Teaching EBP: the critical step of critically appraising the literature.
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Biomedical subjects
Publications and source records attributed to Ellen Fineout-Overholt.
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BACKGROUND: The paradigm shift to evidence-based nursing practice in the United States has been slow. Although multiple barriers to evidence-based practice (EBP) have been identified through prior studies, there is a gap in the literature specifically identifying key variables (e.g., belief that EBP produces quality outcomes) that are correlated with the extent to which nurses engage in EBP. AIM: The primary aims of this study were to (1) describe nurses' knowledge, beliefs, skills, and needs regarding EBP; (2) determine whether relationships exist among these variables; and (3) describe major barriers and facilitators to EBP. METHODS: A descriptive survey was conducted with a convenience sample of 160 nurses who were attending EBP conferences or workshops in four states located within the Eastern Region of the United States. RESULTS: Although participant beliefs about the benefit of EBP were high, knowledge of EBP was relatively low. Significant relationships were found between the extent to which the nurses' practice is evidence-based and (1) nurses' knowledge of EBP, (2) nurses' beliefs about the benefits of EBP, (3) having an EBP mentor, and (4) using the Cochrane Database of Systematic Reviews and the National Guideline Clearinghouse. CONCLUSION AND IMPLICATIONS: 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. EBP mentors may be key in accelerating a more rapid shift toward evidence-based nursing practice. Theoretically driven randomized controlled trials are urgently needed to test the effectiveness of interventions on advancing evidence-based care.
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Health care is in need of change. Major professional and health care organizations as well as federal agencies and policy-making bodies are emphasizing the importance of evidence-based practice (EBP). Using this problem solving approach to clinical care that incorporates the conscientious use of current best evidence from well designed studies, a clinician's expertise, and patient values and preferences, nurses and other health care providers can provide care that goes beyond the status quo. Health care that is evidence-based and conducted in a caring context leads to better clinical decisions and patient outcomes. Gaining knowledge and skills in the EBP process provides nurses and other clinicians the tools needed to take ownership of their practices and transform health care. Key elements of a best practice culture are EBP mentors, partnerships between academic and clinical settings, EBP champions, clearly written research, time and resources, and administrative support. This article provides an overview of EBP and offers recommendations for accelerating the adoption of EBP as a culture in education, practice and research.
Although evidence-based practice (EBP) integrates the best evidence from well-designed studies with a clinician's expertise and patient preferences and values, most of what is emphasized in books and reports on EBP is the 5-step EBP process. However, the consideration of patient values and preferences in making clinical decisions is essential to deliver the highest quality of care. This article briefly reviews the status of EBP in the United States, described the ARCC mentorship model, and highlights how to engage consumers in the EBP process.
From the searches presented, it can be seen that there are times when scientific studies will not be available to answer burning clinical questions. If systematic reviews, evidence-based guidelines, and individual studies are not available, clinicians must then turn to expert anecdotal evidence to guide their decision-making process and interventions. As further randomized controlled trials are conducted to evaluate nursing interventions, more scientific evidence will become available to guide nursing practice. However, it is important to remember that EBP not only encompasses evidence from research and its appraisal, but also includes patient preferences and expertise by the clinician. Because a meta-analysis indicated that patients had 28% better outcomes when nursing interventions were based on scientific evidence rather than interventions that were steeped in tradition (Heater, Becker, & Olson, 1988), it is essential that nurse practitioners and nurses have the appropriate knowledge and skills to translate evidence from research into practice. Asking searchable questions and knowing how to search for and find the best evidence are two key steps in delivering the highest quality of evidence-based nursing care to patients and their families.
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Evidence-based practice (EBP) is a problem-solving approach that incorporates the best available scientific evidence, clinicians' expertise, and patients' preferences and values. Melnyk and Fineout-Overholt have developed the ARCC (Advancing Research and Clinical practice through close Collaboration) model for the purpose of implementing EBP. A pilot study was conducted to test the ARCC model at two acute-care sites. This article shares information learned from the pilot study about what is necessary for successful implementation of EBP in the acute-care setting. These essentials include identifying EBP champions, redefining nurses' roles to include EBP activities, allocating time and money to the EBP process, and creating an organizational culture that fosters EBP. In addition, practical strategies for implementing EBP are presented to encourage implementation of EBP.