Essentials of Evidence-Based Practice Research Paper

5 steps of Evidence Based Practice

Ask a question
Converting the need for information (about prevention, diagnosis, prognosis, therapy, causation, etc) into an answerable question Essentials of Evidence-Based Practice Research Paper
Find information/evidence to answer question
Tracking down the best evidence with which to answer that question
Critically appraise the information/evidence
Critically appraising that evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in our clinical practice)
Integrate appraised evidence with own clinical expertise and patient’s preferences
Integrating the critical appraisal with our clinical expertise and with our patient’s unique biology, values and circumstances  Essentials of Evidence-Based Practice Research Paper

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Evaluate
Evaluating our effectiveness and efficiency in executing Steps 1-4 and seeking ways to improve them both for next time

For quality improvement initiatives to be effective, they should be based on sound evidence. However, there are two main considerations relating to this evidence base. First, the intervention or interventions that the quality improvement initiative seeks to implement should have evidence of benefit: they should lead to improvements in patient outcomes that are, ideally, both clinically important and cost-effective. Evidence that translates basic research into its clinical application through new health technologies (either products or approaches) has been termed the ‘first transnational gap’. Second, quality improvement initiatives should be based on sound evidence of what works to implement these products or approaches. This is the ‘second transnational gap’, which forms the basis of quality improvement and implementation science.[1] We now consider evidence-based healthcare in the context of both these transnational gaps.Essentials of Evidence-Based Practice Research Paper

What is evidence-based healthcare?

How much of what health and other professionals do is based soundly in science? Answers to the question ‘is our practice evidence based?’ depend on what we mean by practice and what we mean by evidence. This varies from discipline to discipline. A study in general practice found that around 31% of therapeutic clinical decisions were based on evidence from randomized controlled trials (RCTs), whereas 51% were based on convincing non-experimental evidence.[2]Essentials of Evidence-Based Practice Research Paper

Sackett et al defined evidence-based medicine (EBM) as ‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients … integrating individual clinical expertise with the best available external clinical evidence from systematic research’.[3] The expansion of EBM has been a major influence on clinical practice over the last 20 years. The demands of purchasers of healthcare keen to optimize value for money have been one driver. A growing awareness among health professionals and their patients of medicine’s potential to cause harm has been another. In this article, we examine the nature of what is nowadays more broadly referred to as evidence-based healthcare (EBHC) in the context of quality improvement and discuss its strengths and limitations.Essentials of Evidence-Based Practice Research Paper

The tools necessary for evidence-based healthcare

The tools needed to practice in an evidence-based way are common across healthcare disciplines. Doctors, nurses and allied health professionals all need the skills to ensure that the work they do – whether with individual clients or patients, or in the development of policies for quality improvement – is based on sound knowledge of what is likely to work.

Of the following five essential steps, the first is probably the most important:

• convert information needs into answerable questions, i.e. by asking a focused question

• track down the best available evidence

• appraise evidence critically

• change practice in the light of evidence

• evaluate your performance.

Step 1. Asking a focused question

Before seeking the best evidence, you need to convert your information needs into a tightly focused question. For example, it is not enough to ask ‘Are antibiotics effective for otitis media?’ We need to convert this into an answerable question: ‘Do antibiotics reduce the duration of symptoms when prescribed to children with otitis media?’Essentials of Evidence-Based Practice Research Paper

The PICO approach can be used as a framework to focus a question by considering the necessary elements. It contains four components:

• Patient or population (children under 5 years)

• Intervention (antibiotics)

• Comparison intervention (placebo)

• Outcome (duration of specific symptoms, e.g. pain, or rate of complications).

Question

Form a focused clinical question using the PICO format to find the evidence for the effectiveness of smoking-cessation interventions in adult smokers who have had a heart attack.

Answer

• P Adult smokers who have had a heart attack.

• I Providing smoking cessation intervention.

• C Providing usual care.

• O Mortality and quit rates.

This gives us the question ‘In smokers who have had a heart attack does a smoking-cessation intervention in comparison with usual care reduce mortality and improve quit rate?’.[4]

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Step 2. Tracking down the evidence

The second step in the practice of evidence-based healthcare is to track down the best evidence. Doctors and nurses often assess outcomes in terms of surrogate pathological end points rather than commonplace changes in quality of life or the ability to perform routine activities (‘the operation was a success, but the patient died’).Essentials of Evidence-Based Practice Research Paper

Traditionally, doctors making decisions about what works have attached much weight to personal experience or the views of respected colleagues. Over time, knowledge of up-to-date care diminishes so there is a constant need for the latest evidence and simple ways to access and use it.[5,6] A study of North American physicians has shown that up-to-date clinical information is needed twice for every three patients seen, but they only receive 30% of this due to lack of time, dated textbooks and disorganized journals.[7]

Rather than relying on colleagues or textbooks, EBHC encourages the use of research evidence in a systematic way. Once a question has been formulated, the research base is then searched to find articles of relevance.Essentials of Evidence-Based Practice Research Paper

What Is Evidence-Based Medicine?

