CU 10 – EVIDENCE BASE PRACTICE

WHAT IS EVIDENCE PRACTICE

EBP is a problem solving approach that enables clinicians to provide the
highest quality of care for patient and families by integrating following
approaches:
 Critical Appraisal and critique of the most relevant research(evidence)
 Considering the own clinician expertise
 Considering preferences and values of the patient (Melynk &Fineout EBP FOLLOWS FIVE STEPS:
Overholt, 2019  Form a clinical question to identify a problem
 Gsther the best evidence
DEFINITION AND CHARACTERISTICS OF EBP
 Analyze the evidence
 (EBP) is the conscientious use of current best practice evidence in
 Apply the evidenffe to clinical practive
making decision about patient care. It is a lifelong problem solving
 Asess the result
approach to clinical practice that integrates the most relevant and best
research, one’s own clinical expertise and patient preferences and WHAT CAN A QUALITY IMPROVEMENT LEARNS FROM EBP
values  Evidence-based medicine and quality improvement are among the most
 Evidence based medicine, generated form systemic reviews of clinically commonly-used terms in healthcare and health systems.
randomized trial has been acknowledge as the strongest evidence upon  Evidence-based medicine is credited as one of the greatest medical
which practice decisions. advances of the 20th century and has influenced spheres far beyond
 EBP is the integration of best evidences available, nursing expertise, the health, from ‘evidence-based policy’ to ‘evidence-based conservation
values and preference of the individuals. Families and communities who  The incorporation of quality improvement into daily clinical practice,
we served comparison of quality improvement with evidence-based medicine may
 (EBP) defined as the integration of best research evidence with clinical provide insights to inform the future progress of the quality
expertise and patient values to facilitate decision making. (DiCenso et al improvement movement
2005). EBP AND QUALITY IMPROVEMENT
Evidence based practice Quality Improvement
 It is also include careful review of research findings according to
 Integration of best clinical  Evaluate effectiveness of nursing
guidelines that nurse scholars have measure the merit of a study or research evidence, clinical interventions and to provide
group expertise and patient values. direction for further improvement
 It emphasizes ritual, isolated and unsystematic clinical experiences,  Is the conscious and judicious use in the achievement of quality
ungrounded opinions, and tradition as a basis of practice and stresses of current best evidence in clinical outcomes and cost
the use of research findings conjunction with clinical expertise effectiveness.
 With the application of EBP comes better patient outcomes, which can and patient values to guide health  Bring about immediate
care decisions (LoBiondo-Wood & improvement of care in a specific
decrease the demand for healthcare resources. Thus, healthcare
Haber, 2010) setting
organizations can reduce expenses.  Translate research into practice  To compare organization to
 For example, outdated practices may have included supplies, equipment  Increase the effectiveness of standards or benchmarks.
or products that are no longer necessary for certain procedures or treatment  To improve patient care processes
techniques.  Encourage some consistency in  Seeks to improve processes in
 EBP is an essential component of safe, quality patient care. Nurses must practice unit and organization
be aware of current practices in order to provide care to patients with  Utilize interdisciplinary approach
 To improve practice.
complicated and debilitating conditions.
BARRIERS TO IMPLEMENTING EBP
BENEFITS OF BBP TO NURSES AND PATIENTS  Lack of knowledge and skills  Demands from patients on certain
 The inclusion of EBP in nursing provides nurses with the scientific  Cultures steeped in tradition type of Tx
research to make well-founded decisions.  Negative attitude about research  Peer/leader/manager resistance
 Through EBP, nurses can stay updated about new medical protocols for and EBP  Resistance to change
patient care. By searching for documented interventions that the  Lack of belief resulting in +  Lack of consequences for not
profiles of their patients, nurses can increase their patients' chances outcome implementing EBP
for recovery  Too much information  Lack of autonomy and power to
 Lack of time and resources change
 EBP enables nurses to evaluate research so they understand the risks or
 Too much patient loads  Inadequate EBP content and
effectiveness of a diagnostic test or treatments. The application of  Organizational constraints behavioral skill in educational
EBP enables nurses to include patients in their care plan. This  Lack of EBP mentors programs
allows patients to have a proactive role in their own healthcare
since they can voice concerns, share their values and preferences, and
CU 11 ETHICO- LEGAL and LEGAL FOUNDATION OF CE
make suggestions on how they want to proceed.
