NURSING RESEARCH 1

Dr. Francis Jay H. Ramos

BUILDING AN EVIDENCED- Siena College of Taytay
BASED NURSING PRACTICE College of Nursing
 FOR ONE WHO IS JUST STARTING A NURSING
CAREER, IT IS DIFFICULT TO APPRECIATE THE VALUE OF
LEARNING THE RESEARCH PROCESS AND THE
IMPORTANCE OF EVIDENCE IN PROVIDING CLIENT
CARE
 NATURE OF EVIDENCE-BASED
PRACTICE
Professional nurses are constantly
challenged to stay abreast of new
information to provide the highest
quality patient care

Nurses nowadays offer creative

approaches to various health problems
as well as designing innovative ways to
make a difference in the health status of
clients
 NATURE OF EVIDENCE-BASED
PRACTICE
Dr. Archie Cochrane, a Random clinical trials are
Evidence-based practice British epidemiologist, the gold standard for
started in the field of was concerned that generating reliable and
medicine evidence was not being valid evidence
critically examined

He was the developer of Oversees up-to-date

Cochrane Reviews, an systematic reviews of
electronic database randomized controlled
which consists of trials of healthcare and
systematic reviews in disseminates these
various healthcare field reviews
 WHAT IS EVIDENCED-BASED
PRACTICE?
The term evidenced-based practice was first used by Gordon Guyatt (Cullum, et al.,
2008) who advocated that ‘evidence from clinical research should be over intuition,
unsystematic clinical experience, and pathophysiology.
▪EBP, as the term is used, is concerned with using empirical, valid and relevant
information in decision making
▪EBP is an important approach to provide the best quality care to patients and their
families
▪EBP improves patient outcomes as compared to traditional practice
EVIDENCE-BASED MEDICINE: WHAT IT IS AND
WHAT IT IS NOT (SACKETT ET AL., 1996)
Best
available
clinical
evidence

Improve
d
patient
Individual
clinical outcomes Patient’s
values and
expectatio
expertise ns
 WHAT IS EVIDENCED-BASED
PRACTICE?
EBP is simple the integration of the best possible
research evidence with clinical expertise and with
patient needs (Grady, 2006)
 THERE ARE 5 KEY STEPS IN THE
EBP PROCESS

Evaluation of
Gathering the
Clinical the practice
Formulation of best evidence
appraisal of Integration of change, as a
a clinical to answer the
the best the evidence result of
question clinical
evidence implementing
question
the evidence
IT IS COMMON FOR NURSES TO IMPLEMENT
PRACTICE CHANGE BASED ON EVIDENCE BUT
FAIL TO EVALUATE THE EFFECTIVENESS OF
THAT CHANGE
EVIDENCED-BASED
NURSING
 EVIDENCE-BASED NURSING
EBN is the application of valid, relevant research-based
information in the nurse decision-making. Research-based
information is used alongside nurses’ knowledge of their
clients, their symptoms, diagnoses, and expressed
preferences which promotes a mutual caring relationship
between the nurse and her client within which decision
making is taking place
 FACTORS AFFECTING
EVIDENCE-BASED HEALTH CARE

Available
resources

Valid,
relevant
research
evidence/
best
evidence

Judgment, Client/
skills, and patient
expertise of preferences
the nurse and
circumstances
FACTORS AFFECTING EVIDENCE-
BASED HEALTH CARE
o EBP is about providing nursing care that is supported by research and clinical trials
o Not all practice can be evidence-based, nurses must use the best available
information on which to base their interventions
o To incorporate research findings into practice is essential in developing a science-
based practice
o The evidence from research studies should encourage nurse practitioners to adopt
the practices that have been found useful and to abandon those practices whose
usefulness has not been supported by evidence
IN ORDER TO JUSTIFY THE WORTH OF EVIDENCES OBTAINED FROM
ALL AVAILABLE RESEARCH FINDINGS, SYSTEMATIC REVIEWS OF
RANDOMIZED CONTROLLED TRIALS ARE CONDUCTED TO DETERMINE
BIASED OR CONSISTENT FINDINGS

