1 of 28

Course: Oncology Nursing

Topic: Evidence-Based Practice

The Nurses International Community

Contact info: info@nursesinternational.org

2 of 28

COPYRIGHT

NI Privacy Policy and Terms of Use.

Contact info: info@nursesinternational.org

3 of 28

Module Goals

Learners will be able to:

Define Evidence Based Practice (EBP).
Discuss the significance of EBP to positive patient outcomes.
Describe the components and process of EBP.
Explain the role of nursing research in patient care.

Contact info: info@nursesinternational.org

4 of 28

Evidence Based Practice Definitions

Scott & McSherry (2009) defined Evidence Based Nursing (EBN) as ‘‘an ongoing process by which evidence, nursing theory and the practitioners’ clinical expertise are critically evaluated and considered, in conjunction with patient involvement, to provide delivery of optimum nursing care for the individual.’

Melnyk et al. (2010) described Evidence-Based Practices (EBP) as ‘a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values.’

Contact info: info@nursesinternational.org

5 of 28

Components of EBP

Clinical expertise
Current research evidence
Patient values and preferences
Continuous reflection, evaluation and refinement of knowledge/practice

Contact info: info@nursesinternational.org

6 of 28

Clinical Expertise

Hybrid of practical and theoretical knowledge.
Adept at making clinical judgements and providing quality care efficiently.
Results from refinement of theoretical and practical knowledge by encountering actual clinical situations.
It is experiential evidence which,

Is not merely an accumulation of total time spent on giving care
But continuous information generation through reflection and re-evaluation of each patient encounter and care intervention.

Benner, 1984 as cited in McHugh & Lake, 2010

Contact info: info@nursesinternational.org

7 of 28

Patient Values and Preferences

Bastemeijer et al. (2017) classified patient’s values into:

Patient and patient’s personal context

Uniqueness
Autonomy

Professional’s characteristics valued by the patient

Compassion
Professionalism
Responsiveness

Interaction between patient and professionals

Partnership
Empowerment

Contact info: info@nursesinternational.org

Bastemeijer et al.(2017)defined each of the above elements as follows:

Uniqueness
Patient’s wish to be recognized and respected as a person with personal history, belonging to a family and a community, and not merely as a patient with a health problem
Patient seek recognition for personal wisdom, experiences, preferences, and knowledge
Autonomy
Respecting patient’s capacity for making his or her own decision regarding their treatment/care
Allow for decision making or participating in decision making by patients and may be relatives
Having autonomy to give power of decision to professional in cases of emergency, of serious illness, or extreme vulnerability.
Compassion
Patient expect care provider to be truly concerned and have an ability and willingness to empathize with for patient
Care provider expected to be understanding, caring, honest, reassuring professional who inspire trust
Professionalism
Professional are expected to be competent, experienced with knowledge, skill and adequate attitude in the fields of direct treatment as well as in communication, information, collaboration with patient care team members, and in the area of openness to discuss alternatives.
Responsiveness
Professionals are expected to deliver committed and responsible execution of treatment and care through fair and humane approach which is also considerate of idiomatic, cultural, or religious values.
patient also values professionals responsiveness towards feeling responsible for organizational limitations such as lack of coordination, inadequate care and staffing, lack of continuity of care, and lack of access/availability of care, time, and information.
Partnership
Patient value an interaction with professionals based on mutual respect and recognition of existing interdependency
Patient values being able to talk easily, deliberately with professional as partners in an open and understanding ongoing dialogue and deliberation
Empowerment
Patients value effort by professionals that enable patients to take control of their own situation, build up their confidence through support and education in learning to deal with the problem and treatment.

8 of 28

Current Research Evidence

Research provides scientific basis for the practice of the profession (AACN, 2006).
According to Northern Care Alliance NHS Group (2020), Research helps to:

Find new treatments.
Ensure existing treatments are used in the best possible ways.
Answer questions that are unknown, fill knowledge gaps.

