EVIDENCED BASED PRACTICES

Evidence-based practice represents both an ideology and a method. The ideology springs from the
ethical principle that the clients deserve to be provided with the most effective interventions
possible. The method of EBP is the way we go about finding and then implementing those
interventions.

● Evidence: It is something that furnishes proof or testimony or something legally submitted to

ascertain in the truth of matter.

● Evidence based practice: It is systematic inter connecting of scientifically generated evidence

with the tacit knowledge of the expert practitioner to achieve a change in particular practice
for the group benefit of well-defined( French 1999)

● Evidence based nursing: It is process which nurses make clinical decisions using the best
available research evidence, their clinicalexpertise and patient preferences (mulhall 1998).

● Evidence based medicine or practice: The conscientious, explicit and judicious use of current
best evidence in making decision about the care of individual patient. (Dr. David Sackett,
Rosenberg, 1996)

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 to critically assess
relevant scientific data or research evidence and to implement high quality interventions for
their nursing practice. (PubMed)

NEED FOR EBP

● For making sure that each client get the best possible services.
● Update knowledge and is essential for lifelong learning
● Provide clinical judgement
● Improvement care provided and save lives.
● Provide practicing nurse the evidence based data to deliver effective care.
● Resolve problem in clinical setting.
● Achieve excellence in care delivery.
● Reduces the variations in nursing care and assist with efficient and effective decision making.

STEPS FOR EBP

SORCES OF EVIDENCE
– Research evidence has assumed priority over other sources of evidence in the delivery of
evidence based health care. It includes

● Filtered resources- Clinical experts and subject specialist pose a question and then
synthesise evidence to state conclusion based on available research. These sources are
helpful because the literature has been searched and results evaluated to provide an answer
to clinical question.

● Unfiltered resources (Primary literature)- It provides most recent information. E.g MEDLINE,
CINHAL etc provides primary and secondary literature for medicine.

● Clinical experiences- Knowledge through professional practice and life experiences makes up
the second part in the evidenced based , person-centered care.
● Knowledge from patients- Evidence delivered from pt’s knowledge of themselves, their
bodies and social lives.

● Knowledge from local context- Audit and performance data Patient stories and narratives
Knowledge about the culture of the organization & individuals within it. Social & professional
networks. Information from feedback Local & national policy.

HIERARCHY OF EVIDENCE

MODELS OF EBP

John Hopkins Nursing EBP Model

– Used as a framework to guide the synthesis and translation of evidence into practice.
–
(Newhouse, Dearholt, Poe, Pugh, & White, 2007)

There are three phases to the JHNEBP model

● The identification of an answerable question.
● A systematic review and synthesis of both research and non-research evidence.
● Translation includes implementation of the practice change as a pilot study, measurement of
outcomes, and dissemination of findings.

IOWA model
– The Iowa model focuses on organization and collaboration incorporating conduct and use of
research, along with other types of evidence. (Titler et al, 2001). It was originated in 1994.

The star point in the model can either be

The star point in the model can either be
● Aknowledge focused trigger (that emerges from awareness of innovative research findings
● A problem- focused trigger (that has its root in a clinical or organizational problem)

The Stetler model

– This model examines how to use evidence to create formal change within organizations, as
well how individual practitioners can use research on an informal basis as part of critical
thinking and reflective practice

The Stetler model of evidence-based practicebased on the following:

● Use may be instrumental, conceptual and/or symbolic/strategic
● Other types of evidence and/or non-research- related information are likely to be combined
with research findings to facilitate decision making or problem solving.
● Internal or external factors can influence an individual's or group's review and use of
●

evidence.
● Research and evaluation provide probabilistic information, not absolutes.
● Lack of knowledge and skills pertaining to research use and evidence-informed practice can
inhibit appropriate and effective use.

This model consists of five phases. Each phase is designed to

– facilitate critical thinking about the practical application of research findings
– result in the use of evidence in the context of daily practice
– mitigate some of the human errors made in decision making.

