Chapter5

Copyright © 2008 Thomson Delmar Learning

Chapter 5Chapter 5

Evidence-Based Health Care


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Objectives Objectives

Upon completion of this chapter, the reader should be able to: Know the history of evidence-based care (EBC)

in nursing Develop an understanding of evidence and its

use in decision making Assume responsibility for developing an

evidence-based approach to patient care


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ObjectivesObjectives

Understand the terminology used to describe types of evidence and evidence-based care processes

Develop an informed view of the current state of evidence-based care and an understanding of the role of nursing in evidence-based decision making

Apply the steps needed to incorporate evidence-based care in their own practice

Conduct a search for evidence on a given topic


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History of Evidence-Based CareHistory of Evidence-Based Care

Initially began in Canada Evidence-based care

The process of providing clinically competent care that is based on the best scientific evidence available

Includes all health disciplines


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Implementation of Implementation of Evidence PracticeEvidence Practice

Find a source of evidence-based content that is developed using good research techniques

The evidence-based content itself must be efficient for clinicians to use at the bedside

Integrate the evidence-based content into order sets, plans of care, and documentation forms


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The ACE Star Model of The ACE Star Model of Knowledge TransformationKnowledge Transformation

Provides a framework for systematically putting evidence-based practice into operation

Star points Knowledge discovery Evidence summary Translation into practice recommendations Integration into practice Evaluation


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Research TerminologyResearch Terminology

Absolute benefit increase

Best practice Case-control study Clinical practice

guidelines Cohort study Control group

Correlational research Dependent variable Descriptive research Evidence-based health

care Follow-up study Health outcomes Independent variable


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Integrative review Longitudinal study Matching Meta-analysis Nonexperimental

research Number needed to

treat Outcomes research

Prospective study Qualitative analysis Quantitative analysis Quasi-experiment Randomized clinical

trial Relative risk Research utilization


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Retrospective design Systematic review Time series design Translation Treatment effect Variable


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Importance of EBCImportance of EBC

There is a lack of agreed-upon standards or processes that are based on evidence

EBC is a process approach to collecting, reviewing, interpreting, critiquing, and evaluating research

Leads to a state-of-the-art integration of knowledge and evidence that can be evaluated and measured through outcomes

Should be viewed as the highest level of care


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Nursing and EBCNursing and EBC

The agency for Healthcare Research and Quality (AHRQ) launched twelve evidence-based practice centers

The initiative partnered with public and private organizations to improve the quality, effectiveness, and appropriateness of care

Nurses work with patients in deciding treatment options


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Attributes of EBCAttributes of EBC

Need to define the meaning of evidence in each health care agency Use the term in daily practice Look for best evidence when evaluating new goals and

programs

Fundamental principles in EBC Evidence alone is never sufficient to make a clinical

decision Evidence-based care involves a hierarchy of evidence

to guide decision making


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Challenges for NursesChallenges for Nurses

Rapidly growing body of scientific literature No unaided human being can read, recall, and

act effectively on the volume of material

Literature is not in a form that is suitable for application to practice Needs to be evaluated and transformed in order

to be useful


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Conducting Evidence Reports Conducting Evidence Reports in Nursingin Nursing

Select problem Review the evidence Summarize the evidence Report results Make recommendations for potential

clinical applications Implement agreed-upon practice changes


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Promoting Evidence-Based Promoting Evidence-Based Best Practices Best Practices

The U.S. health care system does not have uniform definitions of what constitutes efficient, effective, quality health care

It is difficult to get all clinical health care providers to apply EBC processes at the unit level


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Promoting Evidence-Based Promoting Evidence-Based Best Practices Best Practices

EBC processes must be uniform enough to be valid, but also adaptable to specific needs of institutions

EBC requires involvement of and collaboration between clinical practitioners and health care researchers

Health & Medicine

Chapter5