Ever changing health care require nurses to adapt current research evidence/findings into their practice.

Contact info: info@nursesinternational.org

9 of 28

How does EBP affect positive patient outcomes?

Contact info: info@nursesinternational.org

10 of 28

Benefits of EBP in Patient Care

Improved conditions for patient-centered care
Patient preferences are included in decision-making
Consistent health services leading to better equity
Reduction in geographic variation
Reduction in patient’s length of hospital stay
Better patient outcomes
Quality health-care services
Increased patient safety

Jylhä et al., 2017

Contact info: info@nursesinternational.org

11 of 28

Evidence Based Practice: How to?

Melnyk et al.(2010) proposed following steps for EBP:

Step Zero: Cultivate a spirit of inquiry

Step 1: Ask clinical questions in PICOT format

Step 2: Search for the best evidence

Step 3: Critically appraise the evidence

Step 4: Integrate the evidence with clinical expertise and patient references and values

Step 5: Evaluate the outcomes of the practice decisions or changes based on evidence

Step 6: Disseminate EBP results

Contact info: info@nursesinternational.org

12 of 28

EBP Step Zero: Cultivate a Spirit of Inquiry

Melnyk et al., 2009

Spirit of inquiry is an ongoing curiosity about the best evidence to guide clinical decision making.
Stimulates questions in nurses about the evidence supporting their interventions.
EBP starts with spirit of inquiry.
Continual cultivation of a spirit of inquiry is essential foundation for EBP.

Contact info: info@nursesinternational.org

Melnyk et al. (2009) recommend routine use of the following standard set of questions and strategies for building a spirit of inquiry in practice:

Questions that Spark a Spirit of Inquiry:

Who can I seek out to assist me in enhancing my evidence-based practice (EBP) knowledge and skills and serve as my EBP mentor?
Which of my practices are currently evidence based and which don't have any evidence to support them?
When is the best time to question my current clinical practices and with whom?
Where can I find the best evidence to answer my clinical questions?
Why am I doing what I do with my patients?
How can I become more skilled in EBP and mentor others to implement evidence-based care?

Strategies for Building a Spirit of Inquiry:

Write "WHY?" on a poster and place it in the staff lounge or restroom to inspire questions from nurses about why they're engaging in certain practices with their patients. Gather the responses in an answer box. After one month, take the responses and arrange them according to common themes. Address the themes in a staff meeting.
Review and answer the Questions that Spark a Spirit of Inquiry.
Create a poster with these questions and post them where your colleagues will see them. Think about these clinical questions when caring for your patients.

13 of 28

EBP Step 1: Ask Clinical Questions in PICOT format

Well formulated clinical questions guide the search for most current relevant literature.
Types of clinical question:

Foreground question: Specific and relevant to the clinical issue.
Background question: Broader and answer provides general knowledge.

Ask foreground question in PICOT format: Patient Population, Intervention or issue of interest, Comparison intervention or issue of interest, Outcome(s) of interest, and Time it takes for the intervention to achieve the outcome(s).

Stillwell et al., 2010a

Contact info: info@nursesinternational.org

14 of 28

Stillwell et al., 2010a

Contact info: info@nursesinternational.org

15 of 28

EBP Step 2: Search for the Best Evidence

Stillwell et al., 2010b

Clinical question determines the research methodology that provides the best evidence.
To find best evidence

Select relevant databases to search
Search several databases to reduce possibility

of missing relevant literature

Searching strategies:

Choose keywords from the PICOT question
Use database controlled vocabulary
Combine searches by using Boolean connector ‘AND’
Place limits on the final combined search to further narrow results

Contact info: info@nursesinternational.org

16 of 28

EBP Step 3: Critically Appraise the Evidence

Research articles selected for review must be appraised to determine relevance, validity, reliability, and application to clinical question.
Rapid critical appraisal uses three important questions to evaluate a study’s worth:

Are the results of the study valid?

