Implementing An Evidence-Based Practice Change
Implementing an Evidence-Based Practice ChangeBeginning the transformation from an idea to reality.This is the ninth article in a series from the Arizona State University College of Nursing and Health Innovation’s Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach tothe delivery of health care that integrates the best evidence from studies and patient care data with clinician expertiseand patient preferences and values. When delivered in a context of caring and in a supportive organizational culture,the highest quality of care and best patient outcomes can be achieved.The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, onestep at a time. Articles will appear every other month to allow you time to incorporate information as you work to ward implementing EBP at your institution. Also, we’ve scheduled “Chat with the Authors” calls every few months toprovide a direct line to the experts to help you resolve questions. Details about how to participate in the next call willbe published with May’s Evidence-Based Practice, Step by Step.In January’s evidence-basedprac tice (EBP) article, Rebe cca R., our hypothetical staffnurse, Carlos A., her hospital’sex pert EBP mentor, and ChenM., Rebecca’s nurse colleague,began to develop their plan forimplementing a rapid responseteam (RRT) at their institution.They clearly identified the purpose of their RRT project, thekey stakeholders, and the various outcomes to be measured,and they learned their internal re view board’s requirements for re viewing their pro posal. To determine their next steps, the teamconsults their EBP Implementation Plan (see Figure 1 in “Following the Evidence: Plan ningfor Sustainable Change,” Jan uary). They’ll be working onitems in checkpoints six andStrategies to Engage Stakeholders 54 pend time and effort building trust.S Understand stakeholders’ interests. Solicit input from stakeholders.C onnect in a collaborative way. Promote active engagement in establishingmetrics and outcomes to be measured.AJN March 2011 Vol. 111, No. 3seven: specif ically, engaging thestakeholders, getting administrative support, and preparing forand conducting the stakeholderkick-off meeting.ENGAGING THE STAKEHOLDERSCarlos, Rebecca, and Chen reachout to the key stakeholders to tellthem about the RRT project bymeeting with them in their officesor calling them on the phone. Car los leads the team through a discussion of strategies to promotesuccess in this critical step in theimplementation process (see Strat egies to Engage Stakeholders). Oneof the strategies, connect in a col laborative way, seems espe ciallyapplicable to this project. Eachteam member is able to meet witha stakeholder in person, fill themin on the RRT project, describethe purpose of an RRT, discusstheir role in the project, and an swer any questions. They also telleach stakeholder about the initialproject meeting to be held in a fewweeks.In anticipation of the stakeholder kick-off meeting, Carlosand the team discuss the fun damen tals of preparing for anim portant meeting, such as howto set up an agenda, draft key doc uments, and conduct the meet ing. They begin to discuss a timeand date for the meeting. Carlossuggests that Rebecca and Chenmeet with their nurse managerto up date her on the project’spro gress and request her help insched uling the meeting.SECURING ADMINISTRATIVE SUPPORTAfter Rebecca updates her manager, Pat M., on the RRT pro ject,Pat says she’s impressed by theteam’s work to date and of fersto help them move the projectforward. She suggests that, sincethey’ve already invited the stakeholders to the upcoming meet ing,they use e-mail to communicatethe meeting’s time, date, andplace. As they draft this e-mailtogether, Pat shares the follow ing tips to im prove its effectiveness: communicate the essence andimportance of the e-mail in thesubject line write an e-mail that’s engaging,but brief and to the point introduce yourself explain the projectajnonline.com
By Lynn Gallagher-Ford, MSN, RN, NE-BC, Ellen Fineout-Overholt, PhD, RN, FNAP, FAAN, BernadetteMazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP,FAAN, and Susan B. Stillwell, DNP, RN, CNE w elcome the recipients to theproject and/or team and invitethem to the meeting explain why their attendanceis critical request that they read certainmaterials prior to the meeting(and attach those documentsto the e-mail) let them know whom to contact with questions request that they RSVP thank them for their participationBefore they send the e-mail (seeSample E-mail to RRT and Stake holders), the team wants to makesure they don’t miss anyone, sothey review and include all of theRRT members and stake holders.They realize that it’s im portant toinvite the manager of each of thestakeholders and disciplines rep resented on the RRT and askthem to also bring a staff representative to the meeting. In addition,they copy the administrative di rec tors of the stakeholder departments on the e-mail to en sure thatthey’re fully aware of the project.PREPARING FOR THE KICK-OFFMEETINGThe group determines that thedraft documents they’ll need toprepare for the stakeholder kickoff meeting are: an agenda for the meeting the RRT protocol an outcomes measurement plan an education plan an implementation timeline a projected budgetTo expedite completion of the doc uments, the team divides them upamong themselves. Chen volunteers to draft the RRT protocoland outcomes measurement plan.Carlos assures her that he’ll guideher through each step. Rebeccadecides to partner with her unit ed ucator to draft the education plan.Carlos agrees to take the lead indrafting the meeting agenda, im plementation timeline, and projected budget, but says that sincethis is a great learning opportunity, he wants Rebecca and Chento be part of the drafting process.Drafting documents. Carlostells the team that the purpose ofa draft is to initiate discussion andgive the stakeholders an oppor tu nity to have input into the finalprod uct. All feedback is a positivesign of the stakeholders’ involvement, he says, and shouldn’tbe per ceived as criticism. Carlosalso offers to look for any templates from other EBP projectsthat may be helpful in draftingthe documents. He tells RebeccaSample E-mail to RRT and StakeholdersTo: ICU Nurse Manager, 3 North Nurse Manager, Respiratory Therapy Director, Medical Director of ICU, Director ofAcute Care NP Hospitalists, Director of Spirituality Departmentcc: EBP Council Chair, VP Nursing, VP Medical Affairs, ICU Nursing Director, Medical–Surgical Nursing Director,Finance Department Director, Communications Department Director, Risk Management Director, Education DepartmentDirector, HIMS (Medical Records) Director, Quality/Performance Improvement Director, Clinical Informatics Director,Pharmacy DirectorSubject: Invitation to the Rapid Response Project Stakeholder Kick-off MeetingGood afternoon. I would like to introduce myself. My name is Rebecca R. I am a staff nurse III on the 3 North medical–surgical unit. You have either spoken with me or with one of my colleagues, Carlos A. or Chen M., about an importantevidence-based initiative that will help improve the quality of care for our patients. The increasing patient acuity on ourunit and throughout the hospital, and the frequent need for patients to be transferred to the ICU, prompted us to askimportant questions about patient outcomes. For the past few months, Carlos, Chen, and I have been investigating howour hospital can reduce the number of codes, particularly outside the ICU. We have conducted a thorough search forand appraisal of current available evidence, which we would like to share with you.Our team and our managers would like to invite you to participate in a kick-off meeting to discuss an excitingevidence-based initiative to improve the quality of patient care in our hospital. The meeting will be held on March 1,2011, at 10 am in the Innovation Conference Room on the 2nd floor. It is very important that you attend this meetingas you have been identified as a critical participant in this project. We need your input and support as we move forward. So please plan to attend the meeting or send a representative. To ensure that we have sufficient materials for themeeting, please RSVP to Mary J., unit secretary on 3 North.I want to thank you in advance for your help with and support of this project. I look forward to seeing you at themeeting. If you have any questions, please feel free to contact me or any of the RRT project team members.Rebecca R. and the RRT Project Teamajn@wolterskluwer.comAJN March 2011 Vol. 111, No. 355
RRT Protocol Draft for ReviewCurrent evidence supports the effectiveness of an RRT in decreasing adverse events in patients who exhibit specific clinical parameters.Evidence-based recommendations include that RRTs should be available on general units of hospitals, 24 hours a day and seven daysa week, staffed by intensive care clinicians, and activated based on established clinical criteria. The RRT serves a dual purpose of providing both early intervention care to at-risk patients and education in recognizing and managing these patients to clin ical staff.The RRT is available to respond to and assist bedside staff in caring for patients who develop signs or symptoms of clinical deterio ration.RRT MembersRRT members are all ACLS certified. They include:Team Leader: Acute Care NP Hospitalist (credentialed in advanced procedures)Team Members: ICU RNRespiratory Therapist (trained in intubation)Physician Intensivist (ICU MD on call and available to the RRT)Hospital ChaplainInitiation of RRT ConsultAn RRT consult can be initiated by any bedside clinician. Consults should be initiated based on the following patient status criteria.RRT Consult Initiation CriteriaPulmonaryVentilation: Color change (pale, dusky, gray, