Introduction To Evidence Based Nursing

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Introduction To Evidence Based Nursing

• By
• Dr. Hanan Said Ali

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Objectives

• Define evidence informed nursing
• Identify the main imperative for evidence
  informed nursing.
• List the requirement of evidence informed
  nursing .
• Identify how does it relate to clinical
  effectiveness and evidence based practice
• Discuss how to Implement evidence informed
  practice.
• Determine the Strengths of evidence.

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What is evidence informed nursing

• We use the term ( evidence informed nursing )
  in preference to evidence based nursing in
  order to recognizes that nurses are critical
  practitioners.
• The nurse made a decision for actions which can
  be justified from knowledge base.

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The main imperative for evidence informed
nursing

• Proper use of evidence supports nurses in
  accounting for what they do.
• Providing clinically effective patient care and
  being able to justify the procedures used , the
  care plan devised or the services provided by
  reference to authoritative evidence.

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The main imperative for evidence informed
nursing

• Making of decision about the care of individual
  patients and families, on the basis of the best
  available evidence
• Integration of professional judgement and
  research evidence about effectiveness of
  interventions.

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What it requires is that all nurses have

• An understanding of the importance of practice
  being based on the most appropriate evidence on
  effectiveness.
• Access to and the ability to use research
  findings.
• The ability to evaluate research.
• The ability to implement research finding in
  their own practice.

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Evidence informed nursing requires

• The formulation of answerable questions that
  arise from practice- Reflection,
• The searching of the literature or other relevant
  evidence sources Information,
• The evaluation of the evidence for validity ,
  generalisability, and transferability - appraisal

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Evidence informed nursing requires Cont.

• The use of the best available evidence alongside
  clinical expertise and patient preferences in
  planning care - implementation,
• The evaluation by practitioners of their own
  professional practice evaluation.

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The evidence informed nursing cycle
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How does it relate to clinical effectiveness and
evidence based practice

• They refer , at least in part , to using research
  to inform practice and to ensure efficient and
  effective practice.
• It refers to clinical effectiveness as applying
  the best available knowledge , derived from
  research , clinical expertise and patient
  preferences, to achieve the optimum processes and
  outcomes of care for patients.

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How does it relate to clinical effectiveness and
evidence based practice

• It is doing the right thing in the right way for
  the right patient at the right time.
• There is a dissonance between the core beliefs of
  nursing and clinical effectiveness.
• Nurses are committed to providing holistic care
  as opposed to care based on the biomedical model.

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How does it relate to clinical effectiveness and
evidence based practice

• Nurses are committed to treat patients as whole
  people and work with them rather on them.
• Furthermore, effectiveness is only one element of
  the decision making process in deciding on the
  therapeutic intervention others include safety,
  acceptability , cost effectiveness and
  appropriateness.

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Example

• If he was diagnosed with cancer today and was
  faced with the decision about which type of
  chemotherapy to choose, would he want to know the
  evidence regarding the risks and benefits of each
  therapeutic agent as generated from prior
  clinical trials with other similar cancer
  clients?

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Implementing evidence informed practice

• To achieve evidence informed nursing a nurse
  needs to have
• The research awareness skills and the knowledge
  and competence to interpret research material and
  to use it to inform their clinical decision-
  making.
• A managerial and organisational culture that
  facilitate the implementation of research into
  clinical practice.

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To implement evidence- informed practice the
nurse needs
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1. Clinical expertise

• Nurses are professionally accountable for the
  effectiveness of the care they provide and
  imposes on them a duty to monitor and improve
  their knowledge and competence

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1. Clinical expertise Cont.

• The nurses have began to recognise the importance
  of evidence- informed practice and the need to
  have the skills to assess the research literature
  and implement findings in their own day to day
  practice.

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2. Knowledge of research evidence

• There is increased emphasis on using the latest
  and highest- quality evidence to inform clinical
  practice and service delivery to improve health
  outcomes for individuals and the population as a
  whole.

