In a simple and straightforward meaning, the term Evidence simply refers as a testimony and presentation of documents, records, objects, and other such items relating to the existence or non-existence of alleged or disputed facts into which a court enquires. The rules and regulations that conduct and preside over the formation of a detail before a court, jointly called the act of evidence. Evidence submits to all that is normally used to ascertain and reveal the fact of an statement whereas evidence based practice is one of the interdisciplinary method usually applied in the area of medicine such as nursing, psychiatry, neurology, obstetrics and gynaecology, paediatrics including neonatology, pathology which includes toxicology, emergency medicine, pharmacology, and so on. So, evidence based practice follows the fundamental rule which is affirmed as all the common practical evaluation should be prepared according to the approved research studies which should be chosen and explained as per some standards and feature for evidence based practice. In health care system, Evidence based practice refers to all the clinical judgments that are prepared on the basis of investigation and scientific studies which facilitates in the distribution of the high quality care to the patient to make better results. Evidence-based health care practices are accessible for a number of circumstances such as diabetes, heart failure, kidney failure, and asthma. Nevertheless, these practices are not continuously put into practice in care delivery, and discrepancy in practices proliferate. By tradition, patient protection study has concentrated on data analysis to identify patient protection issues and to exhibit that a new practice will guide to improved quality and patient protection. Executing evidence-based protection practices are complicated and require plan that deals with the difficulty of care systems, individual practitioners, senior leadership, and eventually altering health care traditions to be evidence-based protection practice environments.
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There is a great history of practice in nursing field by means of research, initiated by Florence Nightingale. Although for the period of early and mid-1900s, a small number of nurses played a role to this establishment commenced by Nightingale. Through application of research findings in practice, there has been in recent times granted a major control in nursing profession for getting better care. Evidence-based practice (EBP) is the careful and sensible use of the most excellent proof in combination with clinical expertise and patient values to conduct health care conclusions. Observing evidence from randomized controlled trial (RTC) (or randomized comparative trial) which is a specific type of scientific experiment; evidence from other technical approaches like illustrative and qualitative research; as well as utilization of knowledge from technical assumptions, opinion from expertise of the same field, and case reports are the best evidences which support in development of the health care. As soon as there has been an enough evidences from research, the practice should be directed by research evidence in combination with patient values and medical proficiencies. Health care decision making is obtained predominantly from non-research evidence basis like opinion from expert and technical supports. This type of decision is made only when there is lack of sufficient research. As more research is prepared in a particular area, the research evidence must be integrated into the evidence based practice as a tool for the future reference.
Mickibbon (1990) states “evidence based practice involves conscientious as well as complex decision making which is based on available evidence but it will be highly affected by the patients characteristics, situation and priorities”. Health care expertise or we can say professional should be fully trained and should have awareness so that they can appraise the present situation, thoughts, knowledge and use what they have learned from their nursing practices to get better outputs and deliver safe care to the people. They should keep always on track on how to do and what to do in caring the people because delivery of caring job very difficult. Evidence based practice is significant for health professionals for several reasons as it provides evidence for the care of the patient. Evidence subsists in most excellent perform in evaluation of patient health condition, analysis of patient problem , setting up of patient care, intervention to get better function of the patient, or to avoid problem as well as evaluation of patient responses to intervention. Evidence based practice (EBP) is contemplated as one of the significant factor. Most of the health organizations rely on this Evidence based practice for the successful implementation of the care plan. It is found to be the best medical practice. However the idea of Evidence based practice differ in separate places due to its practice sceneries as well as the perspective of different professional may collide due to their level of skills and perception about evidence based practice. Both evidence based medicine (EBM) and evidence based nursing (EBN) come alongside while dealing with Evidence based practice. Therefore, in many difficult situations, there has been involvement of the evidence based medicine and it is said to be one of the key structure while making such decisions. It also helps to simplify the complicated decisions. On the other hand, evidence based nursing is a practical guide to evidence-based nursing for both the students and practitioners. It allows nurses to get better knowledge and review the different types of evidence that are existing simply just by following the techniques step-by-step. It also deliberates the approaches in which these results can be implemented in clinical practice, and how research can be basically applied to clinical-decision making. It helps nurses to give best and safe health care.
