Evidence Based Nursing in

Primary Health Care

Strength of a National Development

Prema .P
Principal
Navodaya College Of Nursing
Raichur
Karnataka
Why we are all here???????
• To visit Chennai in the Name of
conference
• As a part of our academic activity and
meet with our friends
• Our teachers told us so we have too….
• To improve our knowledge in EBP
• To practice EBP in my future
 Ordinary man can try million
times,But only a ambition man can
try one time in a million ways
Conference theme

Evidence based Nursing

Research: Promote Education,
inform Practice, Derive Quality
Care Policies
Outline
Review of
• Primary Health Care
• Nursing contribution to
Principles and Values of PHC
• EBP
• Future of PHC Nursing
Dear Professionals ……….

Your attention is
highly and heartly
appreciable
Destination to the

World…
Over 32 years ago, we had set a
bold aspiration on health in India

India was a signatory to the Alma-Ata

declaration 1978, to attain the
global objective of

“Health for All by year 2000”

Why Alma Ata declaration?
What is Primary Health Care?
Primary health care is essential health care based
on practical, scientifically sound and socially
acceptable methods and technology made
universally accessible to individuals and families
in the community through their full participation
and at a cost the community and country can
afford to maintain at every stage of their
development in the spirit of self-reliance and self-
determination.
(Declaration of Alma Ata, 1978)
Why Nursing in Primary Health
Care ?
Who is PHC Nurse ?
 As per ICN these members are under the
umbrella of PHC Nursing
• Public Health Nurses • Learning Disability
• Community Nurses Nurses
• Health Visitors • District Nurses
• Maternity Nurses • Home Care Nurses
• Practice Nurses • Palliative care Nurses
• Nurse practitioners • Community Pediatric
• School Nurses Nurses and
• Family Nurses
• Community Mental
Health Nurses
For example
• A case study was conducted by Patterson, Elizabeth
(2000) to describe the current role of these nurses and to
identify and analyze the factors that influenced their
scope of practice and hence their contribution to PHC.
The result of the study showed that the practice nurse's
role, and hence contribution to PHC, was found to be
constrained by a number of factors . The majority of
practice nurses believe their role should be expanded to
include autonomous functioning while most of the GPs
were amenable to some extension of nursing practice
but reticent or opposed to any independent interventions
Nursing contribution to principles
and values of primary health care
Equitable Distribution
• National sample survey organization
• A comparative study to assess the utilization of
immunization Services among under-five
children in a selected areas of Raichur district,
Prema(2004)
 
Universal access to care and coverage on
the basis of need
• Nursing care of people with HIV/AIDS in South Africa,
Uys(2003)
• The prevalence rate of AIDS for people aged 15-49 in
south Africa is 18.8% compared to 0.6 in the USA
UNAIDS (2006)
Community Participation
• Community health volunteers‘
• Village health and sanitation community
• Rogi Kalyan Samitis (Patient welfare Society
/hospital Development Committee)
• Decentralization :Involvement of Panchayati Raj
Institutions –PRI (local government bodies )
• Community led initiatives to promote HFA
Sheela Pai and Nagarajaiah (1980) compared the cost of
treatment of chronic schizophrenic patients at hospital
and at community. They found lower cost of home care
and improved family participation in treatment process.
Inter-sectoral coordination and convergence
of programmes
• Convergence with different health related sectors
• Convergence with Indian system of medicine(AYUSH)
• Coordination with rural medical practitioners
• Coordination with Non- Governmental and civil
Organization
• Public Private Partner ship (PPP)
Appropriate Health Technology
• Technology that is scientifically sound, adaptable to
local needs, and acceptable to those who apply it and
those whom it is used, and that can be maintained by
the people themselves keeping with the principle of
self reliance with the resources the community and
country can afford(WHO)
Cont,,

• The ICN code of ethics for Nurses (2006) refers to the

nurse ,in providing care ,ensures that the use of
technology and scientific advances are compatible with
the safety, dignity, and rights of people’. To practice
ethically and responsibility, PHC nurses must be aware
of the range of health technologies available to them and
be knowledgeable about their safety and efficacy.
Research brings change in nursing
education

