Evidence based practice Essay

INTRODUCTION show up-Based make (EBP) is a c beful integration of the trump available designate, joined with clinical expertise. As such(prenominal) it enables soundlyness practicians of all varieties to approach health do by in purposes with an evaluative and qualitative approach. EBP allows the practitioner to assess current and past look, clinical guidelines, and other breeding resources in order to identify applicable literature while differentiating between high-quality and low-quality findings.UNIT BACKGROUNDEvidence found acts was founded by Dr.Ardice Cochrane , a British epidemiologist.Cochrane was a strong proponent using rise from randomize clinical trials beca wasting disease he believed that this was the strongest tell apart on which clinical go for division is to be establish.Evidence ground health c atomic number 18 lend oneselfs ar available for a number of conditions such as asthma,smoking cessation,heart failure and others.However these forms a re non be implemented in care delivery and variation of dosCMS,2008Institute of medicine ,2001.Recent findings in the joined states and Netherlands suggest that 30% to 40 % of patients are not receiving picture found care,and 20% to30% of patients are receiving inessential or potentially harmful care.DEFINITIONThe most common definition of Evidence-Based Practice (EBP) is from Dr. David Sackett. EBP is the conscientious, explicit and fresh engagement of current best record in making decisions about the care of the individual patient. It kernel integrating individual clinical expertise with the best available external clinical evidence from opinionated look. (Sackett D, 1996) Muir Gray suggests that evidence base health care isan approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits the patient best(Muir Gray, 1997)PURPOSES1. Evidence based employment is an approach wh ich tries to specify the agency in which professionals or other decision mkers should make decisions by identifying such evidence that there may be for a confide and rating it according to how scientifically move it may be. 2. Its goal is to eliminate unsound or excessively risky blueprints in favour of those that call for better essences. 3. Evidence based practices has contributed a lot towards better patient outcomes. 4. The ultimate goal of certify based nurse is to provide the highest quality and most cost- cost-effective nursing care possible. 5. The purpose of evidence based practice in nursing is mainly to advance the quality of nursing care.For example If you are caring for a child who was in a motor vehicle accident and sustained a severe head injury, would you want to know and use the effective ,empirically supported treatment established from randomize controlled trials to decrease his or her intracranial pressure?If the solving is yes,the empirical evidences are essentially very chief(prenominal) in most of the clinical decision-making situations. The goal of EBP is the integration of (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/care supportr values to provide high-quality services reflecting the cheers, values, needs, and choices of the individuals we serve. Conceptually, the trilateral principles forming the bases for EBP can be delineate through a simple figureSTEPS OF EVIDENCED found PRACTICE Evidence based practice process involves 5 steps as1. Formulating a clear question based on a clinical problem2. Literture review to search for the best available evidences 3. Evaluating and analyzing the strengths and weaknessof that evidence in monetary value of harshness and genelisability 4. Implementing useful findings in clinical practice based lon valid evidence 5. Evaluating efficacy and carrying into action of evidences through a process of self saying , audit, or peer aseessmen t 1.Formulating a clear question based on a clinical problem ASK the question The first step is to hammer a clear question based on clinical problems.Ideas come from different sources but are categorized intwo areas Problem foc employ triggers and Knowledgee focused triggers. Problem focused triggers are set by healthcare staff through quality improvement,risk surveillance,benchmarking data,financial data, or recurrent clinical problems.Problem focused triggers could be clinical problems,or risk management issues.ExampleIncreased incidence of deep vein thrombosis and pulmonary emboli in trauma and neurosurgical patients.Diagnosis and proper treatment of a DVT is a very most-valuable task for health care professionals and is meant to prevent pulmonary embolism.This is an example of an important re tht more look for can be conducted to bring into evidence based practice. Knowledge focused triggers are created when health care staff read research, comprehend to scientific papers at research conferences.Knowledge based triggers could be new research findings that further heighten nursing ,or new practice guidelines. Example Pain management .,prevention of skin breakd birth , assessing placement of nasogastric tubes, and use of saline to maintain patency of arterial lines.When selecting a question ,nurses should formulate questions that are likely to cause support from people within the organization.The priority of the question should be calculateed as well as the sevearity of the problem.Nurses should consider whether the issue would hold up to many or few clinical areas.Also,the availability of the solid evidence should be considered.This will increase the staff willingness to implement into nursing practice.When forming a clinical question the following should be consideredthe disorder or disease of the patient, the intervention or finding being reviewed, possibly a equation intervention and the outcome.An acronym used to remember this is called the PICO illustration.P-Who is the patient population?I-What is the potential intervention or area of interest?C-Is there a a comparison intervention or control crowd?O-What is the desired outcome?2.Literature review to search for the best available evidence ACQUIRE the evidence Once the topic is selected ,the research relevant to the topic must be reviewed . It is important that clinical studies , integrative literature reviewes , meta analysis, and well cognise and reliable existing evidence based practices guidelines are accessed in the literature retrieval process .The condition can be loaded with optionated nd or biased statements that would clearly taint the findings, thus lumbering the believability and quality of article.Time management is crucial to entropy retrieval.To maintain high standards for evidence based practice implementation, education in research review is necessary to distinguish good research from poorly conducted research.it is important to review the cur rent materials.Once the literature is located, it is helpful to classify the articles either conceptual or data-based.Before reading and critiquing the research ,it is useful to read theoretical and clinical articles to have a broad view of the nature of the topic and related concepts , and to then review existing evidence based practice guidelines. 