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BSN/NURSING RESEARCH 1 (NCM 111)

Academic Year: 2021-2022, 1st Semester
(3:00-4:30 M-W)

MODULE # 2

EVIDENCE-BASED PRACTICE (EBP)

Learning Objectives:

1. Define evidence-based practice (EBP).

2. Discuss the importance of EBP to nursing practice
3. Identify the barriers to evidence-based practice.
4. Differentiate between evidence-based practice and research utilization.

Learning Contents:

INTRODUCTION

Every day, nurses are on the front line of patient care. It is the nurse who first notices a change in patient status. It is
the nurse who implements and then evaluates the effectiveness of interventions. Often, nurses wonder who
determines how nursing is practiced or why procedures are performed a certain way. A nurse might think, “It would
be so much better if we did this procedure a different way.”

Did you ever wonder how you might change or influence the way patient care is delivered? New evidence comes
into play every single day at the bedside as technology changes, research evolves, and patients present with new
and unique disease processes. Nurses who rely simply on the knowledge learned during their basic education quickly
become outmoded. We have all evolved from simple patient care practitioners to nurse scientists. To be a proficient
and informed nurse scientist you need to remain current with the latest research and treatment modalities.

Simply doing things “because we have always done them that way” is an outdated thought process. Today, nurses
must base their nursing and patient care on the latest evidence-based nursing research. If you have ever asked
yourself such questions or wondered about practice issues, evidence-based practice (EBP) can be the roadmap to
suggesting changes in the way patient care is delivered. It is the nurse who provides direct care to the patient. Why
shouldn't the nurse identify patient care problems and procedural issues, thereby recommending for consideration
changes in how patient care is delivered?

Most nurse researchers want their findings to contribute to nursing practice, and there is growing interest among
nurses in basing their practice on solid research evidence. These nurses learn to examine the latest research to
determine the best courses of action for their patients. By relying on this scientific approach, nurses can improve the
standard of patient care over time and introduce new procedures and techniques.

It has only been in the last four decades that nurses have had access to knowledge from nursing research to improve
their practice. Nowadays, nurses are expected to use the best type of evidence to base their nursing care on the so-
called evidence-based practice (EBP).

Engr. Manuel S. Tumalad [email protected] 0915 879 1419

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DEFINITION OF EBP

EBP is defined as the integration of best research evidence with clinical expertise and patient preferences values
to facilitate clinical decision making. This problem-solving approach to clinical practice encourages nurses to
provide individualized patient care.

EBP is the use of clinical research to determine the best forms of patient care. By studying research, expert opinions,
and other forms of data, nurses can identify ways to provide optimal patient care. When nurses look critically at
existing methods, they can improve medical care.

HISTORY OF EBP

Florence Nightingale was credited with improving patient care in the 1800s when she noted that unsanitary
conditions and restricted ventilation could adversely affect the health of patients. She went on to record medical
statistics using patient demographics to ascertain the number of deaths in hospitals and the mortality rate
connected to different illnesses and injuries. The “Lady with the Lamp” kept careful record of medical stats
connecting illnesses to injuries. From this chronicling, Nightingale was able to draw conclusions that would have a
profound effect on modern medicine, such as linking unsanitary conditions and poorly ventilated spaces to a
patient’s failing health. Her efforts comprise a prime example of evidence-based practice (EBP), the process of
collecting, processing, and implementing research findings to improve clinical practice and patient outcomes.

A cornerstone of the evidence-based movement was laid by Dr. Archie Cochrane, a British epidemiologist. Cochrane
struggled with the efficacy of health care and challenged patients to pay only for care that was judged effective
through proven methods. Cochrane introduced the concept of applying randomized controlled trials (RTC) and other
types of research to the nursing practice in 1972. Before Cochrane's contribution to healthcare, medical care
centered on unfounded assumptions without consideration for the individual patient. Cochrane proposed that
healthcare systems have limited resources so they should only use treatments that are proven to be effective. He
believed that RTCs were the most verified form of evidence and his assertion created the foundation for the EBP
movement.

In 1996 David Sackett introduced the term evidence-based medicine along with a definition that is still widely used
today. Unlike Cochrane, Sackett felt that EBP should not only focus on research but should merge evidence, clinical
experience and patient values. As other healthcare professions began adopting Sackett's concept for patient care, it
was renamed evidenced-based practice.

IMPORTANCE OF EBP TO NURSING PRACTICE

Evidence-based practice is now widely recognized as the key to improving healthcare quality and patient outcomes.
Some research findings help eliminate nursing actions that do not achieve desired outcomes. Other findings help
identify practices that improve health care outcomes and contain costs as well.

Although the purposes of nursing research (conducting research to generate new knowledge) and evidence-based
nursing practice (utilizing best evidence as basis of nursing practice) seem quite different, an increasing number of
research studies have been conducted with the goal of translating evidence effectively into practice. Evidence-based
practice provides a critical strategy to ensure that care is up to date and that it reflects the latest research evidence.

Example: The treatment for acute muscle strain has changed over the years. Previously, nurses learned to
ice certain injuries for the first 24 hours and then apply heat to increase blood flow. Now, evidence shows
that only heat is beneficial.