In total just considering about the evidence so the source of that evidence can be either primary or secondary. While dealing with evidence based practice topic selection and formulation of question considering the target group of the population is considered as a main key factor. As per Fitzapatrick (2007) skill which is required for the development of effective approach to the EBP is taken as its first approach while second step is critically evaluating the primary sources of evidence which are gathered according to the research question, than the next step is drawing the research together and critically evaluation of systematic review is its last step.
Models of Evidence Based Practice
For a number of clinical settings, there are several models of Evidence Based Practice that have to be involved. The common constituents of these models are choosing the practice subject matter for example discharge consultation for the patient with heart failure, analysis of evidence, implementation, evaluation of the effect on patient care and supplier performance, and deliberation of the situation in which the practice is implemented. The knowledge that takes place through the practice of interpreting examine into practice is important information to summarize and advice into the process, so that formers can adjust the evidence-based instruction and/or the implementation approaches.
Patient Safety and Quality: A latest abstract structure for enlarging and speeding up the transfer of research results from the Agency for Healthcare Research and Quality (AHRQ), delivery of the patient health care was developed by the broadcasting subgroup of the AHRQ Patient Safety Research Coordinating Committee. This model is a combination of ideas from technical information on learning transfer, social promotion, communal and governmental innovation, and behaviour changes.
Steps of Evidence-Based Practice
Before presenting these steps, we identify the massive challenge to most practitioners presented by this approach, and while utilizing these steps there can be involvement of a large amount of time and stress in a careful method. There are basically two options in relating evidence based practice that may assist to alleviate some of that difficult.
First, one option is that you start your activity of evidence based practice step by step. Measure for yourself the time and energy that concerning these evidence based practice steps takes in that case. Like this, you can get knowledge about costs and benefits of evidence based practice and able to judge yourself properly. Definitely, you will get a lot of benefits in applying evidence based practice and increase your capacity depending upon the case and situation. Each and every application will turn out to be easier as you gain experiences with any new approach and new systems.
The second option to consider in fact depends on the types of deals you give in your organization. In many organizations, the task loads include related difficulties, admittedly with discrepancies between individual client. This may signify that review of the literature to determine what will be helpful for evidence based practice with one client, problem arrangement may be simplified to many of your cases. You will save your maximum time and energy in accomplishing these steps.
The following steps are involved in evidence based practice.
Step 1. Develop A Question
“Develop A Question” is one of the important step of evidence based practice and is not easy task. The whole question formulated should be answerable that should give information about patient, intervention as well as should be able to draw the outcome from the designed question. To make it simple and easy to understand, PICO acronym is planned which helps the health care provider to design question while dealing with evidence based practice. Fitzpatrick (2007) states that there are four elements which will help in the development of clinical question which are taken a PICO where ” P ” stands for population which describes the patient group, ” I “stands for intervention which refers treatment, procedure, tests whereas ” C ” describes the alternative intervention and ” O ” stands for outcomes which describes how intervention affect the population weather it improve or affect. In simple words PICO acronym helps us to identify population/intervention/therapy/procedure as well as sometimes comparison is to be made with next intervention and more important desired outcome can be known through the research which is done by our search strategy by searching the relevant articles. In general formulation of question using PICO play a vital role to determine the direction of our research in evidence based practice as well as based on four component of PICO final question is designed which will help in literature search. This is not as easy as it may first appear. The question may be as complicated as, what are the key factors affecting homelessness, or as focused as, what intervention works best with a given problem? For example, we may be working with clients with overwhelming anxiety. We would want to ask questions such as, what are the best methods for assessing anxiety, and what interventions work best with what different types of anxiety? We also want to be aware in seeking answers to our practice questions that characteristics of the client, practitioner, setting, and other environmental variables play an important part in getting the clearest and best answers to our questions. An intervention that cannot be adjusted to account for cultural differences among clients may not be the best answer to your question.
