COLLEGE OF NURSING

MADURAI MEDICAL COLLEGE

MADURAI
ADVANCED NURSING PRACTICE
SEMINAR ON
NURSING PRACTICE FRAME WORK,SCOPE,
TRENDS,EVIDENCE BASED PRACTICE,EVIDENCE
BASED PRACTICE MODEL.

Submitted to:
Mrs. J .Alamelu mangai M.Sc.(N),MBA,(H.M)
Mrs.N. Rajalakshmi M.Sc.(N),
Nursing tutor GR 2,
College of Nursing,
Madurai Medical College,
Madurai- 20 Submitted by:
Ms. S. Mahalakshmi,
M.Sc Nursing 1 st year,
College Of Nursing,
Madurai Medical College,
Madurai -20

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NAME : MS.S.MAHALAKSHMI

PROGRAMME : M.Sc NURSING 1 YEAR

SUBJECT : ADVANCED NURSING PRACTICE

TOPIC : NURSING PRACTICE

FRAMEWORK, SCOPE, TRENDS, EVIDENCED
BASED NURSING PRACTICE, EVIDENCE BASED
PRACTICE MODEL.

EVALUATOR : Mrs.J.ALAMELU MANGAI,M.Sc(N),MBA,

Mrs.N. RAJALAKSHMI M.Sc(N)

PLACE : COLLEGE OF NURSING

MADURAI MEDICAL COLLEGE
MADURAI

DATE : 16/11/2015

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 INDEX
S.NO CONTENT PAGE
NO
1 Introduction 4
2 Objectives 5
3 Definition of nursing practice 6-9
4 Frame work of nursing practice 9-12
5 Scope of nursing practice 12-21
6 Trends in nursing practice 21-27
7 Evidence based practice 27-28
8 Definition 29
9 Steps of EBP 31-35
10 process OF EBP 35-36
11 Advantages and dis advantages of EBP 36-38
12 Models of evidence based practice 38-42
13 Summary 43
14 Conclusion 44
15 Bibliography 45

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 INTRODUCTION

Society and its health care needs are always evolving. As a

result, today health care faces many challenges, including
rising costs, shortages of professionals, an aging population,
the introduction of new technology and difficulties with
access to care. the demand for collaborative, innovative
clinical practitioners to act as leaders in health care never
been stronger.
Nurses in advanced nursing practice are well
positioned to respond to the evaluation of health care. In
particular, advanced nursing plays a key role in meeting the
health need by building the nursing knowledge, advancing
the nursing profession and contributing to a sustained and
effective health care system.

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OBJECTIVES:
At the end of the seminar the participants will be
able to:
o define nursing practice.
o list down the characteristics of nursing practice.
o explain the nursing practice frame work.
o enumerate the scope of nursing practice.
o enlist the nursing practice in different settings.
o describe the trends in nursing practice.
o explain the roles of professional nurse.
o define evidence based nursing practice.
o list down the needs for evidence based practice.
o explain the steps in evidence based practice process.
o enlist the advantages and dis advantages of EBP
o describe the evidence based practice

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 EVOLUTION OF ADVANCED NURSING
PRACTICE:
 Optimizing the nursing contribution to health care through
expanding their role is an effective strategy for improving
health services.
 As demand technology and knowledge change the ways in
which health care is delivered through advanced nursing
practice.
 It provides opportunity for nurses to expand current roles and
create new ones.
 Advanced nursing practice includes in education, clinical
expertise, leadership skills, understanding organizations,
health policy and decision making.

DEFINITON NURSING PRACTICE:

 Advanced nursing practice is in umbrella the term describing
an advance level of clinical nursing practice that maximizes
the use of graduate educational preparation, in-depth nursing
knowledge and expertise in meeting the health need of the
individual, families, groups, community and populations.
It involves,

 Analyzing and synthezing knowledge and profession.

 Understanding, interpreting and applying nursing
theories and research.