Code of ethics - is an articulation of nine provisions for professional values
CONCERNS RELATED TO EBP IN NURSING and moral obligations with respect to nurse patients and co-workers’
 EBP is focused on science of nursing rather than art of Nursing relationships
 Strict reliance on EBP will place the nurses in role of medical technician,  Honor human dignity
where nursing will be reduced to technical practice - We need to preserve and honor our client’s dignity
 Research involving human is complex, findings must be open for  Nurse-patient boundaries
interpretation and only a basis for practice - It is important to establish our nurse-patient boundaries
 It relates to promoting a link with EBM  Privacy and confidentiality
 It is concern relates to potential linking healthcare reimbursement - All the information your client have shared to you should be treated with
PROMOTION OF EBP IN NURSING the utmost confidentiality and privacy
 Implementation of EBP in Nursing is still evolving, as often as nursing  Accountable for actions
intervention are based on experience, tradition, intuition common - Remember that once you delegate to your subordinate, you are still
sense, and untested theories included in the accountability of the patient
 EBP has grown rapidly, especially over the last decade, the  Maintain competence, safety and integrity and personal growth
incorporation of nursing research findings had stopped. - “Nursing is a life long learning process”
 There is a significant support for increasing emphasis on EBP in Nursing - It is the nurses responsibility to update our knowledge and skills and for us
and many organization such as IOM, STTI, to be involved in continuous professional growth and development
 Practitioners, researchers, and scholars should welcome it as because a - We should attend seminars and trainings
systematic EBP may assist nurses in reducing the gap between the
theory and practice
 Deliver a high quality of care ETHICS - Define as guiding principles of behavior
- We need to ensure that we provide our client safe nursing care and quality ETHICAL - Refers to norms and standards of behavior accepted by the society to which a
care by attending seminars and being updated person belongs
MORAL VALUES - Refers to an internal belief system, What one believe is right
- Care that is given should be evidence-based ETHICAL DILEMMAS - Specific type of moral conflict in which two or more
 Contributes to advancement of his profession principles apply but support mutually inconsistent courses of action
- Once nurse researchers gathered new information, they share it with the ● Example:
field of nursing to contribute to the advancement of our profession - Nurse must respect patient autonomy and individual patient responsibility when we
 Participates in global efforts for health promotion and prevention encourage and support them in their self-management behavior but the ethical principle
 Involve in professional nursing organization of the patient’s right to self determination may clash with professional values that
promote health and health achieved medical outcomes
APPLICATION F ETHICAL PRINCIPLES OF PATIENT EDUCATION
Legal Rights and Duties
Autonomy Beneficence Refers to rule governing behavior or conduct that are enforceable by law under threat of
Veracity Justice punishment. Such as a fine, imprisonment, or both
Confidentiality Practice Acts
Nonmaleficence Documents that define a profession, describe that profession’s scope of practice, and
provide guidelines for state professional boards of nursing regarding standards for
THE ETHICS OF EDUCATION IN CLASSROOM AND PRACTICE SETTINGS practice, entry to a professional via licensure, and disciplinary actions that can be taken
The Student-Teacher Relationship when necessary
 The teacher possesses discipline-specific responses which is the key - Developed to protect the public from unqualified practitioners and to protect the
to students’academic success, career achievement and competent professional title such as registered nurse or RN
care of patients. AUTONOMY
 Potential blurring of professional-personal boundaries ● Refers to right of self determination or self governance
SPECIFIC CRITERIA TO DISTINGUISH BETWEEN INTERACTIONS THAT ARE ● This applies to the patient’s bill of rights informed consent Informed consent
- Has become the primary standard of protecting patient;s right and assist in guiding
APPROPRIATE ethical healthcare practice
 Risk of harm to the students or to the student-teacher relationship - Every human being of adult years has the right to determine what shall be done with
 Presence of coercion or exploitation his / her own body
 Potential benefit to students or the student – teacher relationship - He / she may choose whether to be treated or not and to what extent no matter how
 Balance of student’s interest and teachers’ interest necessary the medical care or how imminant the danger to his / her life or health if he /
she fails to submit to treatment
 Presence of professional ideals - The informed consent safeguards patient’s right to autonomy
The Patient-Provider Relationship - The patient autonomy does allow for healthcare provider to educate the patient but
It is important to recognize the balance of power that exist between a does not allow the healthcare provider to make the decision for the patient
nurse to a nursing student and a patient. - The process involves the physician providing the patient with information about the
Ethics of being a patient includes respecting nurses and trusting them to have diagnosis, procedure and treatment option, and the risks and benefits of the procedure.
the best interest. It is the physician who will provide these delicat information to the patient
Care rendered to patients as being ethical task - Although nurses are not responsible for completing the process of informed consent,
nurses have the duty to verify the informed consent that has been given
Patients have moral claim on the nurse competence.