Joubert, A., Viljoen, M.J. Venter, J. A. &

Bester, C.J. (2002) Evaluation of the effect of a
computer-based teaching programme. (CBTP)
on knowledge, problem-solving and learning
approach. Sample : Convenience sample of
120 nursing students in two educational
Institutions in South Africa.
Components of PHC
Maternal and child health
Sneha Mathew(2010) A Study to assess the
effectiveness of Structured Teaching Programme on
knowledge regarding Selected Obstetric Emergencies
and Their Management among Junior Health Assistant
(Female) Students in selected Training Center Of
Raichur, Karnataka”( Navodaya College Of Nursing,
Raichur)
 
Immunization
• Kotturesh K.M. “An
experimental study to
assess the effectiveness
of Structured Teaching
Programme on Hepatitis
B, Vaccination among the
mothers of under 5
children, admitted in the
paediatric ward at S.C.
Hospital, Hassan, 2006,
(NDRK College of
Nursing)
Nutrition
K.Thilagam (2009)An experimental study to
assess the effectiveness of dietary intervention
on anemia among adolescence girls in selected
area at Thiruvallur District, Saveetha College
of Nursing ,Chennai
Prevention and control of locally endemic
diseases
• Shankarevva N, “A
study to assess the
knowledge and
attitude of high school
children regarding
prevention and
control of tuberculosis
in selected schools at
Bilekalli, 2005
(Maaruti College of
Nursing, Bangalore).
Treatment of common illness and injuries
• Vijayakumari G. “A
study to assess the
effectiveness of
structured teaching
programme regarding
nature and prevention of
accident among mothers
of toddlers in selected
area of Raichur, 2004
(Navodaya College of
Nursing, Raichur).
Provision of essential drugs
• Fuqua and Stevens
(1988) reviewed
studies conducted
about medication
errors. The ward
managed by qualified
nursing staff showed
less medication error
than the ward
managed by technical
staff.
Safe water and basic sanitation
Health education
Lipman (1986) reported
that newly
diagnosed diabetic
children educated
by a nurse were
discharged from the
hospital an average
of 2.2 days earlier
than children taught
only by non nursing
staff.
Know yourself …….

Cow , Tiger, Sheep,

Horse, Pig
What is EBPHC?
Evidence-based Primary Health Care is
defined as the development, implementation,
and evaluation of effective programs and
policies in public health through application of
principles of scientific reasoning, including
systematic uses of data and information
systems, and appropriate use of behavioral
science theory and program planning models.
EBPHC is the conscientious explicit and
judicious use of current best evidence in
making decisions about the care of
communities and population in the domain of
health protection, disease prevention, health
maintenance and improvement
 know the Goals
• Provide practicing nurses with evidence-
based data
• Resolve problems in the clinical setting
• Achieve excellence in care delivery
• Introduce innovation
• Reduce variations in nursing care
• Assists with efficient and effective
decision-making
Goals (con’t)
• Using best evidence to implement the
regulation of nurses
• Resolve regulatory problems
• Achieve excellence in regulation
Why is it important?
Provides
assurance that
decision making is
based on scientific
evidence and
effective practices;
Cont….
• Helps ensure the
retrieval of up-to-date
and reliable information
about what works and
doesn’t work for a
particular health
question;
Cont,,,,
• Provides assurance that
one’s time is being used
most efficiently and
productively in
reviewing the “best of
the best” information
available on the
particular health
question.
When is it important?
• When it’s
important to
have scientific
evidence to
support decision
making;
Cont,,,
• When evaluating
the effectiveness
and cost benefits
of health
programs;
Cont,,,,
• when
implementing
new health
programs;
Cont,,,,
• when
establishing
new policies
Cont,,,,,,
• When
conducting
literature
reviews for
grant projects.
How to do ?
Step 1 :
Formulate
answerable
clinical
question
PICO

