidence-based practice should be considered knowledge that has been derived from a variety of sources that has been subjected to testing and has been found to be credible. (Higgs & Jones, 2000)Some nursing scholars propose that evidence in evidence-based practice should be considered knowledge that has been derived from a variety of sources that has been subjected to testing and has been found to be credible. (Higgs & Jones, 2000) Other scholars recognize that including multiple perspectives and ways of knowing (rather than just the positivist perspective recognized with RCTs) is an important element in conceptualizing the meaning of evidence-based practice in nursing.Other scholars recognize that including multiple perspectives and ways of knowing (rather than just the positivist perspective recognized with RCTs) is an important element in conceptualizing the meaning of evidence-based practice in nursing. (Whall, Sinclair, & Parahoo, 2006)

14. The Bottom Line: Evidence must be critiqued in order to determine its quality and whether or not the study design is appropriate to answer the question that is asked.Evidence must be critiqued in order to determine its quality and whether or not the study design is appropriate to answer the question that is asked. Evidence that is used to inform practice must be subjected to rigorous scrutiny.Evidence that is used to inform practice must be subjected to rigorous scrutiny. Many organizations have systems in place to determine which evidence can guide practice. Advanced practice nurses must work with these established systems.Many organizations have systems in place to determine which evidence can guide practice. Advanced practice nurses must work with these established systems.

15. Evidence-Based Practice: A 5-Stage Process An easy way to remember the stages involved in evidence-based practice is to remember the 5 “A”sAn easy way to remember the stages involved in evidence-based practice is to remember the 5 “A”s AskAsk AcquireAcquire AppraiseAppraise ApplyApply AssessAssess

16. The Five Stages of Evidence-Based Practice 1.Asking a clinical question 2.Acquiring relevant research by searching the literature 3.Appraising (critically) what has been found. If the evidence suggests a need for change, and if it is congruent with the skills of the clinician, available resources, and patient’s preference, then the following stages also occurIf the evidence suggests a need for change, and if it is congruent with the skills of the clinician, available resources, and patient’s preference, then the following stages also occur 4.Applying the evidence to implement change in practice 5.Assessing the outcomes following the change in practice (Ciliska, 2005)

17. Life-Long Learning Starts Now Always remember to bring the same sense of inquiry to your professional practice that you bring to your studies for school.Always remember to bring the same sense of inquiry to your professional practice that you bring to your studies for school. Ask “Why do we do it this way?” or “Is there a better way to do this?”Ask “Why do we do it this way?” or “Is there a better way to do this?”

18. Becoming a Master at Acquiring the Evidence In this course you will learn to structure questions to efficiently search for evidence. You will use these questions, and build on what you have learned in the Library 101 course to effectively search relevant, peer-reviewed journals and data bases for evidence.

19. But how do I appraise the evidence? Evaluating the quality and strength of evidence requires that you review all that you learned in your undergraduate nursing courses, especially content related to critically reading and interpreting research.Evaluating the quality and strength of evidence requires that you review all that you learned in your undergraduate nursing courses, especially content related to critically reading and interpreting research. This course will give you additional information that will assist you in determining the strength of evidence.This course will give you additional information that will assist you in determining the strength of evidence. Check the following web site for a glossary of terms used in EBP: (click on “Resources” once you are in the site to access the glossary and other valuable information) http://www.nursing.asu.edu/caep/index.htmCheck the following web site for a glossary of terms used in EBP: (click on “Resources” once you are in the site to access the glossary and other valuable information) http://www.nursing.asu.edu/caep/index.htm http://www.nursing.asu.edu/caep/index.htm

20. Summary The benefits of implementing evidence- based practice are many, and include improved outcomes and patient satisfaction, and filling the gap between research and practice.The benefits of implementing evidence- based practice are many, and include improved outcomes and patient satisfaction, and filling the gap between research and practice. Now that you have a basic understanding of the concept of evidence-based practice, return to the course module and proceed with the learning activities and required readings.Now that you have a basic understanding of the concept of evidence-based practice, return to the course module and proceed with the learning activities and required readings.

21. References Ciliska, D. (2005). Educating for evidence-based practice. Journal of Professional Nursing, 21(6), 345-350. Higgs, J., & Jones, M. (2000). Will evidence-based practice take the reasoning out of practice? In J. Higgs & M. Jones (Eds), Clinical Reasoning in the Health Professionals, 2 nd Edition. Oxford, UK: Butterworth Heineman. Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press. Melnyk, B., & Fineout-Overholt, E. (2005). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. Philadelphia: Lippincott Williams & Wilkins. Melnyk, B., & Fineout-Overholg, E. (2006). Consumer preferences and values as an integral key to evidence-based practice. Nursing Administration Quarterly, 30(2), 123-127. Rycroft-Malone, J., Seers, K., Titchen, A., Harvey, G., Kitson, A., & McCormack, B. (2004). What counts as evidence in evidence-based practice? Journal of Advanced Nursing, 47(1), 81- 90. Sackett, D., Rosenberg, W., Gray, J., Haynes, R., & Richardson, W. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312(7032), 71-72. Whall, A., Sinclair, M., & Parahoo, K. (2006). A philosophic analysis of Evidence-Based Nursing: Recurrent themes, metanarratives, and exemplar cases. Nursing Outlook, 54(1), 30- 35.