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EVIDENCE BASED

NURSING
FERIKA INDARWATI, S.Kep.,M.Ng.,Ns

TUJUAN PEMBELAJARAN
-

MEMAHAMI TENTANG APA ITU EBN


MENGAPA HARUS MENGGUNAKAN
EBN
BAGAIMANA CARA MEMPEROLEH EBN
BAGAIMANA CARA
MENGAPLIKASIKANNYA

What is Evidence Based


Practice?
Suatu proses dimana hasil penelitian,
pengetahuan klinik dan critical
thinking/reasonong dipakai untuk
membuat keputusan terkait dengan
intervensi yang efektif untuk pasien.

Research vs. EBP


EBP is not about conducting research it
is about USING RESEARCH

Research= systematic process of gathering and


synthesising empirical data to generate
knowledge about a given topic

EBP= the conscientious, explicit and judicious


use of best current evidence in making decisions
about care for clients

What is EBN?

Evidence-Based Practice (EBP), salah


satunya adalah Evidence-Based Nursing
(EBN), merupakan pendekatan yang dapat
digunakan dalam praktik perawatan
kesehatan, yang berdasarkan evidence atau
fakta

Contoh kasus

Selama ini, khususnya dalam


keperawatan, seringkali
ditemui praktik-praktik atau
intervensi yang berdasarkan
biasanya juga begitu.
Sebagai contoh, cairan yang
digunakan dalam perawatan
luka adalah povidone-iodine
10%. praktik ini dipakai
over & over meskipun
yang bersangkutan
menjelang pensiun.

Bila diberikan masukan,


kadang-kadang jawaban
yang keluar adalah :
Selama ini juga begini,
pasiennya juga sembuh kok,
kok repot Padahal,
berdasarkan penelitian yang
terbaru, air kran atau air
matang saja bisa digunakan
untuk perawatan luka

Why need to use EBN?

Tenaga perawat kadang dipenuhi oleh rasa ketidakpastian


tindakan apa yang paling efektif untuk mendapatkan hasil
yg terbaik untuk pasien

Evidence based Nursing (EBN)

EBN pendekatan yg dpt membantu perawat untuk


memberikan kualitas pelayanan yang terbaik dalam memenuhi
kenutuhan pasien dan keluarganya
Meningkatkan kualitas intervensi keperawatan dari yang
berbasis tradisi atau kebiasaan menjadi intervensi berbasis
fakta dan hasil riset

Perspectives on Evidence

Research
Evidence
Nursing action
Clinical
expertise

Patient /
User
perspectives

Practice context

Nursing outcomes

ANY QUESTIONS?
QUESTIONS

How to use EBN


Overview
Five Steps:
Mengidentifikasi dan membuat pertanyaan yang jelas
Mecari sumber literatur Search the literature for relevant
clinical articles and evidence
Melakukan kritisisasi pada sumber/artikel
penelitian/evidence yg ditemukan
Mengimplementasikan evidence kedalam praktek
Mengevaluasi dampak dari implementasi evidence tersebut

REFLECT ON
PRACTICE; IDENTIFY
AREAS OF
UNCERTAINTY
AUDIT

IMPLEMENTATION
WHERE
APPROPRIATE
CRITICAL
APPRAISAL OF
THE RESEARCH

PHRASE
ANSWERABLE
QUESTIONS

SEARCH FOR
RESEARCH
EVIDENCE

Step 1: Formulate a review question


Questions can be in relation to:
The cause of a condition
Diagnosis and assessments
Prevention of conditions
Prognosis of conditions
Treatment outcomes
Client concerns
Economic evaluation

Clinical vs. Review Questions


Clinical Question:
A general question relating to a clinical practice situation
Review Question:
Comes from a clinical question
It is clear and specific to guide the search
A useful question consists of a problem, intervention and
outcome and often takes the form of:
What is the evidence for the effectiveness of X
(intervention) for Y (outcome) in a client with Z (problem or
diagnosis)

How to Write a Review Question


Use PICO format:
P= The population or problem you are

interested in (client group, problem)


I= The intervention that you are interested in
C= The comparison or alternative
intervention (if relevant)
O= The outcome or reason for using the
intervention

Example of PICO Question

What evidence is there for the validity and


relevance of the Barthel Index vs. the COPM as
an assessment of occupational performance for
older adults who have a physical disability?

Critiquing an EBP Question


Identify the PICO components of the
following question:
Are self management strategies more
effective than medical care alone for
improving health status, quality of life and
function amongst adults with coronary
heart disease?

Critiquing an EBP Question


P

People aged Self


Medical care
over 35yrs,
management alone
with coronary interventions
heart disease

O
Health
Status,
quality of life,
occupational
performance/
function

Levels of Evidence
Consider the type of research conducted:
(hierarchical list)
1.
2.
3.
4.
5.
6.
7.
8.

