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Application EBP in Paediatric

Nursing
Dr Henny Suzana Mediani, MNg, PhD
Faculty of Nursing
Universitas Padjadjaran
Sigma Theta Tau International Honor Society of Nursing

• Evidence-based nursing is:


“an integration of the best evidence
available, nursing expertise, and the
values and preferences of the
individuals, families and communities
who are served.”
(Sigma Theta Tau, 2005)
Definition

• Evidence based practice was defined as a


EBP research based decision making process used to
guide the delivery of holistic care by nurses

• The process for research use carefully


• examines a distinct study to determine the
EBP
• strengths and limitations assumed within that
• one study
Global Definition of EBP

The conscientious, explicit and judicious use of current best evidence in making
decisions about the care of individual patients.

Including Both

The best available clinical


Individual clinical expertise evidence from systematic
research

-David Sackett
Definitions

• Evidence based nursing is an


approach to health care practice
that enables nurses to provide the
highest quality of care based on
the best evidences available to
meet the needs of their patients
(Melnick & Finecut, 2005)
Key points
• An evidence-based approach to clinical
practice aims to deliver appropriate care in
an efficient manner to individual patients

• The process entails the integration of


research evidence, clinical expertise and the
interpretation of patients needs and
perspectives in making decisions
• To modernise health care is a commitment to
development of quality, person-centred
EBP health services based on evidence

• The strategy for nursing, making difference

EBP reflect the commitment, and emphasises the


need for a robust evidence base for nursing
The vision for nursing in the
twenty-first century is for all
nurses to seek our evidence
and apply in every day
practice with an increasing
proportion actively
participating in research and
development
The Evidence
• Nurses at the point of care delivery are in the
ideal position to ask & answer clinical questions
• Need strategies that link clinicians with evidence
• Several steps in the EBP process are challenging
• Application oriented approach with active
facilitation is necessary to learn the process

Ellis, Howard, Larson & Robertson, 2005; Estabrooks, Chong, Brigidear & Profetto-McGrath,
2005; Estrabrooks, Rutakumwa, O’Leary, Profetto-McGrath, Milner, Levers & Scott-Findlay,
2005; Fink, Thompson & Bonnes, 2005; Johnson & Mighten, 2005; Pravikoff, Tanner & Pierce,
2005; Schultz, Whiting, Kent, Keane & Gallant, 2004; Waddell & Dunn, 2005
Why Evidence-Based Practice Now?
•A growing body of scientific knowledge
•Increased interest in consistent application of
quality services
•Increased interest in outcomes and accountability
by funders
•Past missteps in spreading untested “best
practices” that turned out not to be as effective as
advertised
•Because they work !!
How Things Change

A Problem is
Recognized

Action-Any Action
How Things Change

A Problem is
Recognized Series of Trail and
Errors Adjustments-
Some Better-Some
Action-Any Action Worse

Informed Action
How Things Change

A Problem is
Recognized

Informed Action

Informed Action-Based on Science


Benefits of EBP

• Improves client care


• Credibility of nursing profession
• Accountability for nursing care
Developing EBP
1. Develop question
– PICO format
• Patient
• Intervention of interest
• Comparison intervention
• Outcome
2. Find and review evidence
– Agency for Healthcare Research and Quality
– Cochrane Database of Systematic Reviews
Developing EBP, continued

3. Integrate information
– Formulate clinical question
– Search relevant databases
– Critically judge quality of evidence
– Develop plan
– Evaluate the practice change
4. Share information
– Dissemination done in variety of ways
Gold Standard for Evidence

• Randomized controlled trial (RCT) –


Participants are randomly assigned to either an
intervention or control group. This allows the
effect of the intervention to be studied in
groups of people who are the same, except for
the intervention being studied.
– Any differences seen in the groups at the end can
be attributed to the difference in treatment alone,
and not to bias or chance.
Peer-Reviewed Research

• Peer review – A process used to check


the quality and importance of research
studies. It aims to provide a wider
check on the quality and interpretation
of a study by having other experts in
the field review the research and
conclusions.
Core Competencies

• Ask: why are we doing this..


what is the evidence?
• Think critically!
• Think out of the box!
Core Competencies (cont.)

• Prioritize and clearly articulate answerable


clinical questions with a focus on outcomes
• Appreciate role of quality improvement activities
• Evaluate practice outcomes
• *Work effectively with others
Core Competencies (cont.)

 Search for evidence

• Evaluate the evidence


Core Competencies (cont.)

•Read and understand


research
Levels of Evidence Hierarchy
(Stetler et al.)*

• Level I: Meta-analysis of multiple RCTs


• (‘gold standard’)
• Level II: Individual RCTs
• Level III: Quasi-experimental
• Level IV: Non-experimental; qualitative
• Level V: Program evaluation; QI; RU; case reports
• Level VI: Opinion of respected authorities
Evidence Based Practice Process

• Identify a practice issue


• Formulate an answerable question
• Search for best evidence
• Critically evaluate the evidence and clinical
relevance
• Make recommendations
• Apply to clinical practice
• Evaluate impact/effectiveness/ outcomes
Thank You

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