• Patient, Population or • What are the

Problem characteristics of
the patient or
population?
• What is the
condition or
disease you are
interested in?
PICO
• What do you
• Intervention or want to do
exposure with this
patient (e.g.
treat,
diagnose,
observe)?
PICO
• Comparison • What is the
alternative to
the
intervention
(e.g. different
drug, surgery)?
PICO
Outcome • What are the
relevant
outcomes (e.g.
morbidity, death,
complications)?
How to formulate question?
You admit a 75 year old woman with community-
acquired pneumonia. She responds nicely to
appropriate antibiotics but her hemoglobin remains at
100 g/l with an MCV of 80. Her peripheral blood
smear shows hypochromia, she is otherwise well and
is on no incriminating medications. You contact her
family physician and find out that her Hgb was 105
g/l 6 months ago. She has never been investigated for
anaemia. A ferritin has been ordered and comes back
at 10 mmol/l. You admit to yourself that you're
unsure how to interpret a ferritin result and aren't sure
how precise and accurate it is.
Here is the question ?
Patient or Problem: Elderly woman with
anaemia
Intervention: Ferritin
Comparison Intervention:
Outcome: Iron deficiency anemia
Question: In an elderly woman with hypo
chromic, microcytic anemia, can a low
ferritin diagnose iron deficiency anemia?
Step 2 :
Select
information
sources
Sources
• Journal literature
• Books
• Conference proceedings & abstracts
• Dissertations & theses
• Unpublished scientific papers
• Government reports (federal, state and local)
• Policy statements, laws & regulations
• Surveillance data
• Newsletters
• Teleconferences & webcasts
• Alert systems
• Listservs
• Internet sources
• Expert opinion 57
Step 3 :
Identify key
concepts and
terms.
“What are effective programs and
interventions for reducing obesity in school-
age children

• Some of the key concepts and

terms, also known as subject
headings, for this question are
child, obesity, and program
evaluation.
Some terms which helps to expand search...
• adolescent • exercise
nutrition • health
• body mass index education/methods
• body weight • health promotion
• child nutrition • health status
• life style
• longitudinal studies
• nutrition/education
Step 4 :
Conduct the
search in subject-
appropriate
databases &
Select documents
for review.
People reading research reports want
investigators to answer four questions:

Why did you start?

What did you do?
What answer did you get?
What does it mean anyway?
Clinical question

• As a nurse practitioner in a primary health care

practice, you see many adult patients with
asthma. The primary health care team wants to
discuss strategies to improve care for these
patients. They are particularly interested in
whether both regular review by a health
practitioner and patient education should be
continued or whether giving patients written
materials is just as effective.
Answerable Question
"Is a self-management programme
that includes asthma education
plus regular review by health
professionals, effective in
improving health outcomes for
adults with asthma?"
PubMed <www.pubmed.gov>
Cochrane Collaboration
<www.cochrane.org>
Searching Terms and Evidence Source:

["asthma" OR "wheeze"] AND "patient education" in

the Cochrane Library. The Cochrane Library is the
most comprehensive source of updated systematic
reviews, and this simple search identifies the
following review which appears to be very relevant to
the question: Gibson PG, Coughlan J, Wilson AJ, et
al. Self-management education and regular
practitioner review for adults with asthma (Cochrane
Review, latest update 29 May 1998). In: The
Cochrane
Step 5 :

Critical
appraisal of
evidence
.
Read the article and decide
• Is the evidence from this randomized trial
valid?
• If valid, is this evidence important?
• If valid and important, can you apply this
evidence in caring for your patient?
Step 6 :

Applying
evidence to
the Patient
Step 7 :

Self evaluation
Know yourself ……..
• Cow for CAREER
• Tiger for PRIDE
• Sheep for LOVE
• Horse for FAMILY
• Pig for MONEY
What are the priority areas of PHC
Research?
• Evidence based practice,
• Quality of care,
• Models of organization and delivery of health
care,
• Integration,
• Economic issue relating to optimal use of
resources,
• Health inequalities and the determinants of
health,
• Illness prevention and health promotion
Dr .A.P.J Abdul Kalam’s Message
for Nurses
How to promote evidence based practice
in Nursing research?
Implication to education
• Curriculum for PHC nursing should be based on
the principles of PHC
• Multi disciplinary learning should become
mandatory component of PHC nursing
curriculum
• Nursing curricula should involve innovative
learning strategies
• PHC nurses should have equitable access to
continuous professional development (CPD)
Implication to research
• Development of methodologies for synthesizing
qualitative research
• Systematic reviews of effectiveness
• Primary research for effectiveness
Implication to practice
• Practice should be oriented towards
participation and empowerment
• Value should be attributed to nursing
practice
OK What this prema is trying for
……. IIIIII
Conclusion

Research should not just satisfy the

urge of researcher to do research, but
it should always be directed to improve
the quality of nursing education
intervention and administrative
approaches.
Thank You
Think Big
Start Small
Act Now