Systematic reviews, meta analysis


Randomised controlled trials (RCTs)
Non-randomised controlled trials
Case controlled trials
Cohort studies
Descriptive studies
Qualitative studies
Expert opinion

LEVELS OF EVIDENCE

Kramer BS. Weighing scientific evidence. Washington DC: National Academies Press;
2009

LEVELS OF PEER REVIEWED


INFORMATION

Primary
Secondary

Primary: original
research
Secondary: review
articles
Tertiary: textbooks,
summaries

Tertiary
Clark N, IT Applications of EBM Principles. Tallahassee, FL: Florida
State University College of Medicine, 2003

20

SECONDARY SOURCES

Clark N, 2003

LEVELS OF EVIDENCE 5S

Straus S, Haynes RB. Managing evidence-based knowledge: the need for reliable,
relevant and readable resources. CMAJ. 2009 April 28; 180(9): 942945.

Type of question = type of study


design
Type of question

Suggested study

Therapy

RCT > prospective cohort

Diagnosis

Prospective, blind comparison to a gold


standard

Etiology/Harm

RCT > cohort > case control > case


series

Prognosis

Cohort study > case control > Case


series

Prevention

RCT > cohort study >case control >


case series

Cost

Economic analysis

Step 2: Searching the literature to


find the evidence

Need to use an organised and systematic


approach
Develop search strategies before you
start, including:
Databases you will use
Key terms to search under
Set limits of your search

Databases to Use
Need to consider:
Is your focus medical or broader?
Is your focus OT specific?
Do you want literature from a particular
country or area? (eg. Australia or Asia)
Is there a specific research method you
want to focus on? (eg. systematic review)

Key Terms and Search Limits

Pull out the key terms from your review


question

Generally the problem, intervention and outcome


Consider alternative or related terms (eg. Occupation
and activity)

Set limits for your search, including

Language of the article


Research design
Date of publication

Step 3: Critically Analysing the


Evidence

Assess the value and trustworthiness of the


evidence
No research is without its flaws, need to ask:
Do the flaws make me question the conclusion?

3 broad areas to analyse:

The rigor of the research


Significance of the results
Impact upon your OT practice

Step 4: Implementing the evidence


Examples of strategies to implement
evidence into practice include:

Apply the results to one or a group of


clients
Reconsider treatment plans/goals
Develop handouts on topics (with other
professionals)

Considerations when implementing


evidence

Who is the right therapist to be implementing the


evidence?
What does the evidence say the right thing to
do is?
What is the right way to implement the
intervention?
What is the right place for the implementation?
What is the right time to implement?

Step 5: Evaluating the impact of the


evidence
When evaluating the impact, consider:

The clients outcomes


Cost effectiveness
Client satisfaction
Therapist satisfaction

Barriers to EBP
Some barriers to EBP that have been discussed in
literature include:

Access and availability to information


Limited time
Lack of EBP skills
Confidence in the value of the evidence
Support from management

HOWEVER, BARRIERS CAN ALWAYS BE


OVERCOME

Becoming an Evidence Based


Practitioner
Strategies include:

Regularly ask clinical reflective questions


Take time to track down the best evidence
to support your therapy
Use the evidence in your therapy
Evaluate the impact of this evidence on
your therapy

Useful Resources
Databases:

AMED- rehab and therapy for allied health


professions, accessed through
www.silverplatter.com/catalog/amed.htm
CINAHL- mainly nursing literature but some
allied health, www.cinahl.com/
Cochrane Library- RCTs and Systematic
Reviews, www.cochrane.co.uk/

Useful Resources
Websites:

HealthWeb: tutorials and guides to searching


literaturewww.healthweb.org/browse.cfm?subjectid=39
British medical journals: articles relating to
EBP- http://bmj.bmjjournals.com/collections/
Canadian Centre for Health Evidence:
description of EBP
www.cche.net/usersguides/main.asp

Useful Resources
Websites Continued:

Joanna Briggs Institute: International


Research Collaboration, centres incl.
www.joannabriggs.edu.au/about/home.php

ANY QUESTIONS?

Thank You

Let whoever is in charge keep this simple


question in her head:

Not how can I always do this right thing myself,


but how can I provide for this right thing to be
always done?
Florence Nightingale, 1860

References:

Alison Lane- Evidence Based Practice


Presentation, Pt Pirie
Mary Russell- Evidence Based Practice
Presentation, UniSA
Taylor, MC 2002, Evidence Based Practice for
Occupational Therapists, Blackwell Science Ltd,
USA
Holm MB 2000, The 2000 Elanor Clarke Slagle
Lecture: Our Mandate for the New Millenium:
Evidence-Based Practice, American Journal of
Occupational Therapy, vol.54, no.6, pp.575-85