3. Evaluating and analyzing the strengths and weakness of that evidence in terms of validity and generalisability APPRAISE the evidenceUse of rating systems to determine the quality of the research is crucial to the development of evidence based practice. Once you have found some potentially useful evidence it must be critically appraised to determine its validity and find out whether it will indeed answer your question. When appraising the evidence the main questions to ask, then, are Can the evidence (e.g. the results of the research study) be trusted? What does the evidence mean?Does this answer my question?Is it relevant to my pract ice?Different appraisal and interpreting skills must be used depending on the kind of evidence being considered. Additionally, guidance and training on appraising different types of evidence are available from some of the websites listed on the Useful Internet Resources. 4.Implimenting useful findings in clinical practice based on valid evidence Evidence is used alongside clinical expertise and the patients perspectives to plan care foundertalk with the patient After determining the internal and external validity of the study ,a decisions is arrived at whether the information gathered does apply to your initial question.It is important to address questions related to diagnosis ,therpy ,harm, and prognosis. Once you have concluded that the evidence is of sound quality, you will need to draw on your own expertise, experience and fellowship of your unique patient and clinical setting. This will help you to decide whether the evidence should be incorporated into your clinical practic e.You must consider both the benefits and risks of implementing the vary, as well as the benefits and risks of excluding any alternatives. This decision should be made in collaboration with your patient, and in consultation with your manager or multidisciplinary team where appropriate.The information gathered should be interpreted according to many criteria and should always be shared with other nurses . 5.Evaluating efficacy and performance of evidences through a process of self reflection ,audit , or peer assessment self-evaluation ultimately after implementation of the useful findings for the clinical practicesefficacy and performance is evaluated through process of self reflection ,internal or external audit or peer assessment.Part of the evaluation process involves following upto determine if your actions or decisions achieved the desired outcome.The Steps in the EBP ProcessASSESSthe patient1. Start with the patient a clinical problem or question arises from the care of the patient ASKthe question2. Construct a well built clinical question derived from the case ACQUIREthe evidence3. Select the appropriate resource(s) and conduct a searchAPPRAISEthe evidence4. Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice) APPLYtalk with the patient5. Return to the patient integrate that evidence with clinical expertise, patient preferences and apply it to practice Self-evaluation6. Evaluate your performance with this patientBARRIERS IN EVIDENCE BASED PRACTICEThere are many barriers to promoting evidence based practices such as Lack of professional ability to critically appraise research.this includes having a considerable amount of research evaluation skills ,access to journals ,nd hospital support to spend time are restrain to the nurses. Lack of time workload pressure ,and competing priorities of patient care can impede use of evidence based practice. Lack of knowledge of research methodsLack of support from the professional colleges and organizations , and lack of confidence nd authority in the research area Practice environment can be resistant to ever-changing tried and true conventional methods of practice.It is important to show nurses who may be resistant to changes the nursing practice the benefits that nurses, their patients and their institutions can reap from the implementation of evidence base nursing practices which is to provide better nursing care. determine ,resources and evidence are the three factors that influence decision making with regard to health care.In adition the nurses need to be more aware of how to assess the information and determine its applicability to the practice.Lack of continuing educational programs . Practices donot give have the means to provide workshops to t each(prenominal) new skills due to lack of funding, staff and time therefore research may be tossed dismissed.if this will occur valuable treatment may never be utilized in the practice. Another barrier is introducing newly learned method for improving the treatments or patients.New nurses susceptibility feel it is not their place to suggest oreven tell a superior nurse that newer , more efficient methods and practices are available. The perceived threat to clinical freedom offered by evidence based practice is incomplete logical nor surprising.When we make decisions based upon good quality information we are inconsistent and biased.MODELS OF THE EVIDENCE BASED PRACTICE PROCESSA number of different sticks and theories of evidence based practice has been developed and are important resources.These models offer frameworks for understanding the evidence based practice process and for implementing an evidence based practice project in a practice setting.Models that offer a framework for guiding an evidence based practice include the following Advancing research and clinical practice through close collaboration(ARCC) model Melynk and fineout-overholt ,200 5 Diffusion of innovations theory Rogers , 1995Framework for adopting an evidence based innovation DiCenso et.al.,2005 Iowa model of research in practice titler et al ,2001Johns Hopkins nursing evidence based practice models Newhouse et.al, 2005 Ottawa model of research use Logan and graham flour ,1998Promoting action on research implementation in health services (PARIHS model-,Rycroft