Evidence-based medicine includes three key components (Figure 1): research-based evidence, clinical expertise (i.e., the clinician’s accumulated experience, knowledge, and clinical skills), and the patient’s values and preferences.

Figure 1: The three components of evidence-based medicine.

Practicing evidence-based medicine is important in today’s healthcare environment because this model of care offers clinicians a way to achieve the Triple Aim’s objectives of improved quality, improved patient satisfaction, and reduced costs. To understand how, consider the prostate cancer example. With evidence-based medicine, a provider can assess the strength of the evidence as well as the risks and benefits of ordering diagnostic tests and treatments for each cancer patient. Such an approach, coupled with the provider’s clinical experience, enables the provider to better predict if a treatment will do more harm than good. It also helps the organization establish a systematic approach to caring for patients with specific conditions (e.g., prostate cancer, heart failure, diabetes). As reported in the article “The Importance and Impact of Evidence-Based Medicine,” using evidence-based medicine “help[s] physicians provide more rational care with better outcomes.”Essentials of Evidence-Based Practice Research Paper

Evidence-based medicine is not just about using evidence to design treatment plans; It also encourages a dialogue between patients and providers, so patients can share in the decision-making and make their values and preferences known. Together, patient and provider can determine an appropriate course of action—or no course of action if that’s on the joint decision. The benefit of this approach is that providers listen to patient concerns and take them into consideration to determine the appropriate treatment plan.

The Five Ways Evidence-Based Medicine Adds Value to Health Systems

Evidence-based medicine helps health systems achieve “gains on all three [triple] aims at once: care, health, and cost,” as stated in the article “The Triple Aim: Care, Health, And Cost.” Therefore, it’s gaining momentum as a viable  model of medical care. There are five ways it’s adding value to healthcare:Essentials of Evidence-Based Practice Research Paper

#1: Helps clinicians stay current on standardized, evidence-based protocols.

There’s an explosion of scientific knowledge being published, making it difficult for clinicians to stay current on medical best practices. In fact, for a primary care physician to stay up to date, they’d need to read 17 articles a day, 365 days a year. This is an impossible task, but evidence-based medicine offers clinicians a way to stay current with best practices using standardized, evidence-based protocols.

#2: Uses near real-time data to make care decisions.

Healthcare staff now has better access to data and more knowledge because of improved technology, such as electronic medical records (EMRs), decision support systems, built-in protocols, data warehouses, and sophisticated analytics. With this improved access to healthcare data, staff can use evidence-based medicine to provide better patient care based on near real-time data. As mentioned in the article “Evidence-Based Decision Making: Global Evidence, Local Decisions,” such “developments can greatly reduce the time necessary to fill gaps in the evidence base and reduce the uncertainty in the decision-making process.”Essentials of Evidence-Based Practice Research Paper

#3: Improves transparency, accountability, and value.

Payers, employers, and patients are all driving the need for the healthcare industry to show transparency, accountability, and value (e.g., high quality and safe care at the lowest possible cost). Practicing evidence-based healthcare can help the industry achieve these goals. According to the manual Evidence-Based Practice Manual: Research and Outcome Measures in Health and Human Services, “Evidence-based healthcare expresses commitment to improve the transparency of reasoning behind policies, increase accountability by justifying decisions on the basis of valid information that can stand up to scrutiny, gauge uncertainty by making explicit the strength of evidence supporting policy, and make policy decisions driven by the best outcomes for the healthcare dollar.”Essentials of Evidence-Based Practice Research Paper

#4: Improves quality of care.

Although the U.S. spends more money per person on healthcare than any other nation in the world, there is broad evidence that Americans often do not get the care they need. With evidence-based medicine, care improves because clinicians have access to previously untapped data and best practices vetted and agreed upon by peers.

#5: Improves outcomes.

The most important reason for the interest in evidence-based medicine is that it works. There’s a lot of data that shows if health systems diligently use the best clinical evidence and expertise, and ensure treatments are consistent with patient values, they’ll realize better outcomes in every way. As demonstrated with 15 case studies in the publication Evidence Based Medicine Matters, the use of evidence-based medicine resulted in improvements ranging from quicker recovery times after surgical procedures to safer ways to deliver breech babies.Essentials of Evidence-Based Practice Research Paper

The Future of Evidence-Based Medicine

With the acceleration of the value-based payment movement that will continue in the years ahead, there is an increasing need for clinicians to have access to the best available evidence to make the best possible decisions to achieve the best possible outcomes. Clinicians must practice evidence-based medicine.