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 CHARACTERISTICS:

 Provision of effective and efficient care delivered with a high

degree of autonomy to an identified population.
 Demonstrate the leadership and initiation of change to
improve client, organization and system.
 Deliberate, purposeful, integrated use of in-depth nursing
knowledge, research and clinical expertise.
 Ability to explain and apply the theoretical empirical, ethical
and experimental foundation of nursing practice.
 Understanding, developmental and dissemination of evidence
based practice.
 Ability to planning, implementing, coordinating programs.
 Demonstration of advanced judgement and decision making
skills.
 Critical analysis influence on health policy

EDUCATIONAL PREPARATION:
 The minimum educational preparation for nursing practice is
graduate degree.
 This gives the theoretical foundation in nursing and promote
the nursing research, generate new knowledge, interpret,
incorporate this knowledge into clinical practice.

RULES:

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  Advanced nursing practice focuses on clinical practice
whether through a direct relationship with clients or
through supportive or consultative role.
 The significant role of the advanced nursing practice is
nursing educator, nurse administrator.the nurse should
demonstrate the knowledge into clinical practice.

REGULATION:

 A frame work describing advanced nursing practice

allows for a coordinated national approach, permits
flexibilities among provinces and allows new roles to
develop such as coordinated approach needed to ensure
that the public has access to consistent, high
qualitynursing services across the country.
 It will also facilitate labor mobility for advanced nursing
practice nurses who are subject to specific provincial or
territorial legislation.

COMPETENCIES:
 Competencies are the specific skills, knowledge, judgement
and personnel attributes required for registered nurse to
practice safety ethically ina designated role and setting.
 Core competencies are based on the depth, breath and range
of nursing knowledge, theory research enhanced by clinical
experience.

Clinical competencies

 Develop multiple advance assessment and intervention

strategies.
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  Guide decision-making in complex clinical situation.
 Generate and incorporate new nursing knowledge and
develop new standards of care

Research competencies

 Identify and implement research based innovations.

 Collect data and evaluate outcome
 Critique, interpret, apply and disseminate evidence base
findings.

IMPACT OF ADVANCED NURSING PRACTICE:

 This evolved to meet the demands of modern health care

through the advanced knowledge and skills.
 It is not only the technical and educational progress and
also the development of advanced nursing practice

SUPPORT FOR ADVANCED NURSING

PRACTICE:

 Advanced nursing practice must be supported and provide

full range of benefits to client, community, health team,
organizations as a whole.

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ANA STANDARDS OF NURSING PRACTICE:
 Assessment
 Diagnosis
 Outcome identification
 Planning
 Implementation
 Evaluation

STANDARDSOFPROFESSIONAL PERFORMANCE:
 Quality of practice
 Practice evaluation
 Education
 Collegiality
 Collaboration
 Ethics
 Research
 Research utilization
 Leadership

DEVELOPMENT OF THE FRAMEWORK:

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  Development of framework that a mission for nursing was
essential was developed bythe vice president and CNO
(chief nursing officer)of the Calgary Health Region.From
that the nurse could utilize on a daily basis to achieve the
vision and mission of nursing in the region.
APROVAL OF FRAMEWORK:
 After several month of consultations with nurses
across the religion, discursion of regional nursing council
and numerous revisions, the final draft of the professional
practice and framework approved by nursing council.

PROFESSIONAL NURSING PRACTICEFRAMEWORK:

The art of nursing

Personal competence
commitmen values
t patients

mission

Attributes of practice

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THE ART OF NURSING:
 Nurse demonstrate the ethical, insight caring practice by
focusing on the wellbeing of the individuals, families and
community.
 ATTRIBUTESOFPRACTICE:
Autonomous professional practice in nursing requires
taking personal responsibilities for excellence in practice
and effective care.

 COMPETENCE
It is grounded upon nursing theory, scientific knowledge and
experience its reflected in everyday practice.

PERSONAL COMMITMENT:
 Nurse demonstrate commitment to profession by valuing
nurse and advancement of the profession and excellence in
patient care.
 It reflects the elements common to the nursing practice
framework.
 Frame work reinforces the pre requisites for promotion of
safe, competent and ethical nursing practice.

