To Build an Evidence-based Practice • Cultivate a spirit of inquiry (clinicians must be comfortable with and excited about asking questions about patient care and institutional or unit-based practices)
Steps of Evidence-based Practice 2. Ask clinical questions in PICOT format P = patient population I = Intervention or Issue of interest C = Comparison intervention or group O = Outcome T = Time frame
Steps of Evidence-based Practice Example of PICOT question: In teenagers (the patient population), how does cognitive-behavioral skills building (the experimental intervention) compared to yoga (comparison intervention) affect anxiety (the outcome) after 6 weeks of treatment (time frame)?
Steps of Evidence-based Practice 3. Search for best evidence (conduct a systematic, integrated review of literature)
Steps of Evidence-based Practice 4. Critical appraisal of evidence found • Are the results of the study valid? (Are the results as close to the truth as possible?) • What are the results? (Did the intervention work? How large was the treatment effect? Would replication of the study yield similar results?) • Will the results help me in caring for my patients? (Are the subjects in the studies similar to my patients? Are the benefits greater than the risks? It the treatment feasible? Does the patient desire the treatment?)
Steps of Evidence-based Practice If the answers to # 4 are yes, 5. Integrate the evidence with clinical expertise and patient preferences to make the best clinical decision.
Steps of Evidence-based Practice If the answers to # 4 are “no,” 5. Generate internal evidence through an EBP implementation or outcomes management project or a research study
Steps of Evidence-based Practice 6. Evaluate the outcomes of the practice change based on evidence (Measure patient outcomes or health care quality to determine if this clinical decision was effective.)
Steps of Evidence-based Practice 7. Disseminate the outcomes of the evidence-based practice change (locally, regionally, nationally)
Barriers to Evidence-based Practice • Staff lack EBP knowledge and skills • Lack of belief that EBP will result in better outcomes that traditional care • Amount of information published • Lack of time to appraise evidence • Overwhelming patient loads
Barriers to Evidence-based Practice • Lack of administrative support • Peer pressure to “not make waves” • Resistance to change • Lack of autonomy over practice • Lack of consequences for not implementing EBP
resource Melnyk, B.M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice (2nd ed.). Philadelphia: WoltersKluwer/Lippincott Williams & Wilkins.