This is an exciting time to be in healthcare because of the opportunities for improvement evidence-based medicine provides. Patients will feel confident they are getting the best care possible because treatments are based on the most current medical knowledge. Costs will also decrease when care improves. Concerns, such as avoidable readmission’s, can be averted when evidence-based medicine is incorporated into daily healthcare operations.Essentials of Evidence-Based Practice Research Paper

The Five Steps to Transition to Evidence-Based Medicine

Moving entire organizations over to an evidence-based model of care presents a few challenges. First, adopting evidence-based medicine as a new standard of practice requires clinicians to change how they were taught to diagnose and treat patients (i.e., the traditional craftsman approach taught during residency or nursing school). Second, providers are already simply trying to keep up with their workloads to treat patients the best they know how. Introducing a new model of care delivery—and learning how to effectively use it—takes time.Essentials of Evidence-Based Practice Research Paper

There are five steps busy clinicians can take to incorporate evidence-based medicine into their practices:

Step #1: Ask a clinical question to identify a key problem.

The first step to moving to an evidence-based model of care is to form teams of clinicians whose role is to ask questions to identify the critical few problems that need to be addressed. Examples of major problems most healthcare organizations need to address include improving throughput and reducing readmission’s.

It’s important to identify a high-priority problem that offers a significant return on investment. Once clinicians see large gains, they become engaged and excited about moving to an improved model of care. Women’s services, ischemic heart care, and surgical departments are examples of areas that typically offer opportunities for major improvements. Clinicians can ask several questions to help identify problems:Essentials of Evidence-Based Practice Research Paper

Why are we practicing this way? Clinicians naturally practice a certain way because that’s how they were taught. Yet with new medical discoveries coming out seemingly every day, what was once a best practice may not be anymore.
Are we adhering to best practices? It’s important to ask this question to determine if current practices are based on today’s most researched processes and practices that lead to the best possible outcomes.

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Can we produce better outcomes with consistency? Care should always be provided based on the best available evidence. This reduces inconsistent outcomes, which improves quality and reduces costs.Essentials of Evidence-Based Practice Research Paper

To significantly impact the improvement of quality in healthcare, one needs to apply evidence-based practice (EBP). Without EBP, healthcare providers are at risk for variances in care that could seriously affect patient outcomes.

A “no-brainer,” right? Yet, healthcare organizations throughout the U.S. continue to grapple with how to apply EBP. A recently published study conducted in collaboration with Elsevier Clinical Solutions and the Ohio State University College of Nursing surveyed 256 nurse executives about their beliefs and perceptions of EBP, along with some environmental aspects of their organizations.1 Among the study’s cardinal findings: even though all the respondents indicated that quality and safety were the highest priority within their organizations, focusing on EBP was the lowest. This presents a dilemma of sorts, because In order to achieve quality and safety, EBP must be applied.Essentials of Evidence-Based Practice Research Paper

Why is there such a contradiction between focusing on quality and safety, and EBP? And what must healthcare organizations do to achieve parity among these three goals? The answer lies in:

• Developing the right organizational culture
• Education and leading with nurses
• Employing models and framework and,
• Advancing an inter professional approach.

Establishing the right organizational culture
Simply disseminating evidence-based resources throughout an organization and expecting clinicians to implement evidence-based guidelines is not enough. In fact, clinicians often admit that they do not know where to find the evidence-based resources within their organization. EBP requires real behavior change, from long-held practices and organizational cultures of “this is the way we’ve always done it here,” to practice supported by science. Leaders who truly embrace a culture of EBP encourage their clinicians to ask questions. If a culture of inquiry does not exist in which people who don’t understand ask questions, practice will not change.Essentials of Evidence-Based Practice Research Paper

Transformation to an EBP culture requires a dynamic team vision along with clear expectations from leaders that EBP is the foundation of all care delivered within their organization. One way to do this is to embed the organization’s vision, mission and strategic plan with its expectations for EBP, as well as making sure that EBP is incorporated in the on boarding process for all new clinicians. Also, those clinicians who fall short on some EBP competencies when hired should be provided with some form of continuing education, including skill-building activities, until they achieve full competency.Essentials of Evidence-Based Practice Research Paper

Education and leading with nurses
Nurses are the largest workforce in the U.S. healthcare system. If we lead with nurses, we can make a tremendous impact. According to The Future of Nursing Report by the Institute of Medicine, this means pushing nurses to practice at the top of their license and embrace EBP.

We must bridge the gap between education and practice. For per-licensure in nursing schools, both faculty and students are hungry for tools that help them apply EBP. Post-censurer, using EBP in the work setting helps nurses apply it and advances their critical thinking. Overall, nurses should be expected to meet new EBP competencies for practicing, which means that baccalaureate and associate degree programs must teach students EBP.Essentials of Evidence-Based Practice Research Paper

Employing Models and Framework
Models and frameworks are critical to EBP. Having a model and/or framework can guide the transformational process by applying evidence at the point of care while integrating the commitment of EBP with other organizational goals.2 Too often, EBP is thought of as a theoretical concept that is difficult to embrace, but that’s just not the case. Employing models and/or frameworks also engages clinicians and scholars who are experts in their respective fields.

