1. TIGER Standards & Interoperability Collaborative
Evidence Based Practice Standards Tutorial

2. Tutorial Outline Objective Definitions
The Practice of Evidence Based Nursing:
a. Clinical Questions
b. Searching Best Evidence
c. Evaluation of Evidence
d. Applying Evidence to Practice
c. Evaluation
Case Study
Resources: Evidence Based Centers, Websites, Journals
Contact information – TIGER & Authors

3. Objective
At the completion of the tutorial the nurse will be able to describe the process of evidence based nursing practice (EBNP) and it’s related importance to the practice of professional nursing and delivery of quality healthcare . The nurse can identify the process of translating the best available evidence into practice and will be introduced to EBP internet resources.
Where is your healthcare record?
How many locations have your healthcare record.
What needs to be represented in your healthcare record?

4. Definition: Evidence Based Practice
A problem solving approach to practice that involves the conscientious use of current best evidence in making decisions about patient care; EBP incorporates a systematic search for and critical appraisal of the most relevant evidence to answer a clinical question along with one's own clinical expertise and patient values and preferences.
1. Melnyk B, Fineout-Overholt E. Evidence-based Practice in Nursing and Healthcare: A Guide to Best Practice. Philadelphia: Lippincott Williams & Wilkins; 2004.

5. Definition: Quality
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

6. Nursing as a Research Based Profession
Current Healthcare Climate Insists on the Wisest Delivery of the Best Clinical Practices and Care:
FACTORS:
Explosion of Literature
Unmet Information Needs
Implementation Delays
Aging Population
Fewer Financial Resources
Higher Acuities
Fewer Staff
Research and Theory for Nursing Practice: An International Journal, Vol. 20, No. 2, 2006
Also University of Minnesota

7. Definition: Best Practices
Best Practices refers to nursing practices
that are based on the best research
evidence. Synonymous terms include
research based practice and research
utilization. An application example would
be use of an AHRQ Clinical Guideline.

8. Evidence Based Advocates: 1
Evidence Based Advocates: 1. Institute Of Medicine: Performance Standards: The Institute of Medicines’ efforts include redesigning care delivery and keeping patients safe. The IOM’s global focus is on improved quality and a transformation of 21st century care delivery. The 2003 IOM report “Health Professions Education: A Bridge to Quality” recommends integration of core competencies to include EBP into health professions education.

9. Evidence Based Advocates: 2
Evidence Based Advocates: AHRQ: Adoption and Consistency of Performance: The Agency for Healthcare Research and Quality’s mission is to improve the quality, safety, efficiency and effectiveness of healthcare for all Americans. The AHRQ funds evidence based centers and supports the National Guideline Clearinghouse

10. Evidence Based Advocates: 3. Specialty Organizations (i. e
Evidence Based Advocates: 3. Specialty Organizations (i.e., AACN, NANN, Sigma Theta Tau, ONS): These organizations provide resources for nurses to identify, critically appraise, and use evidence in practice. 4. ANCC Magnet Recognition Program 5. Payers, Payees and Patients!

11. A Model for Evidence Based Practice
Assess Link Synthesize Design Implement/ Integrate/
Evaluate Maintain
Not sure about this slide (haven’t added explanation…….
It could confuse, however it is the only model I know of that
Has the “link” piece which describes selecting in a
standardized language
Rosswurm & Larrabee, 1999, Sigma Theta Tau Int.

12. Evidence Based Practice: A 5- Step Process
Formulate a well-built question
Identify evidence based resources that answer the question
Critically appraise the evidence
Apply the evidence
Re-evaluate the application of evidence
University of Minnesota Libray

13. 1. Formulate a Well Built Question:
*Construct a specific clinical question using PICO format.
P= Patient Population
I= Intervention/ Issue of Interest
C= Comparison Intervention or Comparison
Group
O= Outcome
(T)= Time
Arizona State University

14. In adult cardiac surgery patients (P), is
1. PICO Example
In adult cardiac surgery patients (P), is
morphine (I) or fentanyl (C) more effective
in reducing postoperative pain? (O)
Arizona State University

15. 2. Identify evidence based resources that answer the question
Search for an evidence based answer using PICO
keywords in critically appraised sources
(relevant research).
Since some evidence is stronger than others and
cannot be regarded equally, evidence hierarchies
have been developed which rate the strength of the
evidence or grade the recommendations.

16. 2. Identify evidence based resources that answer the question
An example of an evidence hierarchy from the U.S.
Dept. Of Health and Human Services ( now AHRQ)
National Guidelines Clearinghouse:
Ia Meta-Analysis of randomized control trials
Ib One randomized control trial
IIa One well designed control study without randomization
IIb One well designed quasi-experimental study
III Well designed non-experimental study
IV Expert committee reports, expert opinions, consensus
statements, expert judgement

17. 2. Identify evidence based resources that answer the question
In 1998 Stetler and colleagues made a contribution to the format which impacted nursing. The admissible evidence was expanded to include
qualitative studies, quality improvement and
program evaluation.
Journal of nursing scholarship 2001, 2nd quarter

18. References