Essential Newborn Care Found enough basis to shift DOH issued AO 2009-0025
under the umbrella of the from the old practice to the mandating all hospital to
Unang Yakap issued by latest protocol aimed at implement the five steps of
WHO through DOH improving newborn care newborn care time-bound to
lessen neonatal deaths

As a result of systematic
reviews, the best practice Nurses now have the
and better ways to achieve resources with which to
nursing goals in its identify successful practices
operational, clinical and and use them as standards
financial prospective can be for safe practice
improved
PYRAMID OF EVIDENCE Randomized controlled trials (experimental studies)

Cohort studies case control studies

Cross-sectional surveys case reports

Quasi-experimental studies

Non-experimental studies

Descriptive studies

Expert consensus

Quality improvement data

Program evaluation data

CHARACTERISTICS OF EVIDENCE-
BASED PRACTICE IN NURSING
EBP has an important characteristics, these are the following:
❖ EBP is a problem-solving approach to nursing practice which involves the
conscientious use of current best evidence in making decisions about patient care
❖ EBP involves a systematic search and critical appraisal of the evidence to answer a
clinical question
❖ EBP also consider the nurse expertise and patients’ values and expectations.
❖ EBP can come up with the best available evidence by nursing research in
combination with theory
❖ EBP allows client preferences and values to be heard
 RESEARCH UTILIZATION AND
EVIDENCE-BASED PRACTICE
Research utilization is the process of synthesizing, disseminating, and using research-
generated knowledge into the nurse clinical practice.
RU facilitates the transfer of innovations and purposive application of research
findings to current nursing practice
RU is often used interchangeably with EBP since research utilization is but a part of
EBP.
Dissemination, a part of research utilization, is the process of knowledge transfer
GUIDES TO EVIDENCE-BASE
PRACTICE IN NURSING
Over the years, at least 7 models for
evidence-based nursing practice have been
developed.
These could serve as guide for action.
1. STETLER MODEL
Stetler model presents a structure for using the research outcomes and suggests a
vehicle for changing policies and procedures. In this model, nurse practitioners,
educators, and policymakers make a summary of research done and use it to
influence educational programs, make practice decisions, and policies
Preparation Comparative
• Identifying the purpose and
evaluation
focus of the literature • Involves a review of
Translation/application
review findings of similar studies. • Implementation of study

Validation Decision making Evaluation

• A key consideration in • The researcher chooses • Determines the impact of
validation is to determine from four possible options; findings
whether the information is to use, consider, delay,
applicable and relevant to reject
the current needs and
problems of the nursing
profession
2. IOWA MODEL
Provides direction for the development of evidence base practice in a clinical agency.
This model was initially developed by Titler and colleagues in 1994 and revised in
2001.
In a health care agency, there are triggers that initiate the need for change, which is
best made based on research evidence.

Knowledge-
focused Problem-
trigger focused
• Change can be
trigger
generated by • Has its roots in a
heightened clinical or
awareness of organizational
new research problem
findings
3. ROGERS’ THEORY OF DIFFUSION
Theory of how, why, and at what rate new ideas and technology spread through
cultures. Diffusion as the process by which an innovation is communicated through
certain channels over time among the members of a social system.
Diffusion of innovations theory by Rogers includes a five-stage process

These consist of The nurse A choice is Using the new Nurses seeks
Knowledge stage

Persuasion stage

Decision stage

Implementation stage

Confirmation stage
initial develop an made to adopt idea to change reinforcement
awareness of attitude or reject the the current of their
the existence toward the innovation practice decisions
of an innovation leading to
innovation or a either
new idea for continuously
use in practice adopt or reject
the evidence
4. OTTAWA MODEL OF RESEARCH
This model uses strategies to apply innovations into
practice such as the use of evidence and other
research findings to practice environment.
5. EVIDENCE BASED MODEL
Similar to Roger’s theory of diffusion of innovation. This
involves comprehensive information on certain issues and
weighing pieces of evidence in relation to literature
reviewed as basis to draw conclusions
END
What is evidence based nursing practice.
Discuss the 7 guides to evidence based nursing practice.