WHAT IS EVIDENCE BASED PRACTICE?

Patient Values/ Preferences Or Expectations

Clinical Data/

Knowledge

Research Evidence

Optimal Decision

What does the patient want?

What are they willing to do?

What does your experience tell you?

What has been the experience of your colleagues?

What does the research say?

Evidence Based Practice Inquiry Process

Focus the

question

Adequate evidence?

Assign / Find

mentor

IRBProposal

& Approval

Datacollection

Data analysis

Disseminate

Impactand/or

outcome

Initialquestion

Unit or

department resource

Assess translation of evidence

into practicesetting

Create action plan and

implement change

Evaluate outcome

and/or impact

Finalize team membership

and schedule conferences

Report results

to decision-makers

Adoptchange

and identify

next steps

Contact Research Advisory Council

or Group (If Applicable)

Appraisalof

literature

Assembleinitial

project team

If answer is yes, proceed to EBP

Project.

If answer is no, proceed to research

project

Consult Librarian &

Do Lit. Search

Adapted from VCUHS Nursing Inquiry Process Diagram

Levels of Evidence Evidence

Based Practice

Guidelines

Meta- Analysis / Systematic

Review

Critically Appraised Topics

[Evidence Syntheses]

Critically Appraised Individual Articles

[Article Synopses]

Randomized Control Trials (RCT’s)

Cohort Studies / Cross-Sectional Study

Case Controlled Studies/

Case Reports

Reviews

Background Information / Expert Opinion

Filtered Information

Unfiltered Information

Qua

lity

of E

vide

nce

Start of

Search

(Idea

l)

Rea

lity

EBP Objective:Clinical Knowledge Bedside

Practice Guideline

Advantages Created by panels of experts Based on professional published

literature

http://www.gwumc.edu/library/tutorials/studydesign101/practiceguidelines.html

Statement produced by a panel of experts that outlines current best practice to inform health care professionals and patients in making clinical decisions.

Where Can They Be Found? o PubMedo CINAHLo National Guidelines Clearinghouse

Disadvantages Slow to change or be updated Not always available, espeically

on controversial topics Recommendations might be

affected by the type of organization creating the guideline

Review Articles Review Articles

• Provide Overview of a field or subject• Synthesize Previous Research • Useful when you need background information and additional references

Systematic Review • Evidence based search and review of the literature on a topic by an

established method.

Meta-Analysis • A systematic method that takes data from a number of independent studies

and integrates them using statistical analysis (Dorland’s Medical Dictionary for Health Consumers)

Primary Research Articles • Present new and original scientific findings • Explain research methodology and provide data

Randomized Controlled Trials (RCT’s)

Cohort Studies

Case-Controlled Studies

Studies that randomly assign individuals to an intervention group or to a control group,

in order to measure the effects of the intervention.

Study in which a particular outcome, such as death from a heart attack, is compared in groups of people who are alike in most ways but differ

by a certain characteristic

Study that compares patients who have a disease or outcome of interest (cases) with

patients who do not have the disease or outcome (controls), and looks back

retrospectively to compare how frequently the exposure to a risk factor is present in each group to determine the relationship between the risk

factor and the disease.

Types of Research Articles

Cause & Effect

Type of Question/ Best Type of Study

 Type of Question

 Best Type of Study

TherapyHow to select treatments to offer patients that do more good than harm and that are worth the efforts and costs of using

them

Randomized Control Trial (RCT)

PreventionHow to prevent a disease or condition

RCT/ Cohort Study / Case Control

PrognosisHow to estimate the patient's likely clinical course over

time and anticipate likely complications of disease

Cohort Study/ Case Control/ Case Series or Case Report

DiagnosisHow to select and interpret diagnostic tests

Blind RCT Compared to the Gold Standard (best treatment/test for diagnosis)

Etiology/HarmHow to identify causes for disease

RCT/ Cohort Study /Case Control

Cost analysisEconomic costs of all facets of a intervention or disease

treatment

Economic Analysis

Search Process Checklist

Top of Pyramid:

Met. Analysis, Sys. Rev. ,

Prac. Guideline

Selecting the Right Resource

• Research Guides • Nursing Research Guide

• Important Databases• PubMed/Medline (Free) • CINAHL• APA PsycNet/PsychInfo• Cochrane Library • TRIP Database (Free)• National Guidelines

Clearinghouse (Free)• PubMed Health (Free)• Medline Plus (Free)

http://guides.library.vcu.edu/nursing

Evidence Based

Practice Guidelines

Meta- Analysis / Systematic

Review

Critically Appraised Topics

[Evidence Syntheses]

Critically Appraised Individual Articles

[Article Synopses]

Randomized Control Trials (RCT’s)

Cohort Studies / Cross-Sectional Study

Case Controlled Studies/

Case Reports

Reviews

Background Information / Expert Opinion

Filtered Information

Unfiltered Information

Qua

lity

of E

vide

nce

Evidence Based

Practice Guidelines

Meta- Analysis / Systematic

Review

Critically Appraised Topics

[Evidence Syntheses]

Critically Appraised Individual Articles

[Article Synopses]

Randomized Control Trials (RCT’s)

Cohort Studies / Cross-Sectional Study

Case Controlled Studies/

Case Reports

Reviews

Background Information / Expert Opinion

Filtered Information

Unfiltered Information

Qua

lity

of E

vide

nce

Objectives: By the end of this presentation you will :

• Have an understanding of how evidence based practice is defined.

• Understand the quality of the different types of literature that are assessed when making decisions based on evidence.

• Be aware of the different types of EBP questions and what studies best answer each type.