What are the 7 steps of evidence

Presentation on theme: "The Seven Steps of Evidence Based Practice"— Presentation transcript:

1 The Seven Steps of Evidence Based Practice

2 Step Zero Cultivate a spirit of inquiry Beginning thoughts of EBP
Lays groundwork Example: In patients with head injuries how does supine positioning compared with elevating the head of the bed 30 degrees effect intracranial pressure.

3 Step One Develop a PICOT question P – population of Interest
I – intervention C – comparison/intervention O – outcome T – time Example: In acute care hospital how does having a rapid response team compared with not having a rapid response team effect the number of cardiac arrests during a 3 month period.

4 Step Two Search for the best evidence
Use PICOT format to help you pick out key words to accurately search BAD example: “What is the impact of having a rapid response team” GOOD example: “acute care hospitals”, “rapid response team”, and “cardiac arrests” (more specific)

5 Step Three Evaluating the studies worth by rapid critical appraisal
3 questions to ask Are results of study valid? What are the results and are they important? Will results help me care for my patients? Blend studies to determine if the conclusions are similar

6 Step Four Integrate evidence into your practice
Hindered based on hospital resources Based on Patient assessments Laboratory data Outcomes from management programs

7 Step Five Evaluate the outcomes of the practice decisions or changes based on evidence Monitor and evaluate EBP changes on healthcare and patient outcomes If results differ from those reported in research monitoring can help determine why Interventions may not work the same in controlled study as it does in the healthcare setting

8 Step Six Disseminate EBP results
Share your successful results in your own institutions, local and national conferences Report in peer review journals, professional news letters, and publications for general audiences Melnyk, B., Fineout-Overholt, E., Stillwell, S., & Williamson, K. (2010). Evidence-based practice: step by step. The seven steps of evidence-based practice: following this progressive, sequential approach will lead to improved health care and patient outcomes. American Journal Of Nursing, 110(1), doi: /01.NAJ d2

9 References Melnyk, B., Fineout-Overholt, E., Stillwell, S., & Williamson, K. (2010). Evidence-based Practice: Step by Step. The Seven Steps of Evidence-based Practice. American Journal Of Nursing, 110(1),

What are the 7 steps of evidence

Nursing discipline adapts to the fast-changing needs of the society, what is applicable yesterday may not be applicable today. The best practice of yesterday may no longer be needed in the coming future.

Nothing stands the test of time, but change. The rule of thumb for Evidence-based practice is either to confirm or to refute. A scientist once said, “A theory is only proven true if you attempted to refute it. If you confirmed its true then improved it. However, when a scientific theory is refuted, it is time to replace it.”

Evidence-based practice (EBP) is a lifelong problem-solving approach that incorporates the best evidence resulted from series or multiple well-designed studies and researches — utilizing a synthesis of a systematic search for the best answers to a critical clinical question and meticulous critical appraisal of most relevant issues and current problems affecting the clinical practice (Melnyk & Fineout-Overholt, 2019).

Furthermore, taking into the account of best decisions about patient care to achieve desired patient outcomes, the merging of science and art created the EBP organizational culture and environment within the context of caring that includes the following:

  1. Strong enough evidence-based theories and theoretical basis of research evidence.
  2. Recommendations for practice from clinical expertise and expert opinions with professional experiences and pieces of training generated from clinical judgment, shreds of evidence from management outcomes or quality improvement projects, clinical reasoning, and the availability of healthcare resources needed to implement evidence-based practice, as well as an evaluation tool to identify its efficacy.
  3. Patient and family preferences, priorities, culture, values, concerns, and expectations focus on the assessment and evaluation of available resources and capabilities.

How did it begin?

Evidence-based practice started in the 1800s by Florence Nightingale, and continue to advance along with the nursing discipline bridging the theory to practice gap (Mackey & Bassendowski, 2017).

The call for EBP was initiated by Dr. Archie Cochrane in 1970s, a British epidemiologist who criticized the medical profession for not providing systematic reviews of evidence in the effectiveness of healthcare (Melnyk & Fineout-Overholt, 2019).

By the late 1980s, evidence-based practice in nursing emerged in the midst of world debates over “What nursing is?”. McEwen & Wills (2019) agreed that nursing is a collaboration of applied and practical sciences as it requires research in its quest for new knowledge to be applied in the clinical practice which is generated from tested theories on the health of human beings as we interact with the environment.

The Quadruple Aims of EBP in Health Care

EBP is the conscientious use of current best evidence in making decisions about patient care targets the quadruple aims in the improvement of healthcare delivery system (Melnyk & Fineout-Overholt, 2019), such as:

  • Enhances the quality of health care
  • Improves patient outcomes
  • Reduces healthcare costs and geographic variations in healthcare delivery
  • Empowers health practitioners with higher job satisfaction rates

How to find a good topic for EBP study?

EBP is goal-oriented towards best practice to improve healthcare for best patient outcomes. Outcomes management (Melnyk & Fineout-Overholt, 2019) has four steps to follow such as:

  1. Define a clinical problem and the target outcome that needs to be improved.
  2. Formulate criteria on how the outcome will be measured.
  3. Identify practices supported by evidence to improve the outcome.
  4. Measure the effects of implementing the best practice on the target outcome.

How strong is strong enough EBP?

A strong enough evidence is needed to make practice change. The level of evidence plus the quality of evidence equals the strength of the evidence, enough to provide confidence among clinicians to initiate the needed change of practice (Melnyk & Fineout-Overholt, 2019).

There is no standard formula on how an EBP should be weighed in to qualify a clinical decision. Notwithstanding the constraints in approving EBP, rating systems and hierarchies of evidence are adapted to grade and evaluate the strength and quality of evidence resulted from research study or report (Nurse.com, 2020).

Furthermore, the website Nurse.com elaborated the rating system for strong EBP which ranges from Level A (the strongest) to Level C (the weakest) and Level ML (multilevel) for clinical practice guidelines with more than one level evidence.

LEVEL A, as the strongest level obtained evidence from randomized control trials and systematic review or meta-analysis, which provide the meticulous reviews of the best evidence on specific topics.

LEVEL B, evidence that is obtained from well-designed control trials without randomization, clinical cohort study, case-controlled study, uncontrolled study, epidemiological study, qualitative study, and quantitative study.

LEVEL C, as the weakest level with evidence obtained from consensus viewpoint and expert opinion, meta-synthesis, and case study.

LEVEL ML (multilevel), clinical practice guidelines and recommendations are based on more than one level of evidence in the rating system.

The seven steps of evidence-based practice which must be implemented meticulously in sequential order with conscientious full engagement to accomplish the target goals of improved patient, health provider, and system outcomes (Melnyk & Fineout-Overholt, 2019; Melnyk, et al., 2010) includes the following:

  1. Cultivate a spirit of inquiry within an evidence-based practice (EBP) culture and environment.
  2. Ask the burning clinical question in PICOT format.
  3. Search for and collect the most relevant best evidence.
  4. Critically appraise the evidence.
  5. Integrate the best evidence with one’s clinical expertise and patient/family preferences and values in making a practice decision or change.
  6. Evaluate the outcomes of the practice decision or change based on evidence.
  7. Disseminate the outcomes of the EBP decision or change.

Argue the Toss

Evidence does not lie, hence it is irrefutable as well. However, EBP remains to be hamstrung to successfully infiltrate the nursing discipline with its practitioners are resistant to change despite the quality and efficacy of the introduced EBP. Wide acceptance of EBP in the health care system grapples to success as most nurses particularly the old ones continue to foster old traditions and the culture of “this is the way we do it here” or “we are used doing like this way” (Melnyk & Fineout-Overholt, 2019).

Moreover, Melnyk & Fineout-Overholt (2019) elaborated on the hurdles that prevent the EBP to accelerates and sink-in the system such as:

  1. Lack of EBP qualified and skilled nurses that include competencies on knowledge, skills, beliefs about the value of EBP, mentorship in EBP, and organizational culture that supports EBP.
  2. Cultures steeped in tradition.
  3. Misconceptions or negative attitudes about research and EBP.
  4. Lack of time and resources to search for and critically appraise evidence.
  5. Overwhelming hospital workloads.
  6. Institutional constraints showing lack of support and incentives.
  7. Peer and leader/manager resistance.
  8. Resistance to change.
  9. Lack of authority and autonomy to change practice.
  10. Nurse leaders and managers uncertainty in measuring the outcomes of practice and the care being delivered.
  11. Budget allocations for resources, staff training and education.
  12. Issues on physical, emotional, and financial costs to patients and family members.
  13. The greater pressure on healthcare providers to provide the most up-to-date practices and health-related information due to mass health awareness widely available on the internet and social media.
  14. EBP evolves continually requiring staff and budget allocations.

While nurses get used of their working conditions, nursing practice becomes obsolete without the current best evidence which often has detrimental effects on the side of the patients. Without EBP patient care is at stake resulting in poor patient outcomes.

Whereas, utilization of best practice guidelines, reviewing, appraisal, and implementation of applicable research evidence will advance the nursing discipline into a well-informed profession. The cycle of interim interventions and eventual refutation makes the health care system progress.

Nursing discipline utilizes wide range of theoretical and practical knowledge in the practice, integrated with evidence-based practice will evolve the profession into a new level of well-informed discipline rendering the highest quality of care and best patient outcomes can be achieved.


References

  1. Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice, 4th Phiiadelpohia: Wolters Kluwer Health.
  2. Mackey, A. & Bassendowski, S. (2017). The History of Evidence-Based Practice in Nursing Education and Practice. Journal of Professional Nursing, 33(1), pp. 51-55. DOI: 10.1016/j.profnurs.2016.05.009
  3. McEwen, M. & Wills, E.M. (2019). Theoretical Basis For Nursing, 5th Phiiadelpohia: Wolters Kluwer Health.
  4. com. (2020). Evidence-Based Practice. Relias. Retrieved on 24 September, 2020 from https://www.nurse.com/evidence-based-practice.
  5. Melnyk, B.M., Fineout-Overholt, E., Stillwell, S.B., & Williamson, K.M. (2010). Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. The American Journal of Nursing, 110(1), pp. 51-53. doi: 10.1097/01.NAJ.0000366056.06605.d2

What are the steps in the evidence

The EBP Process.
Step 1: Frame Your Clinical Question..
Step 2: Gather Evidence..
Step 3: Assess the Evidence..
Step 4: Make Your Clinical Decision..

What are the 6 steps of the evidence

Steps of evidence-based practice.
Ask a question. The evidence-based practice process begins by asking questions about the patient and their health issues. ... .
Look for evidence. ... .
Analyze the evidence. ... .
Integrate your finding. ... .
Evaluate the outcome. ... .
Share the information..

What are the 5 steps of evidence

5 steps of Evidence Based Practice.
Ask a question. ... .
Find information/evidence to answer question. ... .
Critically appraise the information/evidence. ... .
Integrate appraised evidence with own clinical expertise and patient's preferences. ... .
Evaluate..

What are the 4 components of evidence?

... "McMaster Group" of Canadian physicians who developed the contemporary EBP model stated that it has four component parts (Sackett, Rosenberg, Muir Gray, Haynes, & Richardson, 1996): (1) the current clinical circumstances of the client, (2) the best relevant research evidence, (3) the client's values and preferences ...