IMPLEMENTATION OF THE FRAMEWORK:

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  Numeroussession were held to familiarize nursing staff
with the treatment when it was first launched.
 Introduction to framework is routine to orientation for all
new nurses.
 The frame works gives the development of preceptors to
change the nurses.
 Elaboration of the frame work is ongoing process.
 The major elements of the frame work is linked to
expected RN,LPN. The application of the frame work in
practice is not incorporated into nurses ongoing
professional development and continuing educational
plans

EVALUATION AND RESEARCH:

 Now the professional practice framework has been
articulated it will be important to determine
theeffectiveness of implementation and measure the impact
on practice and patient outcome.

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SCOPE OF
NURSING
PRACTICE

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 INTRODUCTION:

The scope of the nursing practice is not limited to specific tasks,

functions or responsibilities but includes direct care giving and
evaluation of its impact, advocating for patients and for health,
supervising and delegating to others, leading, managing,
teaching, undertaking research and developing health policy for
health care system.

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 BACKGROUND

 The scope of nursing practice is defined with in a legislative

regulatory framework and communicates to others roles,
competencies and the professional accountability of the nurse.
Nursing authority comes from the evidence based knowledge.
 The practice and competencies of an individual nurse with in
the legal scope of practice is influenced by various factors
including educational experience.
 Nurses requires appropriate initial and ongoing education and
training as well as lifelong learning to practice competently
with in scope of practice.
 To enable the profession to provide competent leadership
NNA (NATIONAL NURSES ASSOCIATION) should be
vigilant in assuring that nurses are prepared with necessary
competencies to function in leadership roles at all levels of the
health system.
 NNA are also responsible for ensuring that nurses are major
participants in the planning and direction of nursing
education, nursing services, regulatory bodies and other
health related activities.
 Each registered nurse is responsible for and accountable for
making decisions and practicing in accordance with his or her
educational background and experience in nursing .

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 SCOPE OF NURSING PRACTICE:
 Maintains professional regulations through defining
practice establishing an educational system providing
research to further develop the practice base and a code of
ethics.
 The legal boundaries of scope of practice are determined by
definition of nursing found in the NURSE PRACTICE
ACT and provides basis for interpreting the practice of the
individual registered nurse.
 Since each state has legal authority for regulation of
nursing,the definition, scope,of nursing may vary from
place to place.
 However, the purpose of law remains constant to protect
the public.

NURSE PRACTICE ACT

 It was enacted by the legislative to regulate the practice of

nursing.
 The act is designed to protect the public from incomplete
nursing practice, not to protect nurses from discriminatory.
 The act does not address the specific nursing duties that are
proper to be performed by nurses,or hospital staffing patterns,
labor practices or employment criteria.
 Each nurse is responsible for making decisions and practicing
in accordance with individual educational background and
experience in nursing.

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 NURSING PRACTICE IN DIFFERENT
SETTINGS

 Individual RN’S responsibility

 Clinical responsibility
 Research responsibility
 Leadership responsibility

INDIVIDUAL RN’SRESPONSIBILITY

 innovations for improving client care,organization and

systems.
 Identify,conduct and support research as primary
investigator.The registered nurse is responsible for
accountable, professionally and legally for determiner
scope of nursing practice.
 It is important that the nurse make decisions regarding his
or her own scope of practice
.
CLINICAL RESPONSIBILITIES:

 Develop multiple advanced assessment and intervention

strategies within client centered framework.
 Use qualitative and quantitative data from multiple sources.
 Guide decision making in complex clinical situations.
Plan,Initiate,co-ordinate and conduct educational programs
based on needs,priorities & organizational resources.

RESEARCH RESPONSIBILITIES:

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 Identified and implement research based
Evaluate current practice at individual and system levels in
light of research findings.

LEADERSHIP RESPONSIBILITIES:

 Advocating for individuals,families,groups and

communities in relation to treatment and health care
system.
 Identifying learning needs of nurses and other members of
the health care team.
 Developing programs and resources to meet identified
needs.
 Evaluating programs in the organization.
 Identifying gaps in the health care system.

MOBILE NURSING PRACTICE:

 In 1984,a need was seen to evaluate to offer more extensive
home health care for local residents who prepared to
receive care in their own homes.
 This enabled many to reduce costs and remain in their
homes at least for a long period of time.

