Evidence-Based

Practice

An Independent Study Short Course

for Medical-Surgical Nurses
 This module was developed by the
Clinical Practice Committee of the
Academy of Medical-Surgical Nurses,
in accordance with
the 2010 strategic plan.
(Revised February 2013)
Why is EBP relevant to nursing practice?

There is a gap between what we know and what we do

Nursing practice can and must be changed from tradition-
based to science-based

Improved Patient Outcomes

Decreased unnecessary procedures & complications

Greater provider job satisfaction

Third party reimbursement

Effective nursing practice requires information, judgment, and
skill

EBP empowers nurses and expands their skills
The 2011 report by the Institute of Medicine
(The Future of Nursing: Leading Change,
Advancing Health) recommends that all
health care professionals possess certain
skills and competencies in order to enhance
patient care quality and safety.
Competencies necessary for continuous improvement
of the quality and safety of health care systems—
patient-centered care, teamwork and collaboration,
evidence-based practice, quality improvement, safety,
and informatics.
- IOM, 2011
 Purpose of Module
• To provide an overview of evidence-based
practice (EBP), one of the five
competencies that all health care
professionals should possess (Institute of
Medicine, 2011).
– Where and how to find the best possible
sources of evidence for your practice.
– How to formulate clear clinical questions.
– How to search for relevant answers to the
questions.
– Determine when and how to integrate these
new findings into practice.
 Objectives
At the end of this module, you will be
able to:
• Recognize evidence-based practice (EBP)
as one of five core competencies all health
professionals should possess regardless of
their title or discipline.
• Define EBP.
 Objectives
• Identify two characteristics differentiating
research utilization and EBP in nursing.
• List three components of EBP.
• Describe the nurse’s role in EBP.
• Describe the 5 steps of the EBP process.
 Objectives
• Write a researchable clinical question.
• Identify resources for developing relevant
answers to the question.
• Use clinical judgment and the 5-step process for
determining when and how to integrate findings
into practice.
Evidence-Based Practice
is
knowing that what we do is
the best practice.
 How do we know in nursing?
• Tradition
• Authority
• Borrowing
• Trial and error
• Personal experience
• Role modeling and mentorship
• Intuition and reasoning
• Nursing research
 Types of Nursing Research

• Describe
Identify and understand phenomena, issues
• Explain
Clarify relationships
• Predict
Estimate the probability of outcome
• Control
Manipulate the situation to get desired outcomes
Much of what is known from research
has not been applied in practice.
This is known as

Research-Practice Gap
 Research-Practice Gap

During the 1980s and 1990s, nursing

emphasized bridging this research-
practice gap through the development
of research utilization (RU) projects.
 Research-Practice Gap
Steps of the process included:
– Dissemination of knowledge.
– Synthesis of findings.
– Critique of studies.
– Application of findings.
– Development of research-based practice
guidelines (i.e., Agency for Health Care Policy and
Research [AHCPR] practice guidelines; Conduct and
Utilization of Research in Nursing [CURN] practice
protocols).
 Research-Practice Gap

Even though guidelines and knowledge

have been disseminated, the overall
effect on clinical practice and patient
outcomes is unclear.
 Research-Practice Gap
• The problems of importance to medical-
surgical nursing (skin breakdown, pain,
bowel function, treatment adherence,
nausea) and related interventions are
largely not collected in medical record
databases.
• Nursing research studies are predominately
descriptive or qualitative in design, rather
than what is considered more rigorous and
quantitative.
 EBP is…
• Needed to help bridge the research-
practice gap by:
– Strengthening the evidence base so that we know
what works and what doesn’t work in providing
patients with the best outcomes.
– Standardizing evidence across fields to reach the
best outcome for the patient.
– Housing evidence in online databases providing
reviews of the evidence base.
– Translating and consolidating state of the science into
clinical recommendations.
(Stevens, 2004)
 EBP is…

“A problem-solving approach to clinical decision making

within a health-care organization that integrates the best
available scientific evidence with the best experiential
(patient and practitioner) evidence.”

(Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines, 2007)

 Goals of EBP
• Provide practicing nurses with the best
evidence-based data
• Resolve problems in the clinical setting
• Achieve excellence in care delivery
• Reduce variations in nursing care
• Promote effective nursing interventions
• Assist with efficient and effective decision-
making
 Key Components of EBP

Decisions about care are based on:

A. Research evidence.
B. Clinical expertise, judicious use.
C. Patient values and circumstances.
(Institute of Medicine, 2003)
 A. Research Evidence

• Randomized controlled trials

• Laboratory experiments
• Clinical trials
• Epidemiological research
• Outcomes research
• Qualitative research
• Expert practice knowledge, inductive
reasoning
 B. Clinical Expertise

• Knowledge gained from practice

over time
• Inductive reasoning
C. Patient Values, Circumstances

• Unique preferences
• Concerns
• Expectations
• Financial resources
• Social supports
“In nursing, best research evidence refers to
methodologically sound, clinically relevant
research about the effectiveness and safety of
nursing interventions, the accuracy and
precision of nursing assessment measures, the
power of prognostic markers, the strength of
causal relationships, the cost-effectiveness of
nursing interventions, and the meaning of illness
or patient experiences.”
- Evidence-Based Nursing: A Guide to Clinical Practice, 2005
 Nurse’s Role in EBP
American Nurses Association Standards of
Professional Nursing Practice

“The registered nurse participates, as
appropriate to education level and position, in the
formulation of evidence-based practice through
research.”