What are the results and are they important?

Will the results help me care for my patients?

Melnyk et al., 2010

Contact info: info@nursesinternational.org

Melnyk et al. (2010) further described above questions:
Are the results of the study valid?

This question of study validity centers on whether the research methods are rigorous enough to render findings as close to the truth as possible. For example, did the researchers randomly assign subjects to treatment or control groups and ensure that they shared key characteristics prior to treatment? Were valid and reliable instruments used to measure key outcomes?

What are the results and are they important?

For intervention studies, this question of study reliability addresses whether the intervention worked, its impact on outcomes, and the likelihood of obtaining similar results in the clinicians' own practice settings. For qualitative studies, this includes assessing whether the research approach fits the purpose of the study, along with evaluating other aspects of the research such as whether the results can be confirmed.

Will the results help me care for my patients?

This question of study applicability covers clinical considerations such as whether subjects in the study are similar to one's own patients, whether benefits outweigh risks, feasibility and cost-effectiveness, and patient values and preferences.

Chrisman et al. (2014) proposed following criterias for evaluating nursing research credibility:
Validity: Legitimacy, accuracy, and soundness of all aspects of the study
Reliability: Extent to which a measurements result is consistent
Relevance: Logical connection between two ideas, tasks or events
Outcome: Conclusions reached through process of research

17 of 28

EBP Step 4: Integrate the Evidence with Clinical Expertise and Patient Preference and Values

Identification of best research evidence through critical appraisal is not sufficient to justify change in practice.
Identified research evidence must be integrated with nurse’s clinical expertise and patient’s values/preferences.
Institutional variables greatly influences implementation of EBP into practice.

Nurses must continuously thrive to create opportunities in their institution for implementation of EBP into nursing practice!

Melnyk et al., 2010

Contact info: info@nursesinternational.org

18 of 28

EBP Step 5: Evaluate the Outcomes of the Practice Decisions or Changes Based on Evidence

Effective interventions from research literature may not always be effective in all clinical settings.
Monitoring and evaluation (M&E) should follow implementation of EBP.
M&E of EBP change on health care quality and outcomes is done such that,

Clinicians can spot flaws in implementation
Positive effects of the outcomes can be supported
Negative effects of the outcomes can be remedied
Findings different from the research literature can be further analysed and disseminated

Melnyk et al., 2010

Contact info: info@nursesinternational.org

19 of 28

EBP Step 6: Disseminate EBP results

EBP provides vital information on best patient care.
Sharing experiences and outcomes of EBP with colleagues of own or other health care organization help.

Prevent duplication of effort
Prevent perpetuation of clinical approaches that are not evidence-based

Some of the ways to disseminate EBP results are:

EBP rounds in own institution
Presentation at local/regional/national conferences
Report in peer-reviewed journals/professional newsletters/publications

Melnyk et al., 2010

Contact info: info@nursesinternational.org

20 of 28

Why is research important in Nursing?

Contact info: info@nursesinternational.org

21 of 28

Nursing Research

Nursing research develops knowledge to (NINR, 2021):

Build the scientific foundation for clinical practice
Prevent disease and disability
Manage and eliminate symptoms caused by illness
Enhance end-of-life and palliative care

Healthcare is ever changing, influencing the patients needs and expectations.
Ongoing nursing research is paramount for nurses to effectively meet these patient needs and expectations.
Complex health problems mandate interdisciplinary research that provides multiple perspectives (AACN, 2006).

Contact info: info@nursesinternational.org

22 of 28

Nursing Research

Nursing research help nurses by:

Inform current changes in medicine.
Inform current innovative methods for the delivery of care.
Closes gaps between theory and clinical practice.
Supplements knowledge and expertise to reduce errors, injuries, and negative patient outcomes.

Nurses have the responsibility to provide optimal patient care which is possible only through evidence-based practice!