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  This become MOBILE NURSING SERVICES and
changed to MOBILE NURSING SERVICES.and provide
day and night care.
 Mobile Nursing services has been a leader and innovator in
the field of home health care and has transformed this
important method of health care delivery in the south east l
areas.

MOBILE NURSING SERVICE:

This service provides home teaching and care for patients with varied
needs and health problems
 Patients discharged early from hospitals.
 Patient suffering from chronic and acute medical problems.
 Surgical patients.
 Patient requiring IV therapy.
 The elderly.
 Respiratory patients.
 The seriously ill.
 Patients in need of medication management.
 Hospice concept.
 Ventilator dependent.
 Assistance with
bathing,dressing,meals,transportation,light,housekeeping.

MILITARY SERVICES:

FIRST WORLD WAR:

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  It has origin from the army nursing service formed in
1881 as a part of royal army. After first world war(1 st
October 1881) the nursing services was granted
permanent status in Indian army.this date is called as
formation dayof .military nursing service.

SECOND WORLD WAR:

 With the outbreak of second world war nurses once

again found themselves serving all over the world.
 This is the oldest service where the woman directly
contributed to nations was effort by providing care to
the sick and wounded soldiers.
 The army nurses have made a permanent pace in every
nations heart by nursing millions of sick and wounded
soldiers back to health.

RANK STRUCTURES:

 IN DESCENDING ORDER:
 Commissioned officers
 Major general
 Brigadier
 Colonel
 Lieutenant colonel
 Major
 Captain

TELE-NURSING:

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  It refers to the use of telecommunication and
information technology for providing nursing services
in health care when a large physical distance between
patient and nurse.
 It’s a part of tele health and has contact with medical
and non-medical application such as tele-diagnosis,
tele-consultation etc.
 Tele nursing may help solve increasing shortages of
nurses –by reducing distances and save travel time and
to keep patients out of hospital.

ADVANTAGES

Helps to solve increasing shortage of nurses

 Reduce distance and save travel time.
 To keep patients out of hospitals.
 Greater degree of job satisfaction
 Able to visit 5-7 patients in a day.
 Can visit 12-16 patients at a same time.

THE NURSING ROBOT:

 Completed in 1986 the nursing robot is one of the
first fully functioned mobile robot equipped with
manipulation arm.
 Development of robot system is included in the
development of mobile robot system to help
physically handicapped people.
 Nursing robot system has three major components:
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 A self-propelled vehicle ,a robotic arm
mounted on it and a communications post
next to the disabled persons bed.

OCCUPATIONAL HEALTH NURSING

OCCUPATIONAL HEALTH NURSE:

 Occupational health nurses observe and assess the

workers’ health status with respect of job, task and
hazards.
 Occupational health nurse should have,
 Special knowledge of workplace hazards and
relationship to the employee health status.
 Understand industrial hygiene principles of
engineering controls, administrative controls and PPE.
 Have knowledge of toxicology and epidemiology as
related to the employee and the work site.

ACTIVITIES:

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  Observation and assessment of work and work
environment
 Interpretation and evaluation of worker’s medical
occupational history, complaints, screening test,
personal hygiene etc.
 Appraisal of work environment for potential exposure.
 Identification of abnormalities.
 Description of worker’s response.
 Management of occupational and non-occupational
illness and injury.
 Documentation of illness and injury.

SCHOOL HEALTH NURSE

School health nurses areprimary care nurses for school children

they work with individual children young people and families
schools and communities to improve health .
A school nurse is qualified, experienced professional and the
only trained nurse working across health and education
boundaries .they also provide link between the school home and
community.
RESPONSIBILITIES ARE:
 Promoting healthy lifestyles in school.
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  Child and adolescent mental health.
 Chronic and complex health care needs in children and
young people.
 Vulnerable children and young people.
ACTIVITIES:
 Health assessment for children at entrance to school
required
 Individual health interviews
 Immunization programmers
 Child protection
 Health education

SPACE NURSING SOCIETY(SNS):

It is an international space advocacy organization devoted

to space nursing and contribution to space explored by
registered nurses.SNS is an affiliated nonprofit special
interest group associated with the national space society.