- The nurse also acts as a resource to patient who may ask for clarification or information
CRITERIA TO ASSIST THE TEACHER IN COUNSELLING THE PATIENT to be repeated in terms they can understand
 Risk of harm to the students or to the teacher relationship - The nurses’ role is to ensure these information was provided and that the patient
 Presence of coercion or exploitation understands what has been communicated
 Potential benefit to students or the student – teacher relationship - The consent must be granted by the patient or legal guardian before the patient
 Balance between students’ interest and teachers interest undergoes a procedure
 Presence of professional ideals - According to hall and colleagues, informed consent has purposes; legal, ethical, and
administrative
STEPS DESIGNED TO BETTER GUIDE ETHICAL DECISION MAKING
- Legally, simple consent protects the patient against assault and battery in the form of
1. The identification of ethical problem unwanted medical interventions
2. The collection of information to identify the problem and develop solutions - The higher standard of informed consent further safeguards patient’s rights to
3. The development of alternatives for analysis and comparison autonomy, self-determination, and inviolability
4. The selection of best alternatives and justification - Ethically, consent also protects patient’s right to autonomy as well as supports their
5. The development of diverse, impractical ways to implement ethical goals in care. Seeking for respect patient’s autonomy by ensuring the treatment is
decisions and actions directed towards the end desired and chosen by the patient
6. The evaluation of effects and the development of strategies to prevent - Administratively, for the sake of compliance. The informed consent serves the
administrative purpose of a system level check to ensure that a consent process has
similar occurrences occurred
LEGALITY OF PATIENT EDUCATION AND INFORMATION ● Derived from Greek word Auto means self and nomos means law
 Patients’ bill of rights is the right of the patient to adequate information ● Patient’s right to make choices independently
regarding his physical condition, medication, risk, and access to ● Remember that it is the nurse’s responsibility to ensure informed decision making by
information regarding alternative treatment the client (dapat ang client ang magdedecide when it comes to themselves) (if ever
 The Joint Commission (TJC) stated the patient right to education and the client can’t make a decision for themselves, then advance directives will take place)
information - Every individual receiving health care be informed in writing of the right under state
law to make decisions about his or her health care including the right to refuse medical
 The regulation pertaining to patient’s education are published and
and surgical care and right to initiate advance directives.
enforced in many states. VERACITY
 Physicians are responsible and accountable for proper patient education ● Vera = Truth in Latin
 Patient education is central to culture of nursing as well as to its legal ● Veracity = Truthfulness
practice. ● Truth telling
LEGAL AND FINANCIAL IMPLICATION OF DOCUMENTATION ● Nurses are always confronted with issues of truth telling
 To qualify for Medicare and medic-aid reimbursement, the hospital - Regardless of the situation, the nurse must always tell the truth and the patient is
has to show evidence that patient education has been a part of always entitled to the truth.
CONFIDENTIALITY
patient care.
● Personal information that is entrusted and protected as privileged information via
 Respondent superior provides that the employer may be held
social contact, healthcare standard or code. Or legal covenant
liable for negligence, assault, and battery, false imprisonment, slander, ● Health care provider may not disclose information without consent of the patient
libel, and tort ● If sensitive information were not protected, patients would lose trust in their providers
IDENTIFICATION OF PATIENT AND FAMILY EDUCATION IS BASED ON THE and would be reluctant to openly share problems or even seek medical care at all.
FOLLOWING:
 Readiness to learn BREACH OF CONFIDENTIALITY
 Obstacles to learning (language, sensory visual or hearing, low CIRCUMSTANCES BREACHING CONFIDENTIALITY IS
literacy, cognitive deficit LEGALLY PERMITTED
 Referrals, which include a patient advocate or ethics committee
a. When the patient has been the victim or subject of a crime to which the nurse or the
doctor is the witness
b. When the nurses or other health professional suspects or are aware of child or elder
abuse, narcotic use, legally reportable communicable disease, gunshot or knife wound,
or threat of violence toward someone.
Example:
- If the patient test positive for HIV/AIDS and has no intention of telling his spouse about
the diagnosis, the physician has an obligation to warn the spouse directly or indirectly
NONMALEFICENCE
● Defined as “do no harm”
● One of the characteristics of nonmaleficence is refraining from acts that are offensive
to others. Example: being judgmental and bullying
● Ethics of legal determination involving negligence and/or malpractice
Negligence
○ Conducts which falls below the standard established by law for the protection of
others against unreasonable risk of harm
- Involves conduct of professionals that falls below a professional standard of due care.
- “kapabayaan”
Malpractice
○ Refers to a limited class of negligent activities committed within the scope of
performance by those pursuing a particular profession involving highly skilled and
technical services
BENEFICENCE
● An ethical principle that address the idea that a nurse’s actions should promote good
● Defined as doing good for the benefit of others
● In anything that we do as a health educator, it should be done to promote the good
and welfare of the client
● Beneficence can come in many forms such as prevention, and early intervention
actions that contribute to the betterment of client
● Defined as doing good
● Properly carrying out critical tasks and duties contained in job description; in policies,
procedures, and protocols set forth by health care facilities.
JUSTICE
● Fairness and the equitable distribution of goods and services.
● The focus of the law is the protection of the consumer