Contact info: info@nursesinternational.org

23 of 28

Reference:

AACN (2006). Nursing Research. Retrieved from: https://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Nursing-Research

Bastemeijer, C.M., Voogt, L., van Ewijk, J.P., & Hazelzet, J.A. (2017). What do patient values and preferences mean? A taxonomy based on a systematic review of qualitative papers. Patient Education and Counselling,100(5):871-881.

Chrisman, J., Jordan, R., Davis, C., & Williams, W. (2014). Exploring evidence-based practice research. Nursing made Incredibly Easy, 12 (4): 8-12. Retrieved from: https://www.nursingcenter.com/journalarticle?Article_ID=2492783&Journal_ID=417221&Issue_ID=2492774

Contact info: info@nursesinternational.org

24 of 28

Reference:

Jylhä, V. , Oikarainen, A., Perälä, M.L, & Holopainen, A. (2017). Facilitating evidence-based practice in nursing and midwifery in the WHO European Region. Supported by WHO Regional Office for Europe. Retrieved from: https://www.euro.who.int/en/health-topics/Health-systems/nursing-and-midwifery/publications/2017/facilitating-evidence-based-practice-in-nursing-and-midwifery-in-the-who-european-region-2017

McHugh, M. D., & Lake, E. T. (2010). Understanding clinical expertise: nurse education, experience, and the hospital context. Research in nursing & health, 33(4), 276–287. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998339/

Contact info: info@nursesinternational.org

25 of 28

Reference:

Melnyk, B.M., Fineout-Overholt, E., Stillwell, S.B., & Williamson, K.M. (2009). Evidence-Based Practice: Step by Step: Igniting a Spirit of Inquiry. American Journal of Nursing,109 (11): 49-52. Retrieved from: https://journals.lww.com/ajnonline/Fulltext/2009/11000/Evidence_Based_Practice__Step_by_Step__Igniting_a.28.aspx

Melnyk, B.M, Fineout-Overholt, E., Stillwell, S.B, & Williamson, K.M. (2010). American Journal of Nursing, 110 (1): 51-53. Retrieved from:https://journals.lww.com/ajnonline/Fulltext/2010/01000/Evidence_Based_Practice__Step_by_Step__The_Seven.30.aspx

Contact info: info@nursesinternational.org

26 of 28

Reference:

National Institute of Nursing Research (NINR) (2021). National Institute of Nursing Research In Brief. PDF Version. Retrieved from: https://www.ninr.nih.gov/

Northern Care Alliance NHS Group (2020). Why is Research Important?. Retrieved from: https://www.pat.nhs.uk/education-and-research/why-is-research-important.htm

Scott, K. & McSherry, R. (2009). Evidence-based nursing: clarifying the concepts for nurses in practice. Journal of Clinical Nursing, 18 (8): 1085-1095. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2702.2008.02588.x

Contact info: info@nursesinternational.org

27 of 28

Reference:

Stillwell, S.B., Fineout-Overholt, E., Melnyk, B.M., & Williamson, K. (2010a). Evidence-Based Practice, Step by Step: Asking the Clinical Question. American Journal of Nursing, 110 (3):58-61. Retrieved from: https://journals.lww.com/ajnonline/fulltext/2010/03000/evidence_based_practice,_step_by_step__asking_the.28.aspx

Stillwell, S.B., Fineout-Overholt, E., Melnyk, B.M., & Williamson, K. (2010b). Evidence-Based Practice, Step by Step: Searching for the Evidence. American Journal of Nursing,110 (5): 41-47. Retrieved from: https://journals.lww.com/ajnonline/Fulltext/2010/05000/Evidence_Based_Practice,_Step_by_Step__Searching.24.aspx

Contact info: info@nursesinternational.org

28 of 28

Please go to

My Learning Experience

to provide feedback on your experience.

Thank you, and come back soon!

Contact info: info@nursesinternational.org