TRENDS IN NURSING PRACTICE

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TRENDS IN NURSING:
 Trends in nursing are closely tied to what is happening
to health care in general this section discuss current
trends and issues in health care.it is important for you
personally, professionally to have knowledge about all
health care trends.

BROADENING FOCUS:

The focus of nursing has broadened from the care of the ill
person to the care of the people in illness and from care of

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 the only the patient to care of the client the family and in
some instance in the community.
In the past nursing like medicine was oriented towards
disease and illness.
Today,there is increasing recognition of peoples need for
healthcare as distinct from illness care end nurses
independent functions in this area.

SCIENTIFIC BASIS:

In the past nursing largely was either intuitive or relied on

experience or observation rather than research.through trial
and error, the individual nurses discovered with measures
that would assist the client and many nurses become highly
skilled in providing care through experience.

TECHNOLOGY:
Technology is being applied in the health field extensively.

INDICATORS OF INCERASING TECHNOLOGY:

 the proliferation of technological equipment used

case of clients in hospital and homes.
 The increasing home and self-care equipment.
 Use of computers in many areas of health care.

MODERN TRENDS IN NURSING:

 In 1993 a landmark survey found that 1/3rdof the U.S

population had used some non-traditional alternative
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 methods of treatment in addition to standard medical
treatment.
 A few therapies investigated by the OAM (1995) are,
 Biofeedback to control pain
 Acupuncture to relieve pain
 Imagery to control asthma
 Ayurvedic treatment for Parkinson’s disease
 Music therapy to treat brain injuries
 Short cartilage to treat cancer

INDICATORS OF CURRENT TRENDS:

 The increasing number of professionals, articles,
books about balancing of caring and technical skills.
 Many studies regarding caring as an aspect of nursing
 Increasing recognition of nursing needs of client in
technology and environment

CURRENT TRENDS IN NURSING:

1.Changing Demographics and Increasing Diversity
2. The Technological Explosion
3. Globalization of the World's Economy and Society
4. The Era of the Educated Consumer, Alternative
Therapies and Genomics, and Palliative Care.
5. Shift to Population-Based Care and the Increasing
Complexity of Patient Care 
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 6. The Cost of Health Care and the Challenge of
Managed Care
7. Impact of Health Policy and Regulation 
8. The Growing Need for Interdisciplinary Education
for Collaborative Practice
9. The Current Nursing Shortage/Opportunities for
Lifelong Learning and Workforce Development
10. Significant Advances in Nursing Science and
Research

COMPETENCIES FOR HEALTH CARE PRACTITIONERS IN

FUTURE:
 Care of community health
 Expand access to effective care
 Provide contemporary clinical practice
 Emphasize primary care
 Participate in coordinated care
 Ensure cost effective and appropriate care.
 Practice prevention
 Promote healthy lifestyle
 Use technology appropriately
 Manage information
 Provide counselling on ethical issues
 Continue to learn

ROLE OF PROFESSIONAL NURSE

CARE GIVER:
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  The role of nurse is to convey understanding about
what is important and to provide care
 The nurse supports the client by attitude and actions
that showconcern for the client welfare

 Caring is central to most nursing intervention and an

essential attribute of the expert nurse.

Communicator:

 Communication facilitates all nursing actions.

 The nurse communicates to other health care
personnel the nursing interventions planned and
implemented for each client

Teacher/educator:

 it is an interactive process between a teacher and one

or more learners in which specific learning objectives
or desired behavior changes are achieved.

Counselor:
 It involves providing emotional intellectual and
psychological support.
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  The nurse focus on helping the person develop new
attitudes feelings and behaviors rather than on
promoting intellectual growth.

Leader:
 It is defined as the mutual process 0f interpersonal
influence through nurse helps client make decision in
establishing and achieving goals to improve the
client wellbeing.

Researcher:
 Nurses who will engage in research there is agrowing
expectation that all nurses will be able to critically
appraise research reports and will utilize the
scientific studies as a basis for making decisions in
their work.

