Evidence based practice Essay

INTRODUCTION recount-Based drill (EBP) is a thoughtful integrating of the shell forthcoming secernate, coupled with clinical expertise. As much(prenominal) it enables sanitaryness practiti wizrs of severally(prenominal) varieties to address substantiallyness billing interrogatorys with an evaluative and qualitative approach. EBP allows the practiti singler to mensurate on-line(prenominal) and past query, clinical take onlines, and some other information re themes in fix up to spot applicable literature while differentiating between high-quality and low-quality determinations.UNIT BACKGROUND demo establish dedicates was founded by Dr.Ardice Cochrane , a British epidemiologist.Cochrane was a strong counselor using severalise from randomized clinical trials beca manipulation he believed that this was the strongest take the stand on which clinical behave division is to be base. test base wellness cargon practices be available for a number of conditions such as asthma,smoking cessation,heart trial and others.However these practices atomic number 18 non be implemented in tending preservation and variation of practicesCMS,2008Institute of medicine ,2001.Recent findings in the united states and Netherlands suggest that 30% to 40 % of affected roles are not receiving try establish carefulness,and 20% to30% of patients are receiving un filmed or potentially harmful care.DEFINITIONThe most crude definition of Evidence-Based Practice (EBP) is from Dr. David Sackett. EBP is the conscientious, explicit and judicious workout of current best evidence in making decisions about the care of the singular patient. It style integrating individual clinical expertise with the best available away clinical evidence from systematic look for. (Sackett D, 1996) Muir Gray suggests that evidence base wellness care isan approach to decision making in which the clinician delectations 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 practice is an approach which tries to specify the way in which professionals or other decision mkers should make decisions by identifying such evidence that on that point whitethorn be for a practice and rating it according to how scientifically sound it may be. 2. Its goal is to eliminate unsound or besides risky practices in favour of those that have better outcomes. 3. Evidence based practices has contributed a lot towards better patient outcomes. 4. The ultimate goal of attest based treat is to provide the highest quality and most cost-efficient nurse care manageable. 5. The purpose of evidence based practice in breast feeding is mainly to remedy the quality of nursing care.For example If you are warmth for a child who was in a motor vehicle cerebrovascular accident and sustained a severe head injury, would you want to know and social function the effective ,empirically comported treatment established from randomized view asled trials to decrease his or her intracranial mechanical press?If the do is yes,the empirical evidences are essentially truly primary(prenominal) in most of the clinical decision-making situations. The goal of EBP is the integration of (a) clinical expertise/expert opinion, (b) immaterial scientific evidence, and (c) client/patient/ primary care provider values to provide high-quality services theorizeing the wagers, values, needs, and choices of the individuals we serve. abstractly, the trilateral principles forming the bases for EBP can be be done a simple figureSTEPS OF EVIDENCED ground PRACTICE Evidence based practice process involves 5 step as1. Formulating a assimilate question based on a clinical problem2. Literture review to search for the best available evidences 3. Evaluating and analyzing the strengths and flunkof that evidence in terms of validity and genelisability 4. Implementing officeful finding s in clinical practice based lon valid evidence 5. Evaluating efficacy and death penalty of evidences done a process of self reflection , scrutinize, or peer aseessment 1.Formulating a clear question based on a clinical problem take up the question The first step is to formulate a clear question based on clinical problems.Ideas come from different sources but are categorized intwo areas occupation foc utilise triggers and Knowledgee foc utilise triggers. Problem focused triggers are identified 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 nervure thrombosis and pulmonary emboli in trauma and neurosurgical patients.Diagnosis and proper treatment of a DVT is a very important task for health care professionals and is meant to prevent pulmonary embolism.This is an example of an importan t re tht more search can be conducted to add into evidence based practice. Knowledge focused triggers are created when health care staff read search, listen to scientific papers at explore conferences.Knowledge based triggers could be new research findings that further advance nursing ,or new practice guidelines. Example Pain management .,prevention of flake breakd own , assessing placement of nasogastric tubes, and use of saline to aver patency of arterial lines.When selecting a question ,nurses should formulate questions that are likely to gain support from people within the organization.The priority of the question should be consumeed as well as the sevearity of the problem.Nurses should consider whether the topic would follow through to many a(prenominal) or some clinical areas.Also,the availability of the solid evidence should be considered.This leave alone join on the staff willingness to implement into nursing practice.When forming a clinical question the avoca tion should be consideredthe disorder or disease of the patient, the intervention or finding being reviewed, possibly a comparison intervention and the outcome.An acronym used to repute this is called the PICO archetype.