Advancing an inter professional approach
Nursing and other inter professional healthcare executives must build a culture and environment that supports evidence-based care implementation and sustainability to achieve the best patient outcomes.3 Evidence-based councils composed of a team of interdisciplinary clinicians can also enhance EBP throughout an organization and lead to a higher quality of care and improved outcomes.Essentials of Evidence-Based Practice Research Paper

Physicians in particular, who have primarily relied on clinical trials in the past are now viewing evidence-based methodologies as additional options to arriving at quality-focused, value-based care. Along with nurses and other allied health professionals, they are beginning to adopt inter professional EBP as a cornerstone to greatly improve the momentum of this movement.Essentials of Evidence-Based Practice Research Paper

Probably one of the greatest challenges – and opportunities – for EBP is applying it across the care continuum. EBP is very much aligned with the Affordable Care Act and movement from fee-based to value-based service. So, in looking at EBP’s application across the continuum of care, consider this: does it make sense for a patient with heart failure to receive care as an inpatient in a hospital setting that employs evidence-based guidelines and methodologies, to then be sent home and receive care at a heart clinic that doesn’t use an evidence-based approach to care?Essentials of Evidence-Based Practice Research Paper

We now have a great opportunity to establish EBP as a standard pillar across all healthcare settings to ensure that each patient receives evidence-based, consistent care from all providers. In addition, using EBP can enable patients to become more active participants in their healthcare.

What Is Evidence-Based Practice?

EBP is the use of clinical research to determine the best forms of patient care. By studying research, expert opinions, and other forms of data, nurses can identify ways to provide optimal patient care. The EBP systematic process includes the following steps:

Ask a question.
Search the latest research.
Incorporate clinical experience.
Accommodate patient preferences.
Apply the results.Essentials of Evidence-Based Practice Research Paper

When nurses look critically at existing methods, they can improve medical care. For instance, the treatment for acute muscle strain has changed over the years. Previously, nurses learned to ice certain injuries for the first 24 hours and then apply heat to increase blood flow. Now, evidence shows that only heat is beneficial.

The American Nurses Credentialing Center (ANCC) Magnet Recognition Program® requires hospitals to use evidence-based practice in nursing. Nurses need to document and demonstrate that they engage in the research, evaluation and use of evidence-based practice.Essentials of Evidence-Based Practice Research Paper

Evidence-Based Healthcare Decisions

EBP is not only for medical applications. Many healthcare systems have adopted EBP to create policies that address administrative and safety issues as well as patient satisfaction. It is important for organizations to use EBP when determining dress code policies or how to help nursing staff cope with alarm fatigue. The PICOT model is a technique healthcare professionals can use to frame a clinical question and find an answer:

P — Patient or problem.
I — Intervention or issue.
C — Comparison.
O — Outcome.
T — Time

The Benefits of a Dress Code

An important concern for many healthcare facilities is whether or not patients can identify nurses. Dress codes can also affect the spread of infection by restricting exposure to unsterile garments. Personal accessories can also affect patient perceptions — nurses need to appear professional.Essentials of Evidence-Based Practice Research Paper

Evidence-Based Dress Code

Healthcare organizations can turn to EBP to determine the appropriate dress code for their facilities. If the organization cannot find research to guide them, they can form a committee to conduct their own. Here are some questions the committee may pose:

What attire do patients perceive as professional?
How do patients recognize a nurse?
What do patients think nurses should wear?Essentials of Evidence-Based Practice Research Paper

Once it has developed a survey, the committee can distribute it to patients. Asking staff about their attire preferences and consulting with other healthcare systems can also yield useful data. Afterwards, the committee can evaluate the results to develop a dress code that is right for their facility.

Nurses and Alarm Fatigue

Nurses hear many alarms in the course of their work, which can lead to desensitization to sound. Many healthcare devices feature audible alarms, such as beds, infusion pumps, cardiac monitors, ventilators and mechanical vital sign machines. While these alarms are essential, research shows that 72 to 99 percent of alarms that go off do not indicate an emergency.Essentials of Evidence-Based Practice Research Paper

Unfortunately, patient deaths have occurred due to alarm fatigue; a famous case occurred in a Boston hospital. The patient’s alarm volume was turned off — possibly to stop the annoyance of an unneeded alarm — so nurses did not have any indication that the patient was in distress.

Evidence-Based Action Against Alarm Fatigue

Healthcare facilities need to commit to eliminating alarm fatigue. They can assemble a team to collect data on the cases of false alarms and response times. The following questions can guide their research:

What types of alarms do nurses rely on and in which areas?
What are the various levels of alarms (high, medium or low)?
What is the frequency of alarms?
What is the alarm response process?Essentials of Evidence-Based Practice Research Paper
What are the impediments to alarm response?