Advocate:
 A client advocate is an advocate of client right.
 It involves what is best for the client, ensuring that
the client needs are met and protecting the clients
right.

EXPANDED ROLE OF NURSES:

 Clinical nurse specialist
 Nurse practitioner
 Nurse anesthetist

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  Nurse midwives
 Nurse educator
 Nurse administrator.
 Nurse generalist.

CONCLUSION:
 So far we have discussed about the definition of nursing
practice, characteristics, framework of nursing practice,
implementation of frame work, scope of nursing practice,
current and modern trends of nursing practice.

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EVIDENCE BASED
NURSING PRACTICE
MODELS

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INTRODUCTION:
During the 1980s,the term “evidence based
medicine “emerged to describe the approach that used scientific
evidence to determine the best practice.later the term shifted to
become “evidence based practice” as clinicians other than
physicians recognized the importance of scientific evidence in
clinical decision making.
DEFINITION:
The conscientious, explicit and judicious use of
current best evidence in making decisions about care of the
individual patient.
Dr.David Sackett
EBP in nursing is a way of providing nursing care that is guided
by the integration of the best available scientific knowledge with
nursing expertise.this approach requires nurses critically to
assess relevant scientific data or research evidence to implement
high quality interventions for their nursing practice.
NLM PubMed Mesh
Evidence based practice alternatively known as “empirically
supported system” (EST) is the preferentially use of mental and
behavioral health interventions for which systemic empirical
research has provided evidence of statistically significant
effectiveness as treatments for specific problems.

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EBP promotes the collection,interpretation and integration of
valid, important and applicable patient reported,clinician
observed and research derived evidence.
AIMS OF EVIDENCE BASED PRACTICE:
 To do right thing, at the right time,for the right person,
ensure quality care for the individual client.
 To facilitate cost effective care.

EVIDENCE BASED TREATMENT:

It is an approach that tries to specify the way in which
professionals or othersdecision makers should make
decisions by identifying such evidence that there may be
for a practice, and rating it according to how scientifically
sound it may be.
 Its goal is to eliminate unsound or excessively risky
practices in favor of those that have better outcomes.

NEEDS FOR EVIDENCE BASED PRACTICE:

 For making sure that each client get the best possible
services.
 Update knowledge
 Provide clinical judgement
 Improvement care provided and save lines.

PRINCIPLES OF EVIDENCE BASED PRACTICE:

 The evidence is never enough.
 There is a hierarchy of evidence.
NEEDED SKILLS FOR EVIDENCE BASED
PRACTICE:
 Observant and sensitive.
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 Clinical competence knowledge.
 Communication.
 Learner.
 Practitioner.
 Learning skills.
 Research competence

STEPS IN EVIDENCE BASED PRACTICE

PROCESS:

 Evidence based practice allows the practitioner to assess

current and past research, clinical guidelines and other
information resources.
STEP 1:Formulating a well built question
STEP 2:Finding the evidence
STEP 3:Appraising the evidence
STEP 4:Applying the evidence/make clinical decision
STEP 5:Re-evaluation

STEP 1:Formulating a well built question:

With clinical cases, there is often a barrage of details to

digest.To effectively search EBP resources, you first need
to decide what details are important to the question at hand
so you can formulate the question.
A well built clinical question includes the following
components:

 PICO (Is a state of mind):

P-Patient disorder or disease
I-Intervention or finding under review
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 C-Comparison intervention
O-Outcomes
Applying PICO is a systematic way to identify important
concepts in a case,and formulate a question for searching.

FRAMING GOOD QUESTIONS:

The following approach can help you frame good question
Describe the subject:
It may be helpful to phrase the question in this form”How
would I describe a group of patients similar to this one?”
Define which intervention:
You are consider for specific patient or population;it may be
appropriate to name a second intervention with which to
compare the first. (e.g.) traditional x-rays versus MRI.
Define the type of outcome:
Outcome may contain several types. (e.g.) pertain changes in
a physical sign or prognostic indicator, the outcome of a
diagnostic test, a response to therapy, or simply cost
effectiveness.
STEP 2:DATABASE /RESOURCE SEARCHING:
After formulating the clinical question, you need to find
relevant evidence.you may need several types of information
resources. The resources are
 General information(Background)resources

