Chapter 5 Evidence-Based Practice

Key Terms

Clinical guidelines
o Systematically developed statements about a plan of care for a specific
set of clinical circumstances involving a specific patient population.
Confidentiality
o Guarantees that any information a subject provides will not be
reported in any manner that identifies the subject and will not be
accessible to people outside the research team.
Evaluation research
o A form of quantitative research that determines how well a program,
practice, procedure, or policy is working.
Evidence-based practice (EBP)
o A systematic approach to rational decision making that facilitates
achievement of best practices
Ask a clinical question
Collect the most relevant and best evidence
Critically appraise the evidence gathered
Integrate all evidence with ones clinical expertise and patient
preferences and values in making a practice decision or change
Evaluate the practice decision or change
Share the outcomes of EBP changes with others
Experimental study
o Tightly controls conditions to eliminate bias and ensure that findings
can be generalized to similar groups of subjects
Nursing research
o A way to identify new knowledge, improve professional education and
practice, and use resources effectively.
Peer-reviewed
o An article reviewed by a panel of experts familiar with the topic or
subject matter of the article before it was published.
Performance improvement (PI)
o Where an institution analyzes and evaluates current performances and
uses the results to develop focused improvement actions.
PICOT question format for developing a question for research
o P = Patient population of interest
ID patients by age, gender, ethnicity, and disease or health
problem
o I = Intervention of interest
Which intervention is worthwhile to use in practice (e.g., a
treatment, diagnostic test, prognostic factor)?
o C = Comparison of interest
What is the usual standard of care or current intervention used
now in practice?
o O = Outcome

What result do you wish to achieve or observe as a result of an

intervention (e.g., change in patient behavior, physical finding,
patient perception)?
o T = Time
What amount of time is needed for an intervention to achieve an
outcome (e.g., the amount of time needed to change quality of
life or patient behavior)?
Qualitative nursing research
o The study of nursing phenomena that are difficult to quantify of
categorize, such as patients perception of illness.
Quality improvement (QI)
o An approach to the continuous study and improvement of the
processes of providing health care services to meet the needs of the
patients and others and inform health care policy.
Research process
o An orderly series of steps that allow a researcher to move from asking
the research question to finding then answer.
Problem identification
Study design
Conducting the study
Data analysis
Use of the findings

Key Points

A challenge in EBP is to obtain the very best, most current information at the
right time, when you need it for patient care.
Using your clinical expertise and considering patients values and preferences
ensures that you will apply the evidence in practice both safely and
appropriately.
The five steps of EBP provide a systematic approach to rational clinical
decision making.
The more focused a PICOT question is, the easier it will become to search for
evidence in the scientific literature.
The hierarchy of available evidence offers a guide to the types of literature or
information that offer the best scientific evidence.
A randomized controlled trial is the highest level of experimental research.
Expert clinicians are a rich source of evidence because they use it frequently
to build their own practice and solve clinical problems.
The critique or evaluation of evidence includes determining the value,
feasibility, and usefulness of evidence for making a practice change.
After critiquing all articles for a PICOT question, synthesize or combine the
findings to consider the scientific rigor of the evidence and whether it has
application in practice.
When you decide to apply evidence, consider the setting and whether there
is support from staff and available resources.

Research is a systematic process that asks and answers questions that

generate knowledge, which provides a scientific basis for nursing practice.
Outcomes research is designed to assess and document the effectiveness of
health care services and interventions.
Nursing research involves two broad approaches for conducting studies:
quantitative and qualitative.
The research process usually consists of the following steps:
o Identifying the problem
o Designing the study
o Conducting the study
o Analyzing the data
o Using the findings
A thorough analysis of QI data leads clinicians to understand work processes
and the need to change practice.