Chapter 1 EVIDENCE-BASED PRACTICE
LEARNING OBJECTIVES
After completing this chapter, students will be able to:
● Describe the five factors that have led to a greater need for clinicians to use evidence to guide their practice
● Understand the historical roots of evidence-based practice (EBP) in nursing.
● Summarize how the high visibility of healthcare’s quality and safety movement has contributed to the greater need for EBP.
● Discuss the importance of conceptual frameworks and key EBP models used in nursing today
DISCUSSION QUESTIONS
1. How has the high visibility of healthcare's quality and safety movement contributed to the greater need for EBP?
Suggested response: As quality and safety have moved to the forefront of healthcare, clinicians need to know what practices can best improve and optimize patient outcomes. In addition to patient health outcomes, patient satisfaction is crucial to optimize the patient experience. The use of EBP can ultimately improve the quality of care and safety of patients by using researchbased practices that have been proven to lead to the best outcomes.
2. What strategies should healthcare organizations use when selecting and implementing an EBP model?
Suggested response: When selecting an EBP model, it is imperative to use a systematic and formal process to determine which model would fit best with the organization. During the selection process, it is important to consider the elements of EBP models that are important to the organization, whether they apply to all clinical situations and populations, the usability of the model, and whether the model has been properly tested. Once a model is selected, staff should be educated and trained to incorporate the EBP into their practice. The organization should provide ample resources to support the implementation of the chosen EBP model.
3. What is the goal of using a standardized approach delineated by the various models and tools, such as offered by the Johns Hopkins EBP model, when asking a practice question and searching for evidence?
Suggested response: The goal in using standardized tools is to increase the likelihood that more reliable, better decisions are made. Each practice question and evidence search should be approached in a similar, systematic manner to ensure that all types of evidence are reviewed such that in each review, relevant stakeholders, practitioner and patent experience and the local (community, health system or organizational) culture are all considered.
4. How is the PICO format used to develop and refine an EBP question?
Suggested response: The PICO format is used to help identify key terms to use during an evidence search. PICO is an acronym that stands for various components of an effective search. The “P” stands for patient, population, or problem, “I” stands for intervention, “C” stands for comparison with other treatments, and “O” stands for outcome. The use of these search terms can help with the development and refinement of an EBP question.
5. What first step should be completed when using Rosswurm and Larrabee’s model for Evidence-Based Practice Change?
Suggested response: The first step of the model involves assessing the need for change in practice by comparing internal and external data. To compare internal and external data, you must first collect internal data about current practices. Once this data is collected, it can be compared with external data, and the problem can be identified. During this step, it is important to include all relevant stakeholders so they can contribute to the translation process.