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 Filtered resources
 Unfiltered resources

1.General information resources:

you may often encounter conditions outside your specialty
area that you don’t see often and need to get a
comprehensive overview. Background information
provides excellent detailed information. This category
contains resources that provide background information
about various diseases,conditions, and clinical questions.
(e.g.)measles has been nearly eradicated but there has been
a fairly recent outbreak.if you need to refresh your
knowledge of the clinical presentation, diagnosis etc of
measles, a background resource would be the best place to
start.
2.filtered resources:
If you are trying to decide on a course of action for a
patient and want to base your decision on that best
available evidence,consult a filtered resource. In filtered
resource clinical experts and subject specialists pose a
questions and then synthesize evidence to state conclusions
based on the available research.
Examples:Cochrane data base of systemic reviews, info
poems, pier (physician information and education resource)
national guide line clearing house, natural standard,and
natural medicines comprehensive database.

3.unfiltered resources:
If u don’t find appropriate answer in the filtered
resources,you will need to search unfiltered resources to

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locate studies that answer your question.it will provide the
most recent information,but it’s up to the clinician to
evaluate each studies found in unfiltered resources takes
more times and skill,which is why filtered resources are the
first choice for answering clinical questions.

Considered the database of choice for the health sciences,

MEDLINE provides primary and secondary literature for
medicine,nursing,and allied health professions.unlike
filtered resources,literature searches performed in
MEDLINE and other databases provide a firsthand look at
research and clinical topics.

STEP 3:CRITICALLY APPRAISAL:

After identifying an article or resources that seems
appropriate to your question, you must appraise the
information critically. if the study is from a primary source-
one that provides original data on a topic with no
commentary-you should do a validity check. To check for
validity, ask questions related to diagnosis, therapy, harm,
and prognosis.

STEP 4:APPLYING THE EVIDENCE:

Once you have determined that a study is internally

valid,you must decide how the study or other information
applies to your question.to reach your conclusion you may
consult questions related to diagnosis,therapy,harm and
prognosis.

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 Keep in mind that you must interpret the information based
on a number of criteria and depending on your skill and
experience, you may need to confer with a peer.

STEP 5: RE-EVALUATING THE EVIDENCE:

In the process of executing evidence-based practice,you

have developed a clinical question,sought out answers to
verify and support your clinical decision and ultimately
applied the findings to your patient .The Last step in this
process is to evaluate the effectiveness and efficacy of
your decision in direct relation to your patient.

PROCESS OF EVIDENCE BASED PRACTISE:

It is the integration of clinical expertise, patient values, and
the best research evidence into the decision making
process for patient care.
 Clinical expertise refers to the clinicians cumulated
experience,education and clinical skills.the patient brings
to the encounter his or her own personal and unique
concerns,expectations,and values.
 The best evidence is usually found in clinically relevant
research that has been conducted using sound methodology.
The evidence by itself is doesnot make decision for you but
it can help support the patient care process.the full
integration of these three components into clinical
outcomes and quality of life. The practice of EBP is
usually triggered by patient encounters which generates
questions about the effects of therapy,the utility of
diagnostic tests,the prognosis of disease,or the etiology of
disorders.
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  Evidence based practice requires new skills of the
clinician,including efficient literature searching,and the
application of formal rules of evidence in evaluating the
clinical literature

PROCESS OF EVIDENCE BASED PRACTICE:

Clinical expertise

Best research Patient values

evidence and preferences

Resources of evidence based practice:

 Back ground information or expert opinion.
 Research articles or studies.
 Evidence guidelines.
 Evidence summaries and abstracts.
 Systematic reviews and meta analyses

Advantages of evidence based practice:

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 Provide better information to practitioner.
 Enable consistency of care.
 Better patient outcome.
 Provide client focused care.
 Structured process.
 Increases confidence in decision making.
 Generalize information.
 Contribute to science of nursing.
 Provide guidelines for further research.
 Helps nurses to provide high quality patient care.