After gathering this information, nursing staff can create protocols to ensure suitable patient monitoring. Nurses should understand the various alarms in use throughout their healthcare facilities, so they can devise backup plans to guarantee alarm response.

Online RN to BSN Program Incorporates Evidence-Based Practice in Nursing

Students who pursue a BSN at the University of New Mexico (UNM) in the online RN to BSN program complete a course in EBP. Research and Evidence-Based Practice emphasizes how to identify clinical questions, critically assess evidence and convert findings into nursing practice. Nursing students will also discuss ethical issues associated with healthcare research.Essentials of Evidence-Based Practice Research Paper

Nurses learn to seek the most current scientific evidence in order to provide excellent patient care. Evidence-based practice in nursing is crucial to successful patient care, and it is also a good tool for shaping policies, procedures and safety regulations. Thus, EBP continues to improve our healthcare systems both for patients and healthcare professionals.

Nursing best practices are crucial to excellence in healthcare. Nurses with a Bachelor of Science in Nursing are able to apply their evidence-based education with healthcare best practices. The evidence-based curriculum combines research, science, clinical experience and the opinions of experts. These lessons equip nurses with the tools they need to work in the challenging and evolving healthcare industry.Essentials of Evidence-Based Practice Research Paper

Throughout their daily routines, nurses need to use best practices. The following are examples of nursing best practices in these three areas:

Nurse-to-nurse shift change.
Prevention of infection.
Patient care and discharge.

Best Practice for Nurse-to-Nurse Shift Change

In a clinical setting, the term “shift change” may be used interchangeably with any of the following:

Han doff.
Handover.
Sign-out.
Cross-coverage.
Shift report.

The most important element in nursing best practices is communication — especially during a shift change. During a shift change, nurses record and transfer important patient information, and it is imperative that the information is accurate and complete.Essentials of Evidence-Based Practice Research Paper

There is a greater risk of patient care mistakes during a nurse-to-nurse shift change. Problems exist due to the complex nature of specialized health systems. In comprehensive hand offs can result in gaps in patient care — incorrect medications, surgery mistakes and even fatalities. Improper hand offs happen because of a breakdown in communication and the omission of crucial patient information on sign-out sheets.

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A successful hand off happens without interruption to a patient’s care. Regulatory agencies such as the Agency for Healthcare Research & Quality, The Joint Commission and the National Quality Forum have established protocols for hand offs. Details of a patient’s care should not have any omissions regarding medication regimen or treatments, and the new attending nurse should know about any patient restrictions or physical needs. During a shift change, there should be full staff coverage so nurses are free from distractions. The shift change hand off should include the submission of accurate and up-to-date patient documentation and the opportunity to ask questions. The on-duty nurse should verify patient information by reading it back to the end-of-shift nurse.Essentials of Evidence-Based Practice Research Paper

Nursing Best Practices for Evidence-Based Infection Control

According to an article in Critical Care Nurse, hospital patients contract an infection at a rate of 4.5 out of 1,000. A patient who develops an infection is at risk for a prolonged hospital stay, serious illness or death. The transmission of bacteria in hospitals can cause infections at the surgical site, in the urinary tract or other sites as well. Bacteria can also cause central catheter bloodstream infections. One of the concerns about infections is due to the prevalence of multi drug-resistant organisms like Staphylococcus aureus, Aureomycin-resistant enterococcus and gram-negative bacilli.Essentials of Evidence-Based Practice Research Paper

The Joint Commission’s National Patient Safety Goals, the World Health Organization and the Centers for Disease Control and Prevention provide guidelines for the prevention of infections. The evidence-based practice for combating the spread of infection consists of these standard care procedures:

Hand hygiene.
Barrier protection.
Decontamination.
Antibiotic stewardship.

A nurse should conduct hand hygiene after every interaction with a patient and when entering and exiting a patient’s room. Barrier protection includes wearing gloves, gowns, masks and goggles. Decontamination of the room and equipment is necessary in reducing and preventing the spread of infection. Antibiotic stewardship is critical to stopping the overuse of the treatment. Antibiotics should only be used when other methods fail and the therapy should be closely monitored. In extreme cases, patients with an active infection may have to be isolated.Essentials of Evidence-Based Practice Research Paper

Care Rounding and Care Calls to Improve Patient Satisfaction

Hospitals are implementing best practices for patient care follow-up and discharge instruction. Care rounding is used to reduce the need for the patient’s call light. Typically, patients push the call button to notify nurses that they need urgent care. Nurses who institute a care-rounding schedule are more accessible to patients. This procedure reduces the number of times patients use the call light to summon a nurse for a non-emergency reason.