Malone et.al2002 ,2007 Stetler model of research utilization.Stetler ,2001Although each model offers different perspectives on how to translate research findings into practice .It provides an overview of key activities and processes in evidence based practice efforts ,based on a a distillation of common elements from the various models.The most prominent models are Stetler model of research utilization and Iowa model of research in practice. Stetler model of research utilizationThe Stetler model of evidence-based practice would help individual public health practitioners to use evidence in daily pra ctice to inform program planning and implementation. The Stetler model of research utilization helps practitioners assess how research findings and other relevent evidence can be applied in practice. This model examines how to use evidence to create formal change within organizations, as well how individual practitioners can use research on an informal nates as part of critical intellection and reflective practice.Research use occurs in three formssubservient use refers to the concrete, direct application of knowledge. Conceptual use occurs when using research changes the understanding or theway one thinks about an issue. Symbolic use or political/strategic use happens when information is used to justify or legitimate a policy or decision, or otherwise influence the thinking and behaviour of others.The Stetler model of evidence-based practice based on the following suppositions 1. The formal organization may or may not be involved in an individuals use of research or other eviden ce. 2. Use may be instrumental, conceptual and/or symbolic/strategic. 3. 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. 4. Internal or external factors can influence an individuals or groups review and use of evidence. 5. Research and evaluation provide probabilistic information, not absolutes.6. Lack of knowledge and skills pertaining to research use and evidence-informed practice can inhibit appropriate and effective use phase I PreparationPurpose, Context and Sources of Research Evidence Identify the purpose of consulting evidence and relevant related sources. eff the need to consider important contextual factors that could influence implementation. Note that the reasons for using evidence will similarly identify measurable outcomes for Phase V (Evaluation).Phase II ValidationCredibility of Findings and Potential for/ circumstantial Qualifiers of Application priz e each source of the evidence for its level of overall credibility, applicability and operational details, with the assumption .Determine whether a given source has no credibility or fit and thus whether to accept or reject it for synthesis with other evidence .Summarize relevant details regarding each source in an relevant statement of findings to look at the implications for practice in Phase III. A summary of findings should reflect the signification of study findingsreflect studied variables or relationships in ways that could be practically used Phase III Comparative Evaluation/Decision MakingSynthesis and Decisions/Recommendations per Criteria of ApplicabilityLogically organize and vaunting the summarized findings from across allvalidated sources in terms of their similarities and differences. Determine whether it is desirable or feasible to apply these summarized findings in practice others involved). Based on the comparative evaluation, the user makes one of four choices Decide to use the research findings by putting knowledge into effect remove use by gathering supererogatory internal information before acting broadly on the evidence. Delay use since more research is required which you may decide to conduct based on local need Reject or not use .Phase IV Translation/ApplicationOperational Definition of Use/Actions for spayWrite generalizations that logically take research findings and form action terms Identify type of research use (cognitive, symbolic and instrumental). Identify method of use (informal/formal, direct/indirect).Identify level of use (individual, group, organization).Assess whether translation or use goes beyond actual findings/evidence. Consider the need for appropriate, reasoned variation in certain cases. Plan formal dissemination and change strategies.Phase V EvaluationClarify judge outcomes relative to purpose of seeking evidence Differentiate formal and informal evaluation of applying findings in practice. Consider cost-be nefit of various evaluation efforts.Use Research Utilization as a process to enhance the credibility of evaluation data. Include two types of evaluation data formative and outcomeCONCLUSIONEvidence based practices as using the best evidence available to guide clinical decision making.Evidence based practice in nursing is a pocess of locating ,appraising and applying the best evidence from the nursing and medical literature to improve the quality of clinical nursing practices. Evidence-Based Practice (EBP) is a thoughtful integration of the bestavailable evidence, coupled with clinical expertise. As such it enables health practitioners of all varieties to address healthcare questions with an evaluative and qualitative approach. EBP allows the practitioner to assess current and past research, clinical guidelines, and other information resources in order to identify relevant literature while differentiating between high-quality and low-quality findings.Evidence based practice involves making clinical division on the bag of the best possible evidence ,usually best evidence come from the rigrous research.REFERENCE1. Anne M Barker. Advanced Practice treat-Essentials of knowledge for the profession. United States of America Jons and Batlett publishers 2009. P.337-338 . 2. Suresh k Sharma. Nursing research and statistics. Haryana Elsevier 2011. P. 22-27. 3. Dennise F Polit ,Cheryl Tatano Beck. Essentials of nursing research-Appraising evidence for nursing practice. 7th ed. Noida Lippincot Willaims and Wilkins 2009. P. 25-47. 4. Potter Perry. Basic Nursing. 7th ed. Haryana Rajkamal Electric Press 2009. P. 54-57. 5. Dr.R.Bincy. Nursing Research-Building Evidence for Practice. NewDelhi Viva Books 2013. P. 286-297. 6. Judith Habour. Nursing Research. 5th ed. United States of America Mosby Elsevier 2010. P. 386-427. 7. Neelam Makhija. A practice based on evidence based practice. nightingale Nursing Times-A window for health. 2007 September Vol 3 18-21. 8. Models of evide nce based practice. www.nccmt.ca/registry/view/eng/83-html. Accesed october 15, 2013.