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Example: The last thing a patient wants when going to a hospital for treatment is a hospital-acquired
infection. Nurses play a key role in helping to prevent illness before it happens by adhering to evidence-
based infection-control policies. The evidence-based practice for combating the spread of infection
consists of these standard care procedures: hand hygiene, barrier protection, decontamination, and
antibiotic stewardship.
A nurse should conduct hand hygiene after every interaction with a patient and when entering and exiting
a patient’s room. Barrier protection includes wearing gloves, gowns, masks and goggles. Decontamination
of the room and equipment is necessary in reducing and preventing the spread of infection. Antibiotic
stewardship is critical to stopping the overuse of the treatment. Antibiotics should only be used when
other methods fail and the therapy should be closely monitored. In extreme cases, patients with an active
infection may have to be isolated.
Although nurses are busy with many responsibilities, the time it takes to control infection is well worth the
effort.

Example: Nurses used to spend up to 20 minutes a day bathing each patient and changing their dressings,
until research revealed that some dressings are better left in place longer and that daily baths don’t
impact outcomes.

Example: Chewing gum is thought to reduce post-operative ileus (POI) — “a malfunction of intestinal

motility” — by aiding the recovery of the digestive system. One surgical unit nursing team offers sugar-
free gum to alert patients, and instructs them to chew four times a day or more starting six hours after
surgery. This intervention is a result of an EBP nursing research pilot study. This simple, cost-effective
intervention can reduce POI, reduce costs, and alleviate the patient’s pain and suffering.

Evidence-based practice helps nurses provide high-quality patient care based on research and knowledge rather
than because “this is the way we have always done it,” or based on traditions, myths, hunches, advice of colleagues,
or outdated textbooks.

For example, when clinical questions arise, should one look to a nursing textbook for the answers? Remember that
books are not published every year, and new information may not be included in the edition you have. Also, when
using textbooks, consider whether you have the most current edition.

There are also issues to consider when asking colleagues for advice—specifically, be mindful that their responses
may be based on their personal experiences, their observations, what they learned in school, what was reviewed
during nursing orientation, or myths and traditions learned in clinical practice. Recent studies have provided
evidence that most nurses provide care in accordance with what they learned in nursing school and they rarely used
journal articles, research reports, and hospital libraries for reference. Those findings, combined with the fact that
the average nurse is more than 40 years of age, makes it apparent that many nurses’ knowledge is probably
outdated. Practice based on such knowledge does not translate into quality patient care or health outcomes.

Often, nurses feel that they are using “evidence” to guide practice, but their sources of evidence are not research-
based. In many studies conducted, nurses reported that the most helpful knowledge source was experience or
advice from colleagues or patients. The failure to use evidence results in care that is of lower quality, less effective,
and more expensive.

MAJOR COMPONENTS OF EBP

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This definition of EBP requires integration of three major components for medical decision making:  the best
external evidence, the individual practitioner’s clinical expertise, and the patients' preference.

1. Best external evidence: Evaluate and implement the most current, clinically relevant, and scientifically sound
research.
2. Individual clinical expertise: Draw on your personal experience of what has worked and not worked in your
clinical practice.
3. Patient values and expectations: Consider and value the preferences of your individual patients.

STEPS IN THE EBP PROCESS

The EBP systematic process includes the following steps:

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 Ask a question. Formulating a well-detailed, clearly worded question is the catalyst for EBP problem-solving. It
sets forth what the ultimate goal is. Perhaps the goal is to improve a procedure that will help a patient with a
particular condition. This step is crucial to the EBP process because the key words within the question will help
pinpoint a course of treatment for clinicians to administer. The more detailed the question, the better—because
it makes it easier and more likely to be found in a medical database. Here’s an example question: What are the
treatment options and challenges to consider for a COVID-19 patient who has also been diagnosed with Bell’s
Palsy? 
 Search the latest research. It is important to broadly seek out the best available evidence, including high-quality
articles from legitimate sources and other supporting materials containing the highest possible levels of
evidence. Then take a closer look at all of the evidence that’s been gathered to ensure it is indeed of optimal
quality. In addition to providing a critical appraisal of gathered resources, this step also helps determine if the
information or data is pertinent to the patient a nurse is treating and/or the clinical setting at which they work.
 Incorporate clinical experience. Now that the information has been carefully gathered and thoroughly analyzed,
it’s time to put it into action. This step is all about integration, involving a combination of new information
obtained with the nurse’s clinical experience to draw conclusions on how to apply the research findings to
patients.
 Accommodate patient preferences. At this point, the clinician should be especially mindful of patient profiles,
individual preferences, and values.
 Apply and assess the results. This final step completes a cycle whose mission is continuous quality improvement
in clinical care and practice. Should this EBP then be applied to other patients with the same condition? Was the
application of the new information or procedure effective?

THE PICO FRAMEWORK IN EBP

Without a well-focused question, it can be very difficult and time consuming to identify appropriate resources and
search for relevant evidence. Practitioners of EBP often use a specialized framework, called PICO, to form the
question and facilitate the literature search. The PICO model is a technique that healthcare professionals can use to
frame a clinical question and find an answer.