When patients are ready for discharge, they are often impatient and unable to retain a nurse’s instructions about medications or home care. Care calls allow nurses to check up on discharged patients and answer any questions. Generally, a nurse will make a care call 48 to 72 hours after a patient is discharged. Care calls build relationships between nurses and patients and improve patients’ satisfaction regarding their healthcare experience.

Evidence-Based Practice: Definition and Importance

Jerry goes to his doctor’s office after a miserable head cold turns into bronchitis. Jerry’s doctor scratches his head and ponders, ‘I’m not too sure what to do about your bronchitis. Maybe try drinking some grape juice, and if you don’t feel better, come back and see me.’ Feeling confused and miserable, Jerry heads to the store for juice that likely won’t cure his cold.Essentials of Evidence-Based Practice Research Paper

Thankfully, the above scenario is unlikely due to evidence-based practice. This lesson will help explain what evidence-based practice is, why this multi-part collaborative process is important and how providers decide what treatments will be most effective for their patients.

Evidence-based practice is a holistic approach to treatment, which integrates a clinician’s knowledge and expertise, effective treatment interventions, and patient preferences, needs, and values. This approach improves treatment outcomes by taking into account each component of successful treatment. Without evidence-based practice, patients needing care would not receive the most effective treatment. As shown in the above scenario, a doctor might treat bacterial bronchitis with something useless, like grape juice!Essentials of Evidence-Based Practice Research Paper

Evidence-based practice addresses several limitations in treatment, such as the over-use of treatment manuals (a one size fits all approach), the doctor viewed as the prescribe r of treatment (just do what the doctor says), and patient demand (I need those specific pills to fix me). Instead, each component affects and is effected by each other component.

For example, let’s say Jerry goes to another doctor for bronchitis and this doctor, having read research on the effectiveness of antibiotics for bacterial bronchitis, knows that the antibiotic Bronchaway is very successful in treating most cases of bronchitis. Unfortunately, Jerry has taken Bronchaway in the past and it makes him break out in hives. The doctor takes this patient information into account, along with the general efficacy of antibiotics, and chooses another antibiotic to help Jerry get well.Essentials of Evidence-Based Practice Research Paper

This solution has synthesized the clinician’s knowledge and expertise (Bronchaway works well for most patients), effective treatment interventions (research shows antibiotics treat bronchitis), and patient needs (Jerry is allergic to Bronchaway).

Evidence-Based Practice Steps

In order to ensure that patients receive optimal treatment through the integration of clinician expertise, evidence based treatments, and patient preferences and needs, clinicians follow through a multi step process.

1. Ask the Question: Gather information from the patient about current needs for treatment.

Example: Jerry goes to the doctor and reports congestion, coughing, and problems taking in a full breath.Essentials of Evidence-Based Practice Research Paper

2. Acquire the Evidence: Based on patient need, review best research for most effective treatments for the patient’s condition.

Evidence-based practice (EBP) is an interdisciplinary approach to clinical practice that has been gaining ground following its formal introduction in 1992. It started in medicine as evidence-based medicine (EBM) and spread to allied health professions, educational fields, and others. EBP is traditionally defined in terms of a “three legged stool” integrating three basic principles: (1) the best available research evidence bearing on whether and why a treatment works, (2) clinical expertise (clinical judgment and experience) to rapidly identify each patient’s unique health state and diagnosis, their individual risks and benefits of potential interventions, and (3) client preferences and values.[1][2]

Evidence-based behavioral practice (EBBP) “entails making decisions about how to promote health or provide care by integrating the best available evidence with practitioner expertise and other resources, and with the characteristics, state, needs, values and preferences of those who will be affected. This is done in a manner that is compatible with the environmental and organizational context. Evidence is research findings derived from the systematic collection of data through observation and experiment and the formulation of questions and testing of hypotheses”.[3]Essentials of Evidence-Based Practice Research Paper  

What Is Evidence-Based Practice?

Evidence-based practice (EBP) is an important concept that denotes the purposeful use of the best and latest evidence in making the most appropriate decisions about patient care. If you were a medical practitioner or (let’s hope not) you were the patient in a hospital, wouldn’t you want only the best evidence supporting a clinical decision? Of course. It only makes sense. Let’s learn about the key principles behind EBP.

Why Is It Important?

If EBP were not utilized in medical care settings, what would be the alternative? Such situations vary, but the alternatives to using the best evidence in clinical care could look something like:

Applying clinical care that is based on cultural tradition. While some traditional healing methodologies have been and are employed in so called ‘Western’ medicine, many traditional methods not only have no scientific backing but may even be harmful to the patient. The ideas of EMP set forth that the application of tradition alone in the clinical setting is not the best approach to patient care.Essentials of Evidence-Based Practice Research Paper
Using outdated policies/dogma. Instead of changing with the times, the practitioner would stick to what worked in the past without employing the methods that have been shown to work better using the best and latest evidence. In other words, in this alternative to EBP, people are set in their ways and unwilling to change.