“The registered nurse utilizes current evidence-
based nursing knowledge, including research
findings, to guide practice.”

American Nurses Association (2010). Nursing scope and standards of practice.

 Nurse’s Role in EBP
AMSN Standards of Professional Performance
• “STANDARD VII. RESEARCH: Medical-surgical
nurses use research findings in practice.”

Academy of Medical-Surgical Nurses (2012). Scope and Standards of Medical-Surgical

Nursing Practice, 5th Edition.
 Nurse’s Role in EBP
– Generate important questions
– Know basis for nursing practice
– Expect that evidence is the foundation of practice
– Participate in EBP projects
– Disseminate project findings in various forums
– Collaborate with the healthcare team to provide
quality care
EBP Process

There are 5 steps

in judging the
evidence and
determining the
circumstances and
patient values for
guiding application.
 EBP Process
The EBP Process Steps are:
1. Assess practice (formulate question)
What isn’t working?
What do you want to know about?
2. Decide (evidence review)
What resources are available and are they any good?
What has worked in other places?
How can you change your practice?
3. Plan (develop a plan based on findings)
Make a plan to change care based on relevant, applicable information.
Let others help.
4. Intervene (take action to review process or change)
Implement revised caregiving protocol in clinical unit.
5. Evaluate (care improved or modify and again intervene)
How well is that working for you?
 Additional Readings
Ackley, B.J., Swan, B.A., Ladwig, G.B., Tucker, S.J. (2007). Evidenced-Based Nursing
Care Guidelines: Medical-Surgical Interventions, 1st ed.
Aherns, T. (2005). Evidence-based practice: Priorities and implementation strategies.
AACN Clinical Issues. 16(1), 36-42.
Cullen, L., Greiner, J., Greiner, J., Bombei, C., & Comried, L. (2005). Excellence in
evidence-based practice: Organizational and unit exemplars. Critical Care Nursing
Clinics of North America, 17, 127-142.
Greiner, A., & Knebel, E., (Eds.). (2003). Health professions education: A bridge to
quality. Washington, DC: The National Academies Press.
Stevens, K.R., & Staley, J.M. (2006). The Quality Chasm reports, evidence-based
practice, and nursing’s response to improve healthcare. Nursing Outlook, 54(2), 94-
101.
Titler, M., Kleiber, C., Steelman, V., Goode, C., Rakel, B., Barry-Wlker, J., et. al. (1994).
Infusing research into practice to promote quality care. Nursing Research, 43, 307-
313.
Titler, M., Kleiber, C., Steelman, V., Rakel, B., Budreau, G., Everett, L., et. al. (2001). The
Iowa Model of evidence-based practice to promote quality care. Critical Care Nursing
Clinics of North America, 13(4), 497-509.
 References
Academy of Medical-Surgical Nurses.(2012).Scope and Standards of Medical-Surgical Nursing
Practice, 5th Edition.
Ackley, B., Ladwig, G. (2008). Evidence-based Nursing Care Guidelines: Medical-Surgical
Interventions, 1st Ed. St Louis, MO, Mosby, Inc.
American Nurses Association (2010). Nursing scope and standards of practice. Washington, DC:
author.
DiCenso, A., Guyatt, G., & Ciliska, D. (2005). Evidence-Based Nursing: A Guide to Clinical Practice,
1st Ed. St Louis, MO., Mosby.
Fineout-Overholt, E., Melnyk, B.M., & Schultz, A. (2005). Transforming health care from the inside
out: Advancing evidence-based practice in the 21st century. Journal of Professional Nursing,
21(6), 335-344.
Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines, (2007), Newhouse, et al.
Sigma Theta Tau International Honor Society of Nursing.
Institute of Medicine, (US)Greiner, A. & Knebel, E., (Eds.) (2003) Health Professions Education: A
bridge to quality, The National Academies Press, 45-74
Institute of Medicine,(US) National Research Council (2011). The Future of Nursing: Leading Change,
Advancing Health. The National Academies Press.
Melnyk, B. & Fineout-Overholt, E. (2005). Evidence-based practice in Nursing & Healthcare: A guide
to best practice. Philadelphia: Lippincott Williams & Wilkins
National Patient Safety Goals. (2006). The Joint Commission (formerly JCAHO)
Newhouse, R.P., Dearholt, S.L., Poe, S.S., Pugh, L.C., & White, K.M. (2007). Johns Hopkins Nursing
Evidence-Based Practice Model and Guidelines. Sigma Theta Tau International.
Patient Safety & Quality—An Evidence-Based handbook for Nurses. AHRQ Publication No. 08-0043.
Retrieved from http://www.ahrq.gov/qual/nurseshdbk/
 References
Stevens, K.R. (2005). Essential competencies for evidence-based practice in nursing (1st edition). San
Antonio, TX: Academic Center for Evidence-based Practice, The University of Texas Health
Science Center at San Antonio
Stevens, K. R. (2004). ACE Star Model of EBP: Knowledge Transformation. Academic Center for
Evidence-based Practice. The University of Texas Health Science Center at San Antonio.
www.acestar.uthscsa.edu
Titler, M.G. (2008).The evidence for evidence-based practice implementation. In: Hughes, R. ed.
Patient Safety & Quality—An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for
Healthcare Research and Quality. http://www.ahrq.gov/qual.nursehdbk/.