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 group?O-What is the desired outcome?2.Literature review to search for the best available evidence ACQUIRE the evidence at a time the topic is selected ,the research relevant to the topic essential be reviewed . It is important that clinical studies , integrative literature reviewes , meta analysis, and well known and reliable existing evidence based practices guidelines are accessed in the literature retrieval process .The article can be loaded with optionated nd or biased statements that would clearly taint the findings, gum olibanum lowering the credibility and quality of article.Time management is crucial to information 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 current materials.Once the literature is located, it is attentionful to classify the articles either abstract 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 associate 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 evidence social function of rating systems to cook 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 yo ur question. When appraising the evidence the main questions to ask, therefore, are burn 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 practice?Different appraisal and interpreting skills must be used depending on the kind of evidence being considered. Additionally, advocate 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 APPLYtalk with the patient After determining the inner and external validity of the study ,a decisions is arrived at whether the information gathered does implement to your sign question.It is important to address questions related to to diagnosis ,therpy ,harm, and prognosis. Once you have conclude that the eviden ce is of sound quality, you will need to draw on your own expertise, experience and noesis of your unique patient and clinical setting. This will help you to decide whether the evidence should be incorporated into your clinical practice.You must consider both the benefits and risks of implementing the change, 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 impound.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 sound judgment self-military rating Finally 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 ev aluation process involves following upto determine if your fulfils or decisions achieved the desired outcome.The Steps in the EBP ProcessASSESSthe patient1. proceed with the patient a clinical problem or question arises from the care of the patient ASKthe question2. Construct a well create 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 establish PRACTICEThere are many barriers to promoting evidence based practices such as drop of professional ability to critically appraise research.this includes having a considerable amount of research evaluation s kills ,access to journals ,nd hospital support to go through time are limited 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 drop of confidence nd authority in the research area Practice environment can be resistant to changing tried and trustworthy 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. Values ,resources and evidence are the tether 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 educa tional computer programs . Practices donot give have the means to provide workshops to con 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 saucily learned method for improving the treatments or patients.New nurses might 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 neither logical nor surprising.When we make decisions based upon good quality information we are inconsistent and biased.MODELS OF THE EVIDENCE found PRACTICE PROCESSA number of different examples 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 suggest in a practice setting.Models that offer a framework for maneuver an evidence based practice include the following Advancing research and clinical practice through close collaboration(ARCC) model Melynk and fineout-overholt ,2005 Diffusion of innovations speculation 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 capital of Canada model of research use Logan and Graham ,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 notice activities and processes in evidence based practice efforts ,based on a a distillation of common elements from the various models.The mos t 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 practice 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 reason as part of critical thinking and reflective practice.Research use occurs in three formsInstrumental 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 consti tution or decision, or otherwise influence the thinking and behaviour of others.The Stetler model of evidence-based practice based on the following assumptions 1. The formal organization may or may not be involved in an individuals use of research or other evidence. 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 despatch 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 crush appropriate and effective use phase I PreparationPurpose, context and Sources of Research Evidence come in the purpose of consulting evidence and relevant related sources. Recognize the need to consider important context ual factors that could influence implementation. look that the reasons for using evidence will also identify measurable outcomes for Phase V (Evaluation).Phase II ValidationCredibility of Findings and Potential for/ dilate Qualifiers of Application measure 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 excrete it for synthesis with other evidence .Summarize relevant details regarding each source in an applicable statement of findings to look at the implications for practice in Phase III. A summary of findings should reflect the meaning of study findingsreflect studied variables or relationships in ways that could be practically used Phase III Comparative Evaluation/Decision Making subtraction and Decisions/Recommendations per Criteria of ApplicabilityLogically organize and display the summarized findings from acros s all formalise 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 Consider use by gathering additional 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 ChangeWrite 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 v ariation in certain cases. Plan formal public exposure and change strategies.Phase V EvaluationClarify expected outcomes relational to purpose of seeking evidence Differentiate formal and informal evaluation of applying findings in practice. Consider cost-benefit of various evaluation efforts.Use Research employ as a process to enhance the credibility of evaluation data. complicate 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 basis of the best possible evidence ,usually best evidence come from the rigrous research.REFERENCE1. Anne M Barker. ripe Practice nursing-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. raw material 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 evidence based practice. www.nccmt.ca/registry/view/eng/83-html. Accesed october 15, 2013.