Numerous studies have shown that using EBP helps to decrease healthcare costs and improve a patient’s health.

Key Principles

While EBP is, at its core, a notion of using the best and most recent evidence for making good healthcare decisions, there’s a lot more to it. Many hospital systems and medical practitioners in the U.S. and around the world simply don’t use EBP even though they might realistically prefer for their own medical caregiver to use EBP if they found themselves in the hospital as a patient. Why? One reason for this is that EBP is a life-long and active problem-solving approach to medicine. Simply put, it’s not easy. In order to properly employ EBP, the medical practitioner must:Essentials of Evidence-Based Practice Research Paper

Evidence Based Practice signifies a systematic, yet holistic and patient-oriented approach to health care.  EBP is an offshoot of evidence based medicine (EBM), defined in Sackett’s key article:

“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external evidence from systematic research.”Essentials of Evidence-Based Practice Research Paper  

This definition of EBM requires integration of three major components for medical decision making:  1) the best external evidence, 2) individual practitioner’s clinical expertise, and 3) patients’ preference.

Steps in the EBP Process:

Clearly identify the patient problem based on accurate assessment & current professional knowledge and practice. 
Research the literature for relevant research.
Evaluate the research evidence using established criteria regarding scientific merit.
Choose interventions and justify those with the most valid evidence.Essentials of Evidence-Based Practice Research Paper  

Evidence-based Nursing (EBN) goes beyond those three components, adding more extended consideration of patient values, and including access to adequate resources. EBN has been said to incorporate:

the patient’s clinical state, clinical setting and circumstances
the patient’s preferences and actions
the best research evidence, defined as: “methodologically sound, clinically relevant research about the effectiveness and safety of nursing interventions, the accuracy and precision of nursing assessment measures, the power of prognostic markers, the strength of causal relationships, the cost effectiveness of nursing interventions, and the meaning of illness or patient experiences.”

It has been a little over a year since the first set of essential evidence‐based practice (EBP) competencies for practicing nurses and advanced practice nurses (APNs) were published in Worldviews on Evidence‐Based Nursing (Melnyk, Gallagher‐Ford, Long, & Fine out‐Overholt, 2014). In the initial year after publication, there were over 13,000 downloads of this paper, which indicates the great interest worldwide in these new competencies. However, dissemination of evidence alone, including these competencies, does not typically result in changes in real‐world practice and academic settings. Dissemination of evidence must be taken a step further by acting upon the evidence that is published to make changes to improve health care and health outcomes. Now that there is a landmark set of research‐based, essential EBP competencies for practicing registered nurses and APNs, we must take action to implement them in the real world to ultimately improve healthcare quality and patient outcomes as well as to reduce costs.Essentials of Evidence-Based Practice Research Paper

Competence is often described broadly as a concept that incorporates knowledge, skills and attitudes, and the ability to do something well (Ilic, 2009; Melnyk et al., 2014). A variety of health professions have used competencies as a mechanism to determine whether clinicians are providing high‐quality safe care (Gallagher‐Ford, Buck, & Melnyk, 2014; Williams et al., 2010). As an example in the nursing profession, the Quality and Safety Education for Nurses (QSEN) Project is a global initiative that developed six competencies for nursing education to prepare students with the knowledge, skills, and attitudes to improve quality and safety. The QSEN competencies include: (a) patient‐centered care, (b) teamwork and collaboration, (c) EBP, (d) quality improvement, (e) safety, and (f) informatics. Other healthcare disciplines, such as medicine, have developed and implemented competencies, such as essential geriatrics competencies for internal medicine and family medicine, developed in 2010 through a consensus‐building process that included leadership and members of key stakeholder organizations.Essentials of Evidence-Based Practice Research Paper

There are very few validated tools that exist to measure competency in EBP. The three tools that do exist, the Berlin questionnaire, the Fresno tool, and the Assessing Competency in Evidence based medicine (ACE) tool, have focused on medical students and graduates from medical school (Ilic, 2009). The Berlin tool is a 15‐item, self‐report knowledge assessment tool that was created to measure EBP knowledge in medical professionals (Fritsche, Greenhalgh, Falck‐Ytter, Neumayer, & Kunz, 2002). However, a major limitation is that the Berlin tool only assesses step 3 in the EBP process (i.e., critical appraisal of evidence; Ilic, 2009). The Fresno assessment tool also was developed to measure  medical professionals’ EBP competence, specifically knowledge and skills in EBP (Ramos, Schafer, & Tracz, 2003). The Fresno tool is a standardized objective measure of EBP, which is comprised of two clinical scenarios with open‐ended questions that tap four steps in the EBP process to which participants respond. The ACE tool is a 15‐item assessment of EBP competency, including knowledge, attitudes, skills and behaviors (Ilic, Nordin, Glasziou, Tilson, & Villanueva, 2014). It contains a short patient scenario from which a clinical question is presented followed with a search strategy and a hypothetical article extract. Participants taking the ACE assessment answer 15 “yes” or “no” questions that represent four steps of EBP, including forming the clinical question, searching the literature, critical appraisal, and application of the evidence to the patient (Ilic et al., 2014). Essentials of Evidence-Based Practice Research Paper Items 1 through 11 on the ACE tool assess EBP knowledge and skills, and items 12 to 15 assess attitudes toward implementing EBP in the clinical setting. As these three tools were developed specifically to measure EBP competence in the medical profession, there is a tremendous need to develop additional valid and reliable tools that are applicable to other professions, including practicing nurses and APNs. Now that the new EBP competencies for practicing nurses and APNs exist, there is a tremendous window of opportunity to develop an objective valid and reliable assessment based on these competencies.Essentials of Evidence-Based Practice Research Paper