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2. Knowledge of research evidence Cont.

• Evidence informed nursing is a systematic
  approach to providing nursing care that requires
  critical appraisal skills. While research
  evidence is at the centre of it, it does not
  require all nurses to be researcher

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3. An understanding of patient preference and
choice

• Patients and their families place their trust in
  nurses.
• The nurse needs to assess the patients knowledge
  and understanding of their condition and involve
  them in the decision making process regarding
  their care.

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3. An understanding of patient preference and
choice Cont.

• The nurse needs to be able to access and
  critically appraise the evidence in relation to
  the care needs of each patient and communicate
  this information in a style most appropriate to
  the individual patient.

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4. Access to adequate resources

• For nursing to be evidence- informed, research
  needs to be accessible to nurses who understand
  the need to base their practice on research and
  who have the critical appraisal skills necessary
  to evaluate it. ,time to access it and skills to
  implement it.

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Strengths of evidence

• Evidence is categorized according to the overall
  research studies design in preventing bias from
  influencing the research finding.
• What needs to be emphasised here is the value of
  the research in answering the proposed question.

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The Five Strengths of Evidence
Class Strength of evidence
I Strong evidence from at least one systematic review of multiple well- designed randomised controlled trials
II Strong evidence from at least one properly designed randomised controlled trial of appropriate size.
III Evidence from well- designed trials without randomisation , single group pre- post, cohort, time series or matched case control studies.
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The Five Strengths of Evidence Cont.
Class Strength of evidence
IV Evidence from well- designed non experimental studies from more than one centre or research group.
V Opinions of respected authorities based on clinical evidence, descriptive studies or reports of expert committees.
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Best Evidence

• Define the best research evidence?
• Is define as
• Clinically relevant research, often from the
  basic sciences of medicine, but especially from
  patient centered clinical research.
• Without current best evidence , practice is
  rapidly outdated

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Best Evidence Example

• For years , pediatrics primary care providers
  advised parents to place their infant in prone
  position while sleeping, this is beast position
  to prevent aspiration of vomiting. With evidence
  indicating that prone positioning increase risk
  of sudden infant death syndrome, the American
  academic of pediatrics released the clinical
  practice guideline recommending a supine position
  for infant sleep.

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Common Terminology in EBN

• Patient value
• The unique preferences, concerns and expectations
  each client brings to a clinical encounter and
  which must be integrated into clinical decisions
  if they are to serve the patient.

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Common Terminology in EBN Cont.

• Systematic review
• A summary of the medical literature that uses
  explicit methods to perform a comprehensive
  literature search and critical appraisal of
  individual studies and that uses appropriate
  statistical techniques to combine these valid
  studies.
• Cochrane collaboration
• A worldwide association of groups who create and
  maintain systematic reviews of the literature for
  specific topic areas.

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Common Terminology in EBN Cont.

• Case-control study
• A study which involves identifying patients who
  have the outcome of interest (cases) and patients
  without the same outcome (controls), and looking
  back to see if they had the exposure of interest.
  
• Cohort Study
• Involves identification of two groups (cohorts)
  of patients, one which received the exposure of
  interest, and one which did not, and following
  these cohorts forward for the outcome of interest

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Common Terminology in EBN Cont.

• Cross-sectional study
• The observation of a defined population at a
  single point in time or time interval. Exposure
  and outcome are determined simultaneously.
• Meta-analysis
• A systematic review that uses quantitative
  methods to synthesize and summarize the results.

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Common Terminology in EBN Cont.

• Randomization (or random allocation) Method
  analogous to tossing a coin to assign patients to
  treatment groups (the experimental treatment is
  assigned if the coin lands heads and a
  conventional, control or placebo treatment is
  given if the coin lands tails).
• Randomized control clinical trial (RCT)
  Participants are randomly allocated into an
  experimental group or a control group and
  followed over time for the variables/outcomes of
  interest

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