Presented by

Samim khan
Nursing tutor
o 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.
o Evidence based practice (EBP) is the process of making
clinical decisions based upon evidence, combined with
clinical experience and patients expectations.

o 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)
o To provide the high quality and most cast efficient
nursing care possible.
o To advance quality of care provided b health worker.
o To increase satisfaction among patients.
o To focus on nursing practice away from habits and
tradition to evidence and research.
o It results in better patient outcomes.
o It contributes to the science of nursing.
o It keeps practice current and relevant.
o It increases confidence is decision making.
o Evidence based practice seeks to replace practice as usual
with practice guided by rigorous outcomes oriented
research ideally randomized controlled trials.
o It also seeks to make practice a less subjective enterprise
and to rise it to a higher level of accountability.
o Reduces the variations in nursing care and assist
with efficient and effective decision making.
o Providing practice to the nurse evidence based data to
deliver effective care.
o For making sure that each client get the best possible
•
servi ces.

o Update knowledge and is essential for lifelong learning.

o Provide clinical judgment.

o Improvement care provided and save lives

o To provide framework for understanding the evidence

based practice process.

 •• -

• The patient population of interest

• Intervention of interest or range of

intervention.e.g. exposure and risk behavior

• Comparison of intervention e.g. no

intervention.

• Outcomes of interest e.g. accuracy

of diagnosis risk of disease
1. The steler model

2. IOWA model

3. Ross worm and lama bee model

o It was developed as practitioner oriented model in 1994.
o It was revised in 2001 without changes in its focus on
critical thinking.
o 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
1. External evidence
2. Internal evidence
Derived from opinions of concepts.
Comes from the experts own experi ences.
•

It comes from systematically obtain facts or information at ground level

o Successfully implanted since 1994 intervention ally.
o Infuses research into practice to improve quality of care.
o Planned change principles integrated research
and practice.
o Utilizes a multidisciplinary team approach.

Highlights of the models :-

o it incorporates the use of research and other forms
of evidence.
o Interference to support research use might involve every
level of the organization.
o Evidence based practice is linked to quality assurance.
o Staff are given recognition for research work.
o Clinicians are given time and resources for research work.
o This model explains how organizations changes practice
based on research.
o It gives a systemic design.
o It includes both the practitioner and
organizational perceptive.
o It provides guide for regarding implementation of evidence
based practice.
 llllowledp Pocased Trlger1

New research or other literature national agencies guidelines/standard philosophies o

Questions from institutional standard committees

o Develop by rossworm and larabee in 1999. it is based
on theoretical and research literature.

o It begins with the assessment of need and

integration of an evidence based protocol.

o Focuses on the use of change theory, principles of

research and standardizations nursing nomenclature.
STAGES OF ROSSWORM AND lARABEE
MODEL

Link problem interventions and outcomes

Assessment need for change
o Lack of value for research in practice.

o Difficulty in bringing change.

o Lack of administrative support

o Lack of knowledge.

o Lack of time for research.

o Many nurse have not receive any formal instruction in

research and they lack skill to judge the merits of

study.
 ON ...
o Unavailability of research reports, which are not easily
gathered.

o Complexity of the research regarding evidence based

practice.

o Organization have failed to motivate or rewards.

o 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.
 ADVA

o Information explores
o Provide better patient outcomes.
o Ebp increases the efficiency of nurses.

o Making decision based on knowledge that is backed by

research.

o It keeps nursing practice current to the new trends and

updated guidelines of care.
 ONT ••.

o It provides variations in practice because it can help

determine high quality cast effective intervention
that actually work.

o It promotes high quality and cast effective

intervention and treatment.

o Using EBP to provide care to patients increases the

nurses confidence.
o The State of Evidence-Based Practice in US
Nurses: Critical Implications for Nurse Leaders
and Educators
o 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
o 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 b evidence-based.
o Evidence-Based Practice and the Role of Nursing
Leadership
o 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
o 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.
Nurses' Perceived Knowledge, Beliefs, Skills, and Needs
Regarding Evidence-Based Practice: Implications for
Accelerating the Paradigm Shift
o Bernadette Mazurek Melnyk RN, PhD, CPNP/NPP, FAAN,
FNAP
o Ellen Fineout-Overholt RN, PhD
o Nancy Fischbeck Feinstein RN-C, PhD
o Hong Li RN, PhD
o 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.
o 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.
o 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.
o 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.
o 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.
o Brae Kaur Navdeep ; HC Rawat, textbook of advance
nursing practice first edition. Jaypee publisher; page
no 533-541.
o Basheer. P, shabeerkhan . Yasmeen S. A concise
textbook of advanced nursing practice first edition;
EM-ESS medical publisher; page no. 751-757.
o Polit. F. Denise ; back tatano cheryl nursing research ;
generating and assessing evidence for nursing
practice ; tenth edition, waiters kumars publisher
page no 30-41.