Evidence based practice

FOR NURSING

1. EVIDENCE BASED PRACTICE Presented by Monika Devi Msc.(N) HCN, SRHU

2. Introduction Evidence based practice is an approach that enables clinicians to provide the highest quality of care in meeting the multiphase needs to their parents and family.

3. Definition Evidence based practice (EBP) is the process of making clinical decisions based upon evidence, combined with clinical experience and patients expectations. Evidence based practice is the conscientious explicit and judicious use of current. Best evidence in making decision about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence fro systematic research. (Sackett. et al 1996)

4. PROCESS OF EBP

5. AIMS OF EBP To provide the high quality and most cast efficient nursing care possible. To advance quality of care provided b health worker. To increase satisfaction among patients. To focus on nursing practice away from habits and tradition to evidence and research. It results in better patient outcomes. It contributes to the science of nursing. It keeps practice current and relevant. It increases confidence is decision making.

6. OBJECTIVES AND PURPOSES OF EBP Evidence based practice seeks to replace practice as usual with practice guided by rigorous outcomes oriented research ideally randomized controlled trials. It also seeks to make practice a less subjective enterprise and to rise it to a higher level of accountability. Reduces the variations in nursing care and assist with efficient and effective decision making. Providing practice to the nurse evidence based data to deliver effective care.

7. NEED FOR EBP For making sure that each client get the best possible services. Update knowledge and is essential for lifelong learning. Provide clinical judgment. Improvement care provided and save lives To provide framework for understanding the evidence based practice process.

8. STEPS OF EVIDENCE BASED PRACTICE

9. step 1 is based on pico :-

10. Models for evidence based practice The steler model IOWA model Ross worm and lama bee model

11. 1. Stelter model It was developed as practitioner oriented model in 1994. It was revised in 2001 without changes in its focus on critical thinking. It raised awareness about the importance of applying research finding in nursing practice. Meaning of evidence as per stelter model:- Evidence is define as information or facts that are obtained systematically evidence comes from two different sources External evidence Internal evidence

12. Cont…

13. Stelter model

14. 2. Iowa model Successfully implanted since 1994 intervention ally. Infuses research into practice to improve quality of care. Planned change principles integrated research and practice. Utilizes a multidisciplinary team approach. Highlights of the models :- it incorporates the use of research and other forms of evidence. Interference to support research use might involve every level of the organization. Evidence based practice is linked to quality assurance.

15. Cont… Staff are given recognition for research work. Clinicians are given time and resources for research work. This model explains how organizations changes practice based on research. It gives a systemic design. It includes both the practitioner and organizational perceptive. It provides guide for regarding implementation of evidence based practice.

16. Iowa model barriers to using research in nursing

17. 3. Ross worm and laree model Develop by rossworm and larabee in 1999. it is based on theoretical and research literature. It begins with the assessment of need and integration of an evidence based protocol. Focuses on the use of change theory, principles of research and standardizations nursing nomenclature.

18. Stages of rossworm and larabee model

19. BARRIERS TO EBP Lack of value for research in practice . Difficulty in bringing change. Lack of administrative support Lack of knowledge. Lack of time for research. Many nurse have not receive any formal instruction in research and they lack skill to judge the merits of study.

20. Cont… Unavailability of research reports, which are not easily gathered. Complexity of the research regarding evidence based practice. Organization have failed to motivate or rewards. There is a shortage of role models nurse who can be evaluated for their success in using or promoting the use of research in clinical practice.

21. ADVANTAGES OF EBP Information explores Provide better patient outcomes. Ebp increases the efficiency of nurses. Making decision based on knowledge that is backed by research. It keeps nursing practice current to the new trends and updated guidelines of care.

22. Cont… It provides variations in practice because it can help determine high quality cast effective intervention that actually work. It promotes high quality and cast effective intervention and treatment. Using EBP to provide care to patients increases the nurses confidence.