PICO stands for:

 Patient Problem, (or Population)
 Intervention,
 Comparison or Control, and
 Outcome

Framework item: Think about: Example:

Patient Problem What are the patient's demographics such as age, gender Work-related
(or Population) and ethnicity?  Or what is the or problem type? neck muscle pain
Strength training
What type of intervention is being considered? For example
Intervention of the painful
is this a medication of some type, or exercise, or rest?
muscle
Is there a comparison treatment to be considered? The
Comparison or
comparison may be with another medication, another form Rest
Control
of treatment such as exercise, or no treatment at all.
What would be the desired effect you would like to see?
Outcome What effects are not wanted? Are there any side effects Pain relief
involved with this form of testing or treatment?

Engr. Manuel S. Tumalad [email protected] 0915 879 1419

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ADVANTAGES OF EBP

BENEFITS OF EBP IN NURSING

The benefits of EBP in nursing include: 

 Providing nurses with the scientific research to make well-informed decisions.
 Encouraging nurses to provide individualized patient care.
 Improving time management by driving efficiency in nursing.
 Guiding implementation of new technologies into healthcare practice. 
 Helping nurses determine an effective course of action for care delivery.
 Helping nurses stay updated about new medical protocols for patient care.
 Increasing patients’ chances for recovery because decisions are based on documented interventions that align
with patient profiles.
 Enabling nurses to evaluate research so they can best understand the risks or effectiveness of treatments or
diagnostic tests.
 Improving patient outcomes, which can lead to decreasing demand for healthcare resources and reducing
expenses. 

BARRIERS TO EBP

The barriers that prevent nurses from using research in everyday practice have been reported as follows:
• Lack of value for research in practice. Nurses may not know or be aware of research findings.
• Lack of knowledgeable mentors. Nurses in practice do not usually associate or communicate with those who
produce research findings.
• Lack of education about the research process. Nurses do not understand research methods and have never had
formal research classes in their nursing schools.
• Lack of awareness about research or evidence-based practice. Nurses do not understand exactly what EBP is.
• Research reports/articles not readily available. Nurses lack the ability to locate and find relevant research reports.
Many have little or no education or training in information retrieval or accessing computer database
• No time on the job to read research. Nurses have no time to obtain research information.
• Complexity of research reports. Research is often in language that is not clinically meaningful.

Engr. Manuel S. Tumalad [email protected] 0915 879 1419

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• Feeling overwhelmed by the process. Nurses lack the basic knowledge to use information technology.
• Difficulty in changing practice. People have a fear of the unknown and a fear of change.
• Lack of administrative support. The organization (hospital, clinic, health care facility) is not ready for the challenge
and does not support EBP.

Nurses serve instrumental roles in ensuring and providing evidence-based practice. They must continually ask the
questions, “What is the evidence for this intervention?” or “How do we provide best practice?” and “Are these the
highest achievable outcomes for the patient, family, and nurse?” Nurses are also well positioned to work with other
members of the healthcare team to identify clinical problems and use existing evidence to improve practice.
Numerous opportunities exist for nurses to question current nursing practices and use evidence to make care more
effective.

DIFFERENCE BETWEEN EBP AND RESEARCH UTILIZATION (RU)

Research utilization (RU) is the process of transferring research findings to clinical nursing practice. In research
utilization, the emphasis is on using existing data (findings or evidence) from previous nursing research studies to
evaluate a current nursing practice. When the results of a study or a group of studies are adapted into a practical
application that is unrelated to the original study, it is called research utilization (RU). A major component of the
process is reviewing completed nursing research studies that have been published in the literature. It is not
conducting new research which involves the collection of new data to answer a specific clinical practice question.

RU is closely related to evidence based practice (EBP) because both use the evidence found in research to change
the way nurses practice, educate, or administer in “real life.” Research finds the reason, while RU or EBP is putting
the results of the research to work. However, EBP is broader than RU because it integrates research findings with
other factors. EBP is research utilization that includes other influences or considerations specific to the problem at
hand.

The difference between research utilization and EBP is that research utilization may lead to changes in practice that
are based on the results of one study, whereas EBP answers a clinical question based on an in-depth literature
search conducted to find all relevant current research evidence related to that problem. So, although research
utilization was an important concept to nursing, the EBP movement has led to important changes in clinical actions
and practice as a result of collaboration among the disciplines. More recently, research utilization efforts in nursing
have been replaced by evidence-based practice.

In short, RU is a review of research publications; EBP is using the healthcare provider's perception of what care
would be best in individual situations.

Sources/References:

Polit, D. & Beck, C. (2004). Nursing research: Principles and methods (7 th ed.). Philadelphia: Lippincott Williams &
Wilkins.

Beyea, S. C. & Slattery, M. J. (2006). Evidence-based practice in nursing: a guide to successful implementation.
Retrieved on 26 August 2020 from https://www.bookdepository.com/Evidence-Based-Practice-Nursing-Suzanne-
C-Beyea/9781578397228.

Engr. Manuel S. Tumalad [email protected] 0915 879 1419