Disadvantages of evidence based practice:

 Not enough evidence for evidence based practice.
 Time consuming
 Reduced client choice
 Reduced professional judgement /autonomy
 Suppress creativity
 Influence legal proceedings
 Publication bias

Barriers in evidence based practice:

 Lack of value for research in practice
 Difficulty in bringing change
 Lack of administrative support
 Lack of knowledge mentors
 Lack of time for research
 Lack of knowledge about research
 Research reports not easily available
 Complexity of research reports

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  Lack of knowledge about evidence based practice.

EVIDENCE BASED PRACTICE MODEL:

 Settler model of research utilization
 John Hopkins nursing evidence based practice model
 IOWA Model for research in practice
 The conduct and utilization of research in nursing(CURN)
 ACE Star model of knowledge transmission.

STETLER MODEL OF RESEARCH UTILISATION:

This method of research utilization applies research findings at the

individual practitioner level.the model has six phases
 Preparation
 Validation
 Comparative evaluation
 Decision making
 Translation and application
 Evaluation
This model helps practitioners to assess how research findings and
other relevant evidence can be applied in practice. this model
examines how to use evidence to create formal change within
organizations.

2.JOHN HOPKINS NURSING EVIDENCE BASED

PRACTICE MODEL:

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ACE STAR MODEL OF KNOWLEDGE TRANSMISSION

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THIS model depicts various forms of knowledge in a relative
sequence as research evidence is moved through several cycles.
STAGES:
DISCOVERY
This is generating stage .in this stage new knowledge
is discovered through the traditional research methodologies and
scientific inquiry.

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EVIDENCE SUMMARY
This stage is also considered a knowledge generating
stage, which occurs simultaneously with the summarization.
This increases reliability and reproducibility of results
TRANSLATION
The aim of translation is to provide a useful and
relevant package of summarized evidence to clinicians and
clients in a form that suits the time cost and care standards.
INTEGRATION
This is the most familiar stage in health care because of
society’s long standing expectation that health care be based on
most current knowledge. This step involves changing both
individual and organizational practices through formal and
informal channels
EVALUATION
This the final stage it involves evaluation of health outcomes
provider and patient satisfaction ,efficacy,efficiency,economic
analysis and health status impact.
IOWA MODEL FOR RESEARCH IN PRACTICE:
To improve the quality of care, and is an outgrowth of the
quality assurance model using research. The model integrate
evidence based health care acknowledges and uses a
multidisciplinary team approach.

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THE CONDUCT AND UTILISATION OF RESEARCH IN
NURSING(CURN) PROJECT:
This model was designed to develop and test a model for using
research based knowledge in clinical practice settings.it is
viewed as organizational process. Systems change is essential to
establish research based practice on a large scale.
.

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SUMMARY:
SO for we have discussed about the nursing practice, its
frame work, scope ,trends, changing trends in nursing practice.
And about evidence based practice ,its definition ,needs ,steps of
EBP, process of EBP, and about the models of evidence based
practice.as a nurse we have to use the evidence based practice.

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CONCLUSION:

Evidence based nursing should not just satisfy the urge of

conference researcher to do research, but it should always be
directed to improve the quality of nursing education, nursing
intervention and administrative approaches. if we the nurses
can’t implement our own research findings in our nursing
practice, how are we expect government authorities to
implement nursing research findings for nations development.

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BIBLIOGRAPHY:
BOOK REFERENCES:
 Shabeer.R.Basheer ,S.Yaseen Khan “A Text book of
advanced nursing practice”(2013) 1st edition ,Emmess
Medical Publishers,Bangalore.pg.no 648 -660,750-757.
 Samta soni,”Text book of advanced nursing practice”1
st edition (2013),jaypee publication pg.no 540-544.
 BT Basavanthappa “text book of nursing theories”1 st
edition 2007,jaypee publication
 Suresh k sharma”text book of nursing research and
statistics”4 th edition 2013elsevier publication pg.no 22-
30.
JOURNAL REFERENCE:
 Lin.perry “international journal of nursing
practice”vol 21, pg.no453-458.
 Mc.Alen pearson “evidence based practice” nursing
journal pg.no 234-237.

NET REFERENCE:
 WWW.Slide share.com

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