23. summary

24. The State of Evidence-Based Practice in US Nurses: Critical Implications for Nurse Leaders and Educators Melnyk , Bernadette Mazurek PhD, RN, CPNP/PMHNP, FNAP, FAAN; Fineout-Overholt , Ellen PhD, RN, FNAP, FAAN; Gallagher-Ford, Lynn PhD, RN; Kaplan, Louise PhD, RN, ARNP, FNP-BC, FAANP

25. This descriptive survey assessed the perception of evidence-based practice (EBP) among nurses in the United States. Although evidence-based healthcare results in improved patient outcomes and reduced costs, nurses do not consistently implement evidence-based best practices. A descriptive survey was conducted with a random sample of 1015 RNs who are members of the American Nurses Association. Although nurses believe in evidence-based care, barriers remain prevalent, including resistance from colleagues, nurse leaders, and managers. Differences existed in responses of nurses from Magnet® versus non-Magnet institutions as well as nurses with master’s versus nonmaster’s degrees. Nurse leaders and educators must provide learning opportunities regarding EBP and facilitate supportive cultures to achieve the Institute of Medicine’s 2020 goal that 90% of clinical decisions be evidence-based.

26. Evidence-Based Practice and the Role of Nursing Leadership Stetler , Cheryl B. PhD, RN, FAAN; Brunell , Mary MS, RN; Giuliano , Karen K. MSN, RN, CCRN; Morsi , Deborah MS, RN; Prince, Lorna MS, RN; Newell-Stokes, Virginia MS, RN

27. A new term,  evidence-based practice , is beginning to appear both in the healthcare literature and at professional conferences. Its meaning, however, is not always clear, nor is its full implication for nurse administrators explained. This article provides a pragmatic definition of evidence-based practice developed in the nursing division at Baystate Medical Center, Springfield, Massachusetts. It outlines steps required to institutionalize evidence as a routine part of nursing practice and provides examples of its use.

28. Nurses' Perceived Knowledge, Beliefs, Skills, and Needs Regarding Evidence‐Based Practice: Implications for Accelerating the Paradigm Shift Bernadette Mazurek Melnyk RN, PhD, CPNP/NPP, FAAN, FNAP   Ellen Fineout‐Overholt RN, PhD Nancy Fischbeck Feinstein RN‐C, PhD   Hong Li RN, PhD   

29. Background: -The paradigm shift to evidence‐based nursing practice in the United States has been slow. Although multiple barriers to evidence‐based practice (EBP) have been identified through prior studies, there is a gap in the literature specifically identifying key variables (e.g., belief that EBP produces quality outcomes) that are correlated with the extent to which nurses engage in EBP. Aim:  The primary aims of this study were to (1) describe nurses' knowledge, beliefs, skills, and needs regarding EBP; (2) determine whether relationships exist among these variables; and (3) describe major barriers and facilitators to EBP. Methods:  A descriptive survey was conducted with a convenience sample of 160 nurses who were attending EBP conferences or workshops in four states located within the Eastern Region of the United States.

30. Results:  Although participant beliefs about the benefit of EBP were high, knowledge of EBP was relatively low. Significant relationships were found between the extent to which the nurses' practice is evidence‐based and (1) nurses' knowledge of EBP, (2) nurses' beliefs about the benefits of EBP, (3) having an EBP mentor, and (4) using the Cochrane Database of Systematic Reviews and the National Guideline Clearinghouse. Conclusion and Implications:  Health care systems need to implement interventions that not only increase nurses' EBP knowledge and skills, but also strengthen their beliefs about the benefit of evidence‐based care. EBP mentors may be key in accelerating a more rapid shift toward evidence‐based nursing practice. Theoretically driven randomized controlled trials are urgently needed to test the effectiveness of interventions on advancing evidence‐based care.

31. conclusion

32. references Brae Kour Navdeep ; HC Rawat, textbook of advance nursing practice first edition . Jaypee publisher ; page no 533-541. Basheer. P, shabeerkhan . Yasmeen S. A concise textbook of advanced nursing practice first edition; EM-ESS medical publisher; page no . 751-757. Polit. F. Denise ; back tatano cheryl nursing research ; generating and assessing evidence for nursing practice ; tenth edition, wolters kumars publisher page no 30-41.