Concept of Evidence-Based Practice in Nursing

What is Evidence-Based Practice (EBP) in Nursing?

Evidence-Based Practice in nursing is the systematic integration of the best current research evidence, clinical expertise, and patient values to guide clinical decision-making and improve patient outcomes.

It is not just about using research it is about combining research findings with nursing experience and patient preferences to provide safe, effective, and personalized care.

Core Components of EBP (The Three Pillars):

1. Best Available Evidence
   • High-quality, up-to-date research findings from systematic reviews, randomized controlled trials, and clinical guidelines.
2. Clinical Expertise
   • The nurse’s own professional skills, knowledge, and past clinical experiences.
3. Patient Preferences & Values
   • The patient’s personal values, cultural beliefs, concerns, and expectations.

Importance of EBP in Nursing:

• Improves patient safety and quality of care.
• Reduces variations in practice.
• Encourages critical thinking and informed decision-making.
• Enhances professional accountability.
• Bridges the gap between research and clinical practice.

The EBP Process in Nursing (Step-by-Step):

1. Ask a Clinical Question
   • Use the PICO format:
     P – Patient/Problem
     I – Intervention
     C – Comparison
     O – Outcome
2. Search for the Best Evidence
   • Use databases such as PubMed, CINAHL, Cochrane Library.
3. Critically Appraise the Evidence
   • Assess reliability, validity, and applicability of research findings.
4. Integrate the Evidence
   • Combine research evidence with clinical expertise and patient preferences.
5. Implement the Practice Change
   • Apply the new approach in the clinical setting.
6. Evaluate the Outcomes
   • Measure results and determine effectiveness.
7. Disseminate the Results
   • Share findings with colleagues and contribute to nursing knowledge.

EBP process involves the following five steps.

• Formulating a clear question based on a clinical problem: The first step is to formulate a clear question based on clinical problems. The source for formulating a question is generally categorized into two broader classes, that is, (1) problem-based source and (2) knowledge-based source.
•  Problem-based sources: In this category, the health care professionals get an idea about relevant question for EBP from the clinical or risk assessment data, such as data of quality improvement, risk surveillance. Benchmarking data, financial data, recurrent clinical problems, etc., For example, increased incidence of pressure sore in critical care units may be one of the important issues to be considered for EBP

• Knowledge-based sources: The health care professionals may obtain knowledge of newer evidence from the scientific journals, publications, research conferences or EBP guidelines published by statutory bodies, which may enhance nursing care practices. For example, new evidence on nursing care interventions on prevention of bed sore, pain management, tube feeding techniques, arterial and venous line potency, infection control, deep vein thrombosis prevention, etc.

The Levels of Evidence-Based Practice

Four primary levels of evidence come into play when you’re making clinical decisions.

1. Level A acquires evidence from randomized, controlled trials and is considered the most reliable.
2. Level B evidence is obtained from quality-designed control trials without randomization.
3. Level C typically gets implemented when there is limited information about a condition and acquires evidence from a consensus viewpoint or expert opinion.
4. Level ML (multi-level) is usually applied to complex cases and gets its evidence from more than one of the other levels.

Benefits of Evidence-Based Practice in Nursing

Besides keeping healthcare practices relevant and current, evidence-based practice in nursing offers a range of other benefits to you and your patients:

• Promotes positive patient outcomes
• Reduces healthcare costs by preventing complications 
• Contributes to the growth of the science of nursing
• Allows for incorporation of new technologies into healthcare practice
• Increases nurse autonomy and confidence in decision-making
• Ensures relevancy of nursing practice with new interventions and care protocols 
• Provides scientifically supported research to help make well-informed decisions
• Fosters shared decision-making with patients in care planning
• Enhances critical thinking 
• Encourages lifelong learning

REFERENCES

1. Al Maqbali, M. (2024). Introduction to Nursing Research. In: Essential Research for Evidence-Based Practice in Nursing Care. Springer, Cham. https://doi.org/10.1007/978-3-031-78298-5_1
2. Suresh Sharma, Nursing Research & Statistics, 4th Edition – December 27, 2022, Elsevier India Pulblishers, ISBN: 9788131264478
3. Pearson, nursing Research and Statistics, Nursing Research Society of India, 2013 Dorling Kindersley (India) Pvt. Ltd, ISBN 9788131775707
4. Scott K, McSherry R. Evidence-based nursing: clarifying the concepts for nurses in practice. J Clin Nurs. 2009 Apr;18(8):1085-95. https://pubmed.ncbi.nlm.nih.gov/19077021/
5. Barría P RM. Use of Research in the Nursing Practice: from Statistical Significance to Clinical Significance. Invest Educ Enferm. 2023 Nov;41(3):e12. doi: 10.17533/udea.iee.v41n3e12. PMID: 38589312; PMCID: PMC10990586.

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