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The new research‐based EBP essential competencies provide leaders with another tool that can assist them in taking action and moving their organizations toward high quality safe care. They can be implemented in a broad range of applications. The EBP competencies should be set as an expectation of performance in organizations. They should be introduced during the onboarding process for all new hires and clearly incorporated into job descriptions and performance appraisals for all new and practicing nurses and APNs in healthcare systems across the globe. They also can be used as a tool for conducting assessments of practicing nurses’ and APNs’ knowledge and skills in EBP to identify gaps where targeted continuing education and skills building workshops are needed. Until all practicing nurses and APNs achieve all of these competencies, they can be built into clinical ladder systems to provide an incentive for nurses to become more proficient in their EBP knowledge and skills. They also can be integrated into expectations for members of shared governance councils to ensure that decisions and recommendations from councils are based in evidence as opposed to tradition.Essentials of Evidence-Based Practice Research Paper

The new EBP competencies also can be used as a guide for educators to prepare students in the necessary knowledge and skills they need to leave academia and function competently in EBP as practicing nurses and APNs in real‐world practice settings. One academic barrier to the preparation of students to achieve these competencies is that many faculty across the United States and globe have excellent research skills, but do not have comparable EBP knowledge or skills needed to teach students the seven‐step EBP process and how to rapidly translate findings from research into healthcare settings to improve care and outcomes because they themselves were taught rigorous research instead of an evidence‐based approach to care (Melnyk, 2013). Further, many educators in academia have the misperception that it is essential for students to first learn research before they can be taught EBP. These barriers often create negative attitudes toward research and a lack of foundational understanding of EBP in students that further slow its implementation in the real world (Melnyk, 2013). In those institutions that do provide an outstanding education in EBP, it is critical that students enter healthcare settings that value and emphasize EBP instead of care that is steeped in tradition (e.g., that is the way it is done here). Practice and academia need to be in sync with each other so that what students learn in academia and how they experience real‐world practice are aligned for the best outcomes to be achieved. This requires that partnerships be forged between all academic and practice settings.Essentials of Evidence-Based Practice Research Paper

There are healthcare systems in the United States that have already begun to implement the new EBP competencies. For example, The Ohio State University Health System in the Midwest, USA, has begun to incorporate the EBP competencies into its clinical ladder system and their onboarding program. Nationwide Children’s Hospital in Columbus, Ohio, USA, is integrating the competencies into its policy and procedure committee. This trans disciplinary committee participated in a self‐assessment using the EBP competencies, which provided data that informed the development of targeted education sessions for the group to increase EBP knowledge and skills. Ongoing mentoring also has been provided to develop and build EBP skills so the competencies can be achieved. In addition, Flagstaff Medical Center, a member of Northern Arizona Healthcare in Flagstaff, Arizona, USA, has integrated the EBP competencies into its clinical educator and clinical nurse specialty positions and is beginning to integrate them into all nursing positions. We would like to hear from others who have begun the process of integrating the new competencies in clinical or academic settings.

In conclusion, it is terrific that there is finally a set of research‐based EBP competencies for practicing nurses and APNs. However, if these competencies are not used in actual practice, they will be added to the plethora of other evidence‐based interventions and research findings that are published but not implemented in the real world to improve healthcare quality and patient outcomes. A quote by Stephen R. Covey (1989) is “To know and not to do is not to know.” Having so much knowledge that never gets translated into real‐world settings is not acceptable in this high stakes situation; people around the world deserve the best health outcomes. Moving health care to an evidence‐based approach to care can no longer be an academic exercise or something to be done on top of other role responsibilities. EBP must be in the DNA of all trans disciplinary practicing clinicians and the foundation of care that is delivered. It is only when this happens that we will have a healthcare system free of complications, errors, and wasteful spending along with a healthier world for people across the globe.Essentials of Evidence-Based Practice Research Paper