Johns Hopkins Nursing Evidence-Based Practice Model

Evidence-Base practice (EBP) is defined as: “based on problem identified from the practitioner’s area of practice; a combining of best evidence and professional expertise and an integration of this into current practice; about ensuring patients receive quality care, being part of quality improvement processes; about collaboration and requiring a team approach” (French, 1999). Scott and Mcsherry (2008) supported the French’s assertion, proposing the key elements of EBP are that it is a theory-driven process, which involves the use, evaluation and application of research; identification of best evidence; evaluation of care; problem solving; decision-making; clinical expertise; and requires patient involvement. Evidence-based practice is made of evidence, clinical expertise, patient preference, the context of care (Barker, 2013). In brief, evidence-based practice is the parameter in the nursing practice that it requires that the nurses gather and use clinical evidence to make decision for the patients so that in the nursing process they can deliver the quality of care for the patients (Ellis, 2013). In the other words, in the nursing practice all the nursing procedures performed by the clinical evidence supported.

Evidence based practice is an integral part of nursing care. According to the Academy of Medical-Surgical Nurses, evidence based practice is defined as, “the conscientious use of current best evidence in making decisions about patient care.” (AMSN) The use of evidence based practice has drastically improved patient outcomes, increased quality and safety of healthcare, and reduced costs for facilities. (Melnyk, 2016) In this paper I will provide the history of evidence based practice, how it has already been incorporated and impacted healthcare, and why it is important to nursing and healthcare as a whole.

Even though evidence informed practice helps improve healthcare, there are still a few limitations. One main limitation is lack of time and accessibility. The best quality evidence is usually very difficult to locate, a busy nurse may not have the time to delve deep to find reliable sources. (NICE 2007) However there are now

Although provider barriers exist, your ability to reflect upon the patient problem “and extract the important components to form the clinical question” will likely form the basis for a review of research on the best evidence to address this concern (Fineout-Overholt & Johnston, 2005, p. 157). According to Dr. White (Laureate, 2011), the Johns Hopkins Nursing Evidence-based Practice (JHNEBP) model is a highly adaptable framework. In her discussion about barriers, Dr. White states “… when you think about how a practice question gets designed, if you're doing it only from the nursing perspective, you may not think about what the other professionals are interested in and knowing about”(Laureate, 2011, Transcript of recorded interview). Therefore,

Evidence-based practice is an approach used by health care professionals to continually use current best evidence-based research to make ethical and reliable decisions regarding patient care. “Research to promote evidence-based practice is becoming more and more a part of the regular work of health care leaders” (Grand Canyon University, 2015, p. 1). However, it is important to determine the difference between solid research and flawed research that provides unreliable inferences. Evidence-based research includes focusing on a clinical question; and includes the review and incorporation of several studies to strengthen the results of the new study (Grand Canyon University, 2015). Roddy et al. and Ganz et al. articles will be assessed to determine if the recommended changes were backed by solid research that warrants changes in a hospital.

The purpose of a systematic review is to attempt to find, evaluate and synthesize high quality research relevant to the research question. A systematic review uses carefully developed data collection and sampling procedures that are put in place in advance as a protocol. (Polit, 2012). A systematic review must contain the following: a clear inclusion and exclusion criteria, an explicit search strategy, systematic coding and analysis of included studies, and a meta-analysis if possible. (Hemingway & Brereton, 2009). Systematic reviews are conducted by nurse researchers to avoid reaching incorrect or misleading conclusions that

Evidence base practice is essential in nursing practice. It incorporates 3 key components which are clinical expertise, patient values, and best research evidence in order to provide the most effective and safe decision making for patient care. Neglecting a key component can affect the accuracy and efficiency of a research. Clinical expertise is based on a clinician’s experience, skill, education level and understanding in a certain area of nursing practice. Patient values can impact evidence base practice depending on their needs, preferences, expectations, values, understanding, and concerns. Best research evidence can be obtained from clinical research with supporting evidence base literature and sound methodologies. Each component will be discussed in further detail and how it links to clinical decision making by registered nurses in order to achieve the best evidence-based practice available.

Briefly describe the problem or issue that you have decided to be the topic for your project proposal in order to orient your classmates and faculty

Findings of evidenced based practice have to be disseminated to ensure that innovations for practice are replicated or applied in other settings by stakeholders in the health fraternity and healthcare professionals (Forsyth, Wright, Scherb & Gaspar, 2010). One of the objectives of dissemination should be to improve the practice. Dissemination of evidenced based practice findings in nursing is very critical in knowledge synthesis, translation, and translation. It is imperative in strengthening healthcare, informing policy, and improving practice decisions based on clinical evidence (Rycroft-Malone & Bucknall, 2010). This is realized by transforming clinical changes into practice. It actually involves two stage processes namely: translation of evidence into practice and integration of research recommendations into actual practice. Effective dissemination of evidence based practice findings enable staff to share information about developments in healthcare practice and implement innovation (Freemantle & Watt, 1994).

Sterile technique is required for insertion of an indwelling urinary catheter in the hospital setting, but clean technique can be used for intermittent catheterization in non-acute settings. By itself, sterile technique on insertion doesn't prevent UTI’s. Prevention of UTI’s depends on knowledge of causes, proper care techniques, and early catheter removal. Nurses are taught early on in school that sterile technique helps to reduce infections. It was drilled in our heads the entire time and now to have the evidence tell us that early catheter removal, along with proper technique good hand hygiene is the key to reduce UTI’s.

It synthesizes the results of various primary studies by using strategies that reduces biases and random errors. These reviews follow a strict scientific design and provide consistent estimates about the effects of interventions, therefore, conclusions are defensible. Systematic reviews shows where knowledge is lacking and can be used to guide future research. These reviews are usually carried out in the areas of clinical tests such as diagnostic, screening and prognostic; public health interventions; economic evaluations; adverse effects and how and why interventions work. Cochrane reviews are systematic reviews undertaken by Cochrane Collaboration members, aims to help people to make well-informed decisions about healthcare by preparing, maintaining, and promoting the accessibility of systematic reviews of the effects of healthcare

Evidence based practice is an important priority in nursing because it ensures that the best quality and most effective care is being used. Restraint use is an intervention that is being minimized more and more. It can be an important intervention when necessary but there are specific circumstances and guidelines that must be followed. Evidence based practice is proving that restraint use may be eliminated due to safety concerns and more beneficial interventions being used.

According to The American Nurses Association (ANA) Evidenced-based practice is a "scholarly and systematic problem-solving paradigm that results in the delivery of high quality healthcare" (American Nurses Association, 2010, p. 65). Through the use of evidence-based practice nurse and other health care professional have the ability to create clinical decisions, which allows clinical questions to be answered and aid in quality improvement. Furthermore creating a safe, efficient, productive environment for patients and staff that may result in improving patient outcomes and reduce expenses. Nursing research helps health care providers provide evidence-based practice, which may result in quality improvement (Rebar & Gersch, 2015).

The study was a systematic review of scientific papers selected by a search of the SciELO, Cochrane, MEDLINE, and LILACS-BIREME databases. Among the 2169 articles found, 12 studies proved relevant to the issue and presented an evidence strength rating of B. No publications rated evidence strength A. Seven of the studies analyzed were prospective cohorts and 5 were cross-sectional studies.

“Sleep Quality in Nurses: A Randomized Clinical Trial of Day and Night Shift Workers” is a quantitative study by Nui, Chu Chung, Lin, Chang, and Chou published in the journal of Biological Research for Nursing (2012). The article aims to compare the amount of recovery time needed by nurses that work the night shift in relation to nurses that work the day shift. In order to determine if a study is eligible to use for developing evidence based practice it is important to critique research articles (Lobiondo-Wood & Haber, 2014) for their quality and applicability. This will determine if the study is relevant and can be applied to nursing practice. That is the purpose of this paper.