Barriers in EBP
– 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
– Lack of knowledge about EBP

Advantages of EBP
– 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 EBP
– Not enough evidence for EBP
– Time consuming
– Reduced client choice
– Reduced professional judgement/ autonomy
– Supress creativity
– Influence legal proceedings
– Publication bias

Evidence-Based Practices in Nursing Management

LECTURE DESCRIPTION:
Concepts on evidence-based practice, care standards and competencies in relation to achieving
efficient, safe and competent nursing care service.

GOALS:
Provide appropriate evidence - based nursing care using a participatory approach based on variety
of theories and standards relevant to health and healing, research, clinical practice, client
preferences and client and staff safety customer care standard.

OBJECTIVES:
. Utilize knowledge on updated National Nursing Care Competencies to provide efficient
nursing care and effective nursing leadership.
. Demonstrate proficient knowledge on updated Professional Nursing Practice Standards and
Patient Safety Standards for current and relevant nursing care.

Evidence-Based Practices in Nursing Management

EBM is the utilization of various types of research evidence by managerial leaders to support
decision making to improve processes and outcomes. EBM provides managers with the resources
they need to create positive change such as collective scientific evidence and validated information.

According to Beyea and Slattery, the advantages of EBP include:

● Better patient outcomes
● Contributions to the science of nursing
● Keeping practice current and relevant
● Increasing confidence in decision-making

A. National Nursing Care Competency Standards (NNCCS)

• The development of the NNCCS for nursing practice started in 2001 through the initiative of the
Professional Regulation Commission
• Board of Nursing (PRC-BON) which created a National Task Force for Core Competency Standards
Development. The project was completed in 2005.

SIGNIFICANCE OF THE 2012 NATIONAL NURSING CORE COMPETENCY STANDARDS ( 2012

NNCCS)

● Basic Nursing Education Program in the Philippines through the Commission on Higher
Educatio )CHED).
● Competency-based Test Framework as the basis for the development of course syllabi and
test questions for "entry level" nursing practice in the Philippine Nurse Licensure
Examination.
● Standards of Professional Nursing Practice in various settings in the Philippines.
● National Career Progression Program (NCPP) for nursing practice in the Philippines.
● Any or related evaluation tools in various practice settings in the Philippines

2012 NATIONAL NURSING CORE COMPETENCY STANDARDS (2012 NNCCS)

● I. BEGINNING NURSE'S ROLE ON CLIENT CARE

● II. BEGINNING NURSE'S ROLE ON MANAGEMENT AND LEADERSHIP
● III.BEGINNING NURSE'S ROLE ON RESEARCH

B. Philippine Professional Nursing Practice Standards

Legal Basis

– Article 3 Sec.9 (c) of R.A. 9173/ "Philippine Nursing Act 2002" : Board shall monitor & enforce
quality standards of nursing practice necessary to ensure the maintenance of efficient,
ethical and technical, moral and professional standards in the practice of nursing taking into
account the health needs of the nation.

Standards of Professional Nursing Practice

– are authoritative statements of the duties that all registered nurses, regardless of role,
population or specialty are expected to perform competently

Standards of Professional Nursing Practice

– Standards of care describe the competencies of the nurse and the indicators of performance.
– The primary purpose of nursing standards is to promote, guide, and direct professional
nursing practice.

Nursing Practice Standard Domains

A. VALUE-BASED NURSING PRACTICE STANDARDS

– is a clinical decision-making process guided by empirical body of knowledge, ethico-moral
values and practices, rules ad regulations, combined with appropriate competencies in client
care reflecting personal and professional values when engaging with others of diverse
cultures.

● Standard a1. Care of Clients

● Standard a2. Ethical, Moral, Legal Practice
● Standard a3. Personal and Professional Values
B. KNOWLEDGE-DRIVEN NURSING PRACTICE
– refers to the consistent application of a scientific body of knowledge and skills through the
integration of the different patterns of knowing (Carper, 1978) such as esthetics, ethics, and
personal relationship as bases for safe and sound judgement to appropriate care of clients.

● Standard b1. Research

● Standard b2. Evidence Based Nursing Practice
● Standard b3. Continual Quality

C. OUTCOME-ORIENTED PROFESSIONAL RELATIONSHIP

– refers to intra and inter-professional relationships that lead to an enhancement of one's role
through communication, collaboration and understanding of cultural context to achieve
mutually-agreed upon outcomes for client care.

