Evidence Based Practices in Nursing: Evidence to Action (Make a Case for Change)

1. EVIDENCE
TO
ACTION

2. Outline
• Evidence based practices
• Sources of evidence and its level
• Translate the evidence into practice
• Perceive knowledge and attitude on evidence based practices
• The process involved in evidence based practices
• Barriers or gaps between evidence
• Nurses role in translation of evidence into action
• Make a case for change
Prepared By: Gaurav Kohli

3. Introduction
The availability of information and the growth of science-
significant improvement in health outcomes of the
world.
However differences in outcomes, health in equalities and
poorly performing health cause real challenge to nurses.
Acknowledges the not enough understanding on how to
make effective interventions widely available to the
people.
Stronger emphasis is needed not just on the discovery of
new drugs and diagnostics but also on how we put
knowledge into use; on how we close the gap between
evidence and action Prepared By: Gaurav Kohli

4. Perception on EBP
• A study on American Registered Nurses’ perceptions,
attitude and knowledge /skills associated with evidence
based practices (koehn & Lehman 2008). The findings
shows that participants had moderate scores on practice
and attitude toward evidence based practices.
• The two most cited barriers to implementing evidence-
based practice were time and knowledge.
• The findings suggest the value of providing adequate
knowledge for better nursing care.
Prepared By: Gaurav Kohli

5. Evidence Based Practices
• EBP aims to base health care on the finding from
systematic evaluation of the efficacy of given
interventions, rather than tradition or custom and
practice (Taylor 2003)

7. What is ‘Evidence’
• Define as :
the availability facts or circumstance,
supporting or otherwise a belief,
proposition or indicating whether or not a
thing is true or valid
(Oxford English Dictionary 2009)
Prepared By: Gaurav Kohli

8. Types of Evidence
• Not all evidence is equally useful-research findings are
weighed more heavily in decision making process
because it uses systematic methods to collect the data.
• Different types of evidence are more relevant to different
questions and nurses need to be actively engaged in
making sure that relevant research, where available, is
identified, appraised and used appropriately.
Prepared By: Gaurav Kohli

9. How do we decide on the evidence?
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10. Applicability of The Evidence? -Critical
Appraisal
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11. Level of Evidence
Prepared By: Gaurav Kohli

12. The Need to Translate Evidence Into Action
• Pravikoff, Tanner and Pierce (2005) found that nurses
typically using their knowledge from school, their own
experience from the past, or usual practice and
knowledge from co-workers to guide their practice
• Its also found that medical science and technology have
advanced at extreme rapid pace, but delivery of health
care has lagged behind.
• This report made it clear that “usual practice” is not good
enough anymore. The switch must be made based on
evidence.
Prepared By: Gaurav Kohli

13. From Evidence to Action:
• Changes are rarely easy as it involves changing the way
people and the system behave.
• Change can frequently be messy, waste time and can
have unpredicted consequences.
• However change can be exciting and motivating.
• Understanding and planning how to take evidence into
practice, to action knowledge, is important.
• This area, because it is so critical, has been the subject
of an increasing amount of research itself.
Prepared By: Gaurav Kohli

14. Gap Between Translating Evidence into Action
• Practice environment (organizational context)
–Financial disincentives-lack of reimbursement
–Organizational constraints-lack of time, work demand
–Perception of liability-risk of formal complaint
–Patient expectations
–Insufficient guidelines
–Standard practice-Satisfied with usual knowledge and
practice
–Key person does not agree with the evidence
–Lack of knowledge in research method, condition,
management
Prepared By: Gaurav Kohli

15. Gap (con’t)
• Knowledge and attitude
–Sense of competence- self confidence
–Information overload- unable to identify the correct
evidence
• No access to published papers
• Literature is ambiguous or conflicting
Prepared By: Gaurav Kohli

16. Bridging The Gap-evidence into Action
• Building partnerships
– bringing individuals, groups and teams together to
develop a shared vision and sense of purpose
• Using champions/change agents /opinion leaders
–identifying and recruiting key people to support the
change; they need credibility and to be respected by the
individuals you are seeking to influence.
• Feedback on performance
Prepared By: Gaurav Kohli

17. Bridging Gap (Con’t)
• Sharing and disseminating information
– through a variety of media, and designed with specific
audiences in mind; it can involve writing leaflets, the use
of plays, and the other media
• Education and training interventions – such as
continuing education modules, decision support
systems, one to one coaching, online learning, use of
simulations.
• Standardizing practice – using care pathways, clinical
audit, variance reporting, checklists and guidelines.
Prepared By: Gaurav Kohli

18. Make A Case For Change
• Case for change is a process and strategy to discover
new, updated, filtered and approved nursing practices for
the better patient care.

19. Pre-requisites to Make A Case for Change
PRE REQUISITES
Clearly defined boundaries
Appropriate and transparent decision making
Understood power and authority
Appropriate resources
Information and feedback system
Receptive to change
Prepared By: Gaurav Kohli

20. IMPLEMENTATION
TEAM Pt. centered
DEVELOPMENT & evidence EVALUATION
DISCUSSION based
practices
REFIENMENT
SECURING THE
&
SOURCES REQUIRED
MODIFICATION
-RESEARCH
-PROFESSIONAL
EXPERTISE &
CLINICAL EXPERTISE
-LOCAL DATA &
INFORMATION
PROCESS FOR MAKING A CASE
-PATIENT
FOR CHANGE
PREFERENCE &
EXPERIENCE

21. Effective Case For Change Includes :
Valid
Reproductive & Flexible
Cost Effective
Development of team
Prepared By: Gaurav Kohli

22. Illustration:
• A systematic review demonstrated that wearing jewelry
affected efficacy of hand hygiene.
• A randomized control trial demonstrated sufficient
evidence and there is association between jewelry and
hand hygiene
• A team organized to discuss, implement and monitor the
nursing staff to avoid wearing jewelry during pt. care.
• Arranged the sources required to implement the
evidence ( lockers, secure places, manpower, finance)
• Strict guidelines developed based on evidence to avoid
wearing jewelry during patient care
• Team regularly evaluate and refine the guidelines to
increase the effectiveness and utilization of patient
centered and safe care

23. Nurses’ role
• Understand about EBP and involve in putting the
knowledge into action- vital to local service innovation
and the development of new ways of working.
• Disseminate the available evidence
• Committed to developing an environment conducive to
evidence
–-informed decision making and practice- work closely
with the teams that use their findings, including the wider
community.
–Building partnerships among health professionals and
policy makers, nursing education to facilitate
disseminating and application of evidence
Prepared By: Gaurav Kohli

24. Conclusion
• Health care systems need to
implement interventions that
not only increase nurses' EBP
knowledge and skills, but also
strengthen their beliefs about
the benefit of evidence-based
care.
Prepared By: Gaurav Kohli