Principles of EBP
Evidence Based Practice
Evidence based practice (EBP) is a meticulous, unequivocal and shrewd use of the best present evidence while performing important decision making for a patient (Khammarnia, Haj Mohammadi, Amani, Rezaeian & Setoodehzadeh, 2015). Personal clinical expertise is incorporated together with the finest outer medical evidence from methodical research (Budd, Hough, Wegener & Stiers, 2017; Schaffer, Sandau & Diedrick, 2012). Patient values, personal preferences, concerns as well as expectations form part of the decision making process when identifying the best care for a patient (Joseph-Williams, Elwyn & Edwards, 2014). Quality life and ideal clinical results come as a result of the integration of the above mentioned aspects (Duke University Medical Center1, 2018).
The specific component, however, that triggers the whole practice of EBP is encounters of the patient (Duke University Medical Center1, 2018). These patient experiences generate questions concerning the effects of treatment, efficacy of diagnostic examinations, the prediction of diseases and the causes of disorders. EBP has its requirements as the clinician’s new skills, effective and ability to research competently, and even applying official rules in the evaluation of clinical literature.
EBP follows some clear steps, strategies and processes. This, like all other practices is bound to challenges that are barriers or challenges to implementing. This study is going to expound on all these aspects to form a rational discussion.
There are two fundamental principles assumed by EBP. The first one is that scientific evidence alone cannot inform competent decision making in clinical care (Rice, 2011). This means that scientific evidence is only a constituent of the decision making practice and cannot take the role of the other steps. EBP involves integration of the finest scientific evidence together with best relevant knowledge and judgment, values and principles held by the patient, and the circumstances of the patient condition as at the time for clinical examination (Murphy, MacCarthy, McAllister & Gilbert, 2014).
The second major principle of EBP is that there exist hierarchies that direct how decisions are to be made within each formula of evidence. This means the processes of EBP are guided by specific rules on how to interpret the evidence available. This principle particularly addresses EBP as a wholesome process involving decision makers in healthcare settings collecting and critically evaluating evidence in guiding decisions. This principle is against the traditional model of decision making whereby healthcare relied on intuition and information from superiors’ commands (Murphy, et al., 2014).
In order to put the aforementioned principles of evidence based practice a set of skills/ steps has to be followed. These skills are in components such as developing researchable question, developing and implementing the best search strategy, critically assessing internal and external evidence, integrating various evidently sources and finally evaluating outcomes (Murphy, et al., 2014).
The identification of the problem question is enhanced by an accurate assessment and competent specialized knowledge and practice (Duke University Medical Center2, 2018; Murphy, et al., 2014). It is advisable to start with the patient because a clinical question starts or arises from the care of a patient. The assessment here is patient-focused and it involves focusing on self-motivated and static risk factors. Here the actuarial risks/ needs of a patient are assessed. This can also be an offender’s assessment. While in most cases, nurses are unaware to be asking the relevant question, the process is evolving and thus availing more information. Other people choose to focus on outcome-based questions. Other ways of formulating a focused researchable question is by looking at the background and treatment recommendations after appraising evidence, looking at recommended systematic reviews, and comparison of the situation with the clinical practice guidelines (Budd, et al., 2017; Evans, Yeung, Markoulakis & Guilcher, 2014)
Steps of EBP
Searching strategies for evidence can be by use of bibliographic databases that have scientific research literature like PubMed. Systematic reviews and expert opinions are also steps of EBP that inform searching for evidence. Looking at policies practiced in other jurisdictions is also important (Murphy, et al., 2014). Personal experiences are also important aspect but not widely used. However, there are four sources that have been accepted under the principles of EBP to be taken into account when looking for evidence. They are scientific literature published in academic journals, organizational data, facts and figures, practitioners’ experience in their professional nursing and medical careers, and stakeholders’ values and concerns having been subjects to previous decisions (Murphy, et al., 2014).
There is a need to appraise evidence critically because of different factors. The first on is that evidence is not always perfect and can lead one astray in many ways. Evidence have been overstated giving strong claims but only based on a single information source inapplicable in all situations (Murphy, et al., 2014). Different clinicians use different ways of appraising evidence to determine its validity in decision making. This can be by examining the credibility of the source- well-known and trusted journals which are preferred. Credibility is determined by another factor; how current is the resource? Adequacy of the evidence must also be considered. All the guidelines to be followed should be examined whether to be following the Medicine’s trusted guidelines criteria. Other ways are by seeking intervention from other experts in the institution and following the clinical reasoning cycle. My decision making while appraising evidence is by following clinical reasoning.
The application of evidence gathered and appraised also follows a clear incorporation process into practice. The outcomes of the decision are evaluated at this phase. Gathering input from literature of high quality, opinion from experts, clients and staff. Financial considerations are important aspects in this step of EBP (Murphy, et al., 2014).
Evaluation of outcomes is an important phase in that it determines areas to be improved in the future (Murphy, et al., 2014). This majorly by measuring treatment and prevention outcomes. All these are determined by the satisfaction of the consumer. To avoid a biased evaluation it is advisable that the evaluation be done early (in advance).
The use of research in clinical practice is faced with several barriers (Scurlock-Evans, Upton, & Upton, 2014). This is further affected by the organizational setting where the nurses operate. When nurses don’t get the necessary support in their respective institutions, then an effective evidence based practice is with challenges. Another aspect is the nurse’s values of research and skills, the quality of research and the communication and presentation of research (Shifaza, Evans & Bradley, 2014).
According to Wood, Ohlsen and Ricketts (2017) in mental health clinics, there are certain barriers to the implementation of collaborative care as per the EBP model. The study highlights that lack of efficient case managers, soiled working habits, ineffective commissioners and poor clinical supervision are among the factors that affect the implementation. These factors inhibit a good coordination between carers. When there is poor communication implementation of change becomes a problem (Dang & Dearholt, 2017) .Communication relates to the presentation of research and that can be either a barrier or a facilitation to literature. When literature is physically available or published, compiled in one location, statistical analyses being understandable and the nurse is fully aware of where to find it, the evidence based practice become a success (Shifaza, et al., 2014). While the aforementioned factors are negative (barriers), poor EBP results are expected.
Challenges to EBP
This is also supported by another study Bach-Mortensen, Lange & Montgomery (2018) that lack of support and expertise, and insufficient guidelines on how to perform the care affect the adaptation of EBPs in clinical fields.
There are also facilitators of the use of research that support an effective interpretation of the identified literature. They include, peer support by the management, sufficient time to allow for a review of the literature, the presence of supportive colleagues, availability and adequacy of the relevant research, reassuring policies, and opportunities for training (Hersen & Sturmey, 2013). These barriers and facilitators can be categorized into, individual factors, communicational factors, administrative factors and value of research (Shifaza, et al., 2014).
Individual barriers include poor research skills from lack of efficient research methods, deprived consciousness of research outcomes, poor appraisal skills and even an adverse attitude towards research (Shifaza, et al., 2014). When a nurse in a mental clinic is not well acquainted with research skills, she might be unable to apply the best EBP for a patient with other medical issues apart from mental illness. The beliefs of nurses concerning the significance of research and self-confidence in the research skills affect EBP decision making. When the nurse has no confidence in implementing change, the outcomes of her decision are likely to be poor. The same case with inability to evaluate quality research from poor research. The opposite of all these individual barriers is a facilitation to effective EBP.
These are also certain limitations in the institution where EBP is to be performed. The factors relate to lack of enough time to read, examine, scrutinize, publicize, and implement the evidence from research (Joseph-Williams, et al., 2014). Others include inadequacy in authority and facilities to propagate change in the practice setting or support the implementation process (Duncombe, 2018; Shifaza, et al., 2014).
Patient preference is an analysis of a person who is knowledgeable concerning likelihood and severity of the consequences and hazards of medical interventions, procedure and results from aspects of healthcare. Clinical practice guidelines ought to be adopted in a manner that it is not only the provider’s interests are considered but also the patient’s point of view. Patients have different characteristics and preferences and therefore the care directed to them should be flexible to adapt to those preferences in a manner that the patient will take part in the decision making process. Involvement requires that providers give information to the patient while taking an action and asking the patient of his or her opinion for the same, how he likes it to be done and how he generally feels about the EBP paradigm (Budd, et al., 2017).
As much as it is essential to include consumers in the decision making process, some situations do not necessarily seek patient’s preference. In one of my clinical experiences, a woman (Veronica) of an advanced age (86 year old) had a fall that broke her left femoral neck, dislocated uncle and profuse bleeding from bruised knee and shoulder. That was itself an emergency considering the woman was weak and old and was admitted into the emergency department unconscious. The decision I made as at that time were not by any way related to the patient’s preference but I relied on the other aspects of EBP to offer care in collaboration with my colleagues and deriving the best method to administer care from my superiors and informed literature search. Veronica’s son who was present just told me to do what is right to help her mother. His preference was based on what I would choose to do to help the situation.
Some patients are strongly affiliated to their culture, religion, social and spiritual values (Goldstein & Morrison, 2013). These factors to them are what establish quality of life and personal beliefs about health. Despite that these factors may be overlooked at some situations, it is always advisable to put the preferences into considerations as they may determine the subjectivity of the patient to care given or advised.
Identification of Evidence
Clinical Question and Literature Search
PICO Question
What is the effect of performing an emergency surgical operation on an elderly woman with a broken femoral hip, bruised shoulders and left knee, and dislocated ankle? Without considering her preferences and values?
PICO Table
|
Type of patients or problem |
Intervention |
Comparison intervention |
Outcome |
|
Broken Femoral Hip, bruised shoulders and left knee and twisted ankle of an elderly (86years) unconscious woman |
Surgical operation without patient’s preference |
Waiting until the patient is conscious to establish her values |
Saving life, survival, quality life, |
|
Keywords Femur, hip, neck, fall |
Keywords Palliative care, anesthesia, analgesia, patient’s preference |
Keywords Cultural, spiritual, religious, ethical and social values |
Keywords Quality life , prolonged life, reduced bleeding, |
Literature Used; Google Scholar
[HTML] nih.gov
Mortality after distal femur fractures in elderly patients
PN Streubel, WM Ricci, A Wong, MJ Gardner – Clinical Orthopaedics and …, 2011 – Springer
Background Hip fractures in the elderly are associated with high 1-year mortality rates, but whether patients with other lower extremity fractures are exposed to a similar mortality risk is not clear. Questions/purposes We evaluated the mortality of elderly patients after distal …
Cited by 112 Related articles All 15 versions
Distal femur fractures of the elderly—different treatment options in a biomechanical comparison
D Wähnert, K Hoffmeier, R Fröber, GO Hofmann… – Injury, 2011 – Elsevier
… the four-screw distal locking (SCN) and lowest for two screws distally (T2 … al.Biomechanical evaluation of the less invasive stabilization system for the internal fixation of distal femur fractures … Meyer, NA Plaxton, PD Postak, et al.Mechanical comparison of a distal femoral side plate … Cited by 55 Related articles All 8 versions
Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases
WM Ricci, PN Streubel, S Morshed… – … of orthopaedic trauma, 2014 – journals.lww.com
Objectives:Locked plating has become a standard method to treat supracondylar femur fractures. Emerg.
Cited by 123 Related articles All 7 versions
High complication rate in locking plate fixation of lower periprosthetic distal femur fractures in patients with total knee arthroplasties
NA Ebraheim, J Liu, SZ Hashmi, KR Sochacki… – The Journal of …, 2012 – Elsevier
… Distal femoral fractures adjacent to a total knee arthroplasty present surgeons with a challenging situation … procedure, and the challenges faced, the current study found that contralateral reverse locking plate fixation of a distal periprosthetic femur fracture in patients …
Cited by 46 Related articles All 5 versions
… periprosthetic fractures of the knee in the elderly patients: a comparison of treatment using allograft-implant composites, standard revision components, distal femoral …
K Saidi, O Ben-Lulu, M Tsuji, O Safir, AE Gross… – The Journal of …, 2014 – Elsevier
The following study is a review of 3 different treatment methods for treating comminuted
distal periprosthetic femur fractures in 23 patients over the age of 70 (average age 80, range
70–90). Reconstruction techniques included 7 allograft prosthesis composite (APC), 9 …
Cited by 38 Related articles All 5 versions
[BOOK] Rockwood and Green’s fractures in adults
JD Heckman, MM McQueen, WM Ricci, P Tornetta… – 2015 – kubalibri.cz
… Get the definitive guide on fracture treatment, written by the world’s top orthopaedic surgeons … It is an essential resource on fractures for every orthopaedic surgeon or resident. Features: NEW chapters on: Management of the Geriatric or Elderly Patient; Management of Bone …
Cited by 2341 Related articles All 6 versions
[HTML] sciencedirect.com
[HTML] Distal femur fractures. Surgical techniques and a review of the literature
M Ehlinger, G Ducrot, P Adam, F Bonnomet – Orthopaedics & Traumatology …, 2013 – Elsevier
… [1] M. Court-Brown, B. CaesarEpidemiology of adult fracture: a review … 3] PN Streuble, WN Ricci, A. Wong, MJ GardnerMortality after distal femur fractures in elderly … U. Kammerlander-Knauer, R. Schmid, et al.Functional outcome and mortality in geriatric distal femoral fractures …
Cited by 48 Related articles All 6 versions
Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures
EK Rodriguez, C Boulton, MJ Weaver, LM Herder… – Injury, 2014 – Elsevier
… not pre-defined, which meant that each surgeon treated a distal femoral fracture that exhibited … Many of the published studies of LLP treatment of distal femur fractures have reported … Unfortunately, mortality in geriatric fractures of the distal femur approaches that observed for hip …
Cited by 88 Related articles All 5 versions
[HTML] nih.gov
Secular trends in the incidence of hip and other osteoporotic fractures
…, IOF CSA Working Group on Fracture … – Osteoporosis …, 2011 – Springer
… of the pelvis [67], calcaneus [67], ribs [68], distal humerus [69], distal femur [70] and … The temporal patterns for distal forearm fractures in northern Europe seem similar to those … Evans JG, Seagroatt V, Goldacre MJ (1997) Secular trends in proximal femoral fracture, Oxford record …
Cited by 563 Related articles All 24 versions
Functional outcome and mortality in geriatric distal femoral fractures
C Kammerlander, P Riedmüller, M Gosch, M Zegg… – Injury, 2012 – Elsevier
… there are several ways to stabilise distal femoral fractures in the elderly … In this cohort study all distal femoral fracture patients aged 65 years and older treated within … Patients with pathological fractures, multiple fractures, patients who underwent any organ transplantation and …
Cited by 47 Related articles All 6 versions
[PDF] rcseng.ac.uk
The use of computed tomography in identifying radiologically occult hip fractures in the elderly
S Heikal, P Riou, L Jones – … The Royal College of Surgeons …, 2014 – publishing.rcseng.ac.uk
… and dislocations,Imaging,X-ray,Computed tomography,Magnetic resonance imaging,Accidental fall … Elderly patients presenting with falls and subsequent femoral neck fractures are vulnerable … Initially missed occult fractures of the proximal femur in elderly patients: implications …
Cited by 17 Related articles All 6 versions
… clamp-assisted reduction and cephalomedullary nailing without cerclage cables for subtrochanteric femur fractures in the elderly: Surgical technique and results
J Mingo-Robinet, M Torres-Torres, M Moreno-Barrero… – Injury, 2015 – Elsevier
… in high-energy trauma or in older osteopenic patients after a low-energy fall [1]. In … The purpose of this study was to evaluate 26 consecutive subtrochanteric fractures in elderly patients treated … with the patient supine on a radiolucent fracture table, with the fractured limb placed in …
Cited by 20 Related articles All 6 versions
[HTML] sciencedirect.com
[HTML] Treatment of recent trochanteric fracture in adults
P Adam – Orthopaedics & Traumatology: Surgery & Research, 2014 – Elsevier
… In elderly subjects, trochanteric fracture results from bone fragility associated with frequent falls, induced by certain … It often follows a simple high fall, resulting in total lower-limb impotence … Elderly patients are not ideal candidates, due to the serious risk of loss of independence …
Cited by 11 Related articles All 7 versions
Risk factors for falls among older adults: a review of the literature
AF Ambrose, G Paul, JM Hausdorff – Maturitas, 2013 – Elsevier
… The risk of falling increases with the number of risk factors present and with age [35]. Table 1 summarizes the risk factors reviewed here. Table 1. List of fall risk factors discussed in review. Intrinsic risk factors for falls, Demographic, Age. Gender. Race. Systems, Gait and balance …
Cited by 519 Related articles All 9 versions
Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment
PM Rommens, A Hofmann – Injury, 2013 – Elsevier
… Low-energy accidents such as falls from a standing position are sufficient to produce fractures of the femoral neck … MRI (B) images of the sacrum of an 80 years old woman after a low-energy fall from a … of pure FFP Type Ia and Ib lesions is much less common in the elderly than in …
Cited by 111 Related articles All 5 versions
[HTML] nih.gov
[HTML] Surgical prevention of femoral neck fractures in elderly osteoporotic patients. A literature review
E Chiarello, G Tedesco, M Cadossi… – Clinical cases in …, 2016 – ncbi.nlm.nih.gov
… Stress distributions within the proximal femur during gait and falls: implications for osteoporotic fracture … Verhulp E, van Rietbergen B, Huiskes R. Load distribution in the healthy and osteoporotic human proximal femur during a fall to the side. Bone … Osteoporosis in the elderly …
Cited by 6 Related articles All 7 versions
[PDF] boneandjoint.org.uk
The outcome of tibial diaphyseal fractures in the elderly
ND Clement, NJF Beauchamp… – The bone & joint …, 2013 – online.boneandjoint.org.uk
… Super-elderly patients were more likely to be women and to have sustained the fracture after a fall, but all other variables were similar to those in the elderly group (Table II) … Factor, Elderly (n = 139), Super-elderly (n = 94), p-value … Mechanism (n, %), 0.044. Falls, 80 (58), 63 (67) …
Cited by 23 Related articles All 5 versions
[HTML] nih.gov
[HTML] Early orthogeriatric treatment of trauma in the elderly: a systematic review and metaanalysis
B Buecking, N Timmesfeld, S Riem… – Deutsches Ärzteblatt …, 2013 – ncbi.nlm.nih.gov
… rate of complications during hospital stay; this was also true of patients who fell during the … These included, among others, a reduced rate of falls (14) and more frequent recovery of … Int J Geriatr Psychiatry (19), Taiwan, 4, Unilateral proximal femoral fracture caused by fall. Age ≥60 …
Cited by 48 Related articles All 7 versions
[PDF] sagepub.com
Fragility hip fractures in elderly patients in Bhubaneswar, India (2012-2014) a prospective multicenter study of 1031 elderly patients
SK Dash, R Panigrahi, N Palo… – … orthopaedic surgery …, 2015 – journals.sagepub.com
… Institution. Institutional Access. Shibboleth. Open Athens. Need Help? Geriatric Orthopaedic Surgery & Rehabilitation. AOTrauma International Geriatric Fracture Society. Journal Indexing … Journal, New Content, Announcements. Geriatric Orthopaedic Surgery & Rehabilitation,
Cited by 17 Related articles All 7 versions
Management of fractures in a geriatric surgical patient
J Tinubu, TM Scalea – Surgical Clinics, 2015 – surgical.theclinics.com
… Midshaft femur fracture in older patient caused by a ground-level fall … Google ScholarSee all References , 2 x2Aschkenasy, MT and Rothenhaus, TC Trauma and falls in the … the fractures can be a life-changing event and result in a previously independent individual falling into a …
Cited by 19 Related articles All 4 versions
People and Problem: Above 60 years old with femur fractures
Intervention: Patients underwent surgery in 4 days and 48 hours
Comparison: Does not correspond
Outcomes: Reduced Mortality with Prompt Surgeries
References
Bach-Mortensen, A., Lange, B., & Montgomery, P. (2018). Barriers and facilitators to implementing evidence-based interventions among third sector organisations: a systematic review. Implementation Science, 13(1). doi: 10.1186/s13012-018-0789-7
Duke University Medical Center1. (2018). LibGuides: Introduction to Evidence-Based Practice: 1. ASK. Retrieved 7th Sep. 2018 from https://guides.mclibrary.duke.edu/c.php?g=158201&p=1035584
Duke University Medical Center2. (2018). LibGuides: Evidence Based Practice (NUR 4169): What is EBP? Retrieved 7th Sep. 2018 from https://fgcu.libguides.com/EBP
Duncombe, D. (2018). A multi-institutional study of the perceived barriers and facilitators to implementing evidence-based practice. Journal of Clinical Nursing, 27(5-6), 1216-1226. doi: 10.1111/jocn.14168
Evans, C., Yeung, E., Markoulakis, R., & Guilcher, S. (2014). An Online Community of Practice to Support Evidence-Based Physiotherapy Practice in Manual Therapy. Journal of Continuing Education in the Health Professions, 34(4), 215-223. doi: 10.1002/chp.21253
Hersen, M., & Sturmey, P. (2013). Handbook of evidence-based practice in clinical psychology, adult disorders (p. 111). Hoboken, N.J.: Wiley.
Joseph-Williams, N., Elwyn, G., & Edwards, A. (2014). Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Education and Counseling, 94(3), 291-309. doi: 10.1016/j.pec.2013.10.031
Joseph-Williams, N., Elwyn, G., & Edwards, A. (2014). Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Education And Counseling, 94(3), 291-309. doi: 10.1016/j.pec.2013.10.031
Khammarnia, M., Haj Mohammadi, M., Amani, Z., Rezaeian, S., & Setoodehzadeh, F. (2015). Barriers to Implementation of Evidence Based Practice in Zahedan Teaching Hospitals, Iran, 2014. Nursing Research and Practice, 2015, 1-5. doi: 10.1155/2015/357140
Murphy, M., MacCarthy, M., McAllister, L., & Gilbert, R. (2014). Application of the principles of evidence-based practice in decision making among senior management in Nova Scotia’s addiction services agencies. Substance Abuse Treatment, Prevention, and Policy, 9(1), 47. doi: 10.1186/1747-597x-9-47
Rice, M. (2011). Evidence-Based Practice Principles. Journal of the American Psychiatric Nurses Association, 17(6), 445-448. doi: 10.1177/1078390311426289
Budd, M., Hough, S., Wegener, S., & Stiers, W. (2017). Practical Psychology in Medical Rehabilitation (pp. 548- 555). Cham: Springer International Publishing.
Dang, D., & Dearholt, S. (2017). Johns Hopkins Nursing Evidence-Based Practice Third Edition (pp. 202-203). Sigma Theta Tau.
Goldstein, N., & Morrison, R. (2013). Evidence-based practice of palliative medicine (p. 268). Philadelphia: Elsevier/Saunders.
Schaffer, M., Sandau, K., & Diedrick, L. (2012). Evidence-based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209. doi: 10.1111/j.1365-2648.2012.06122.x
Shifaza, F., Evans, D., & Bradley, H. (2014). Nurses’ Perceptions of Barriers and Facilitators to Implement EBP in the Maldives. Advances in Nursing, 2014, 1-7. doi: 10.1155/2014/698604
Scurlock-Evans, L., Upton, P., & Upton, D. (2014). Evidence-based practice in physiotherapy: a systematic review of barriers, enablers and interventions. Physiotherapy, 100(3), 208-219.
Wood, E., Ohlsen, S., & Ricketts, T. (2017). What are the barriers and facilitators to implementing Collaborative Care for depression? A systematic review. Journal Of Affective Disorders, 214, 26-43. doi: 10.1016/j.jad.2017.02.028
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