● Standard c1. Communication

● Standard c2. Collaboration and Team work
● Standard c3. Transcultural Nursing Care

D. LEADERSHIP AND GOVERNANCE

– is influencing other people through the exercise of authority, direction, control and regulation
in the practice of the nursing profession to achieve desired goals.

● Standard d1. Personal and Professional Development

● Standard d2. Personal Responsibility and Accountability
● Standard d3. Positive Practice Environment.
● Standard d4. Social Responsibility.
● Standard d5. Resource Management

C. Patient Care Safety Standards

What is Patient Safety?

– Patient Safety is a health care discipline that emerged with the evolving complexity in health
care systems and the resulting rise of patient harm in health care facilities. It aims to prevent
and reduce risks, errors and harm that occur to patients during provision of health care.

Due to unsafe care, below are some of the patient safety situations causing most concern.
– Health care-associated infections
– Unsafe surgical care procedures
– Unsafe injections practices
– Diagnostic errors occur
– Unsafe transfusion practices
– Radiation errors
– Sepsis
– Venous thromboembolism (blood clots)

7 patient safety goals for 2021 from Joint Commission

1. Improve the accuracy of patient identification.

– Using two patient identifiers, not including patient's room or location
2. Improve staff communication.
– The complete verbal and telephone order or test result is written down by the receiver of the
order or test result.
3. Improve the safety of medication administration.
– Policies and/or procedures are developed to address the identification, location, labeling, and
storage of high-alert medications.
4. Reduce patient harm associated with clinical alarm systems.
– Implements a process for the initial assessment of patients for fall risk and reassessment of
patients when indicated by a change in condition or medications, among others.
5. Reduce the risk of healthcare-associated infections.
– Policies and/or procedures are developed that support continued reduction of health care-
associated infections.
6. Better identify patient safety risks in the hospital.
– A number of research approaches can be used at stage 1 to identify risks and hazards
including the use of medical records and administrative record review, event reporting, direct
observation, process mapping, focus groups, probabilistic risk assessment, and safety
culture assessment.
7. Better prevent surgical mistakes.
– Policies and procedures are developed that support uniform process to ensure the correct
site, correct procedure, and correct patient, including medical and dental procedures done in
settings other than the operating theatre.

D. Standards of Nursing Practice

– Standards of nursing practice developed by the American Nurses' Association (ANA) provide
–
guidelinesfor nursing performance

– They are the rules or definition of what it means to provide competent care

– The registered professional nurse is required by law to carry out care in accordance with what
other reasonably prudent nurses would do in the same or similar circumstances.

ANA Standards of Nursing Practice

● Standard 1: Assessment: The registered nurse collects comprehensive data pertinent to the
patient's health or the situation.
● Standard 2: Diagnosis: The registered nurse analyzes the assessment data to determine the
diagnoses or issues.
● Standard 3: Outcomes Identification: The registered nurse identifies expected outcomes for a
plan individualized to the patient or the situation.
● Standard 4: Planning: The registered nurse develops a plan that prescribes strategies and
alternatives to attain expected outcomes.
● Standard 5: Implementation: The registered nurse implements the identified plan.
● Standard 6: Evaluation: The registered nurse evaluates progress toward attainment of
outcomes.
● Standard 7: Quality of Practice: The registered nurse systematically enhances the quality and
effectiveness of nursing practice.
● Standard 8: Education: The registered nurse attains knowledge and competency that reflects
current nursing practice.
● Standard 9: Professional Practice Evaluation: The registered nurse evaluates one's own
nursing practice in relation to professional practice standards and guidelines, relevant
statutes, rules, and regulations.
● Standard 10: Collegiality: The registered nurse interacts with and contributes to the
professional development of peers and colleagues.
● Standard 11: Collaboration: The registered nurse collaborates with patient, family, and others
in the conduct of nursing practice.
● Standard 12: Ethics: The registered nurse integrates ethical provisions in all areas of practice.
● Standard 13: Research: The registered nurse integrates research findings into practice.
● Standard 14: Resource Utilization: The registered nurse considers factors related to safety,
effectiveness, cost, and impact on practice in the planning and delivery of nursing services.
● Standard 15: Leadership: The registered nurse provides leadership in the professional
practice setting and the profession.