Step 2. Find the Evidence
The next step of the evidence based practice is to find out the appropriate search process and gathering valuable evidence as well as some supportive evidence for the researchable question. Critical Appraisal Skilled Programmed (CASP) is introduced as a tool to carry on this step. In this section, significant examination of the articles is done with the help of CASP. The main section of the guides accessible on evidence based practice is dedicated to this search process. There are several ways of finding evidence, but particularly three ways of finding evidence are important and relevant in search process. These are associated with the use of internet. The first two ways of finding evidence involves of retrieving available analysis of the research literature, while the third way of finding evidence involves do- it-yourself analysis. The first process of finding evidence is to find a meta- analytic review. Meta-analyses are quantitative reviews of the literature. The second process of finding evidence is to find a available conventional analysis of the literature. This is occasionally called the box- score method because the reviewer frequently simply inserts the overall optimistic studies and pessimistic studies and introduces a conclusion. The third process of finding evidence is to accomplish a review of all the available evidence yourself. It takes a lot of time and difficult than the other ways of finding evidence.
Step 3. Analyze the Evidence
The third step is to analyse the particular studies where you are having more than just a exceeding understanding of research design and methodology as well as the commitment to putting in the time to apply your understanding to the analysis of studies.
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Step 4. Combine the Evidence with Your Understanding of the Client and Situation
The process of finding, the process of implementing, decision making are all difficult tasks and major keys for evidence based practice. It becomes even more exciting when we think how to acclimatize it to the current client problem and situation arrangement. If you found the evidence that is collected is based on a people that is separate from the client with whom
you are dealing, then you will have to find another most excellent way to adapt what you found
in the literature to the situation in which you are working. The number of such
related changeable that could affect your decision are numerous, together with ethnic
and cultural dissimilarities, income amount and income security, accommodation, family circumstances, and so on.
Step 5. Application to Practice
This is another step that involved in evidence based practice and we can say it is the easiest part of evidence based practice. When decision making is finalized or decision is ready to put into practice the matter you have recognized as evidence-based, all that is left to do is to implement that material. Evidently, a specialist might get that he/she does not have enough knowledge to immediately implement that material; therefore, a period of adjustment will be necessary. This can be completely improved by maintaining in one’s possession a number of books explained already that present the intervention practices that have been found to be efficient in bureaucratic guidebooks.
Step 6. Monitor and Evaluate Results
The last step for evidence based practice is to monitor and evaluate the results that have been implemented. Perfect results are never certain. So, the topic is so vital to evidence based practice. As practitioners, we must put a great effort and find out the effective results using different tools and techniques and other guidelines.
Evidence-Based Practice Implementation
Evidence based practice implementation and evaluation is the final part of evidence based practice and this segment deals about significant study of implementation and evaluation. When the research is carried out, it should be implemented. Implementation is considered as guideline for changing practice which will help to assume and constantly use evidence based research findings and innovations in everyday practice. Implementing and sustaining evidence based practices in health care settings contains complicated interrelationships among the evidence based practice topic (e.g., reduction of medication errors), the organizational social system characteristics (such as operational structures and values, the external health care environment), and the individual clinicians.
When the clinical enquiries of end users can be concentrated through use of existing evidence that is enveloped with end users in mind, steps of the EBP process take less time and more effort can be directed toward the implementation, evaluation, and sustainability components of the process. For example, finding, critiquing, and synthesizing the evidence; setting forth EBP recommendations with documentation of the type and strength of evidence for each recommendation; and determining appropriateness of the evidence for use in practice are accelerated when the knowledge-based information is readily available. Some distilled research findings also include quick reference guides that can be used at the point of care and/or integrated into health care information systems, which also helps with implementation.
Evidence based practice includes implementing the best-known practices into the clinical setting using a systematic methods. As a result, safe, high-quality, and cost-effective care will be more likely to occur consistently. Although the science of interpreting research into practice is quite new, there is some conducting evidence of what implementation interventions to use in supporting patient safety practices. However, there is no special projectile for interpreting what is known from research into practice. To move evidence based interventions into practice, several techniques and methods may be needed. In addition, what works in one situation of care may or may not work in another situation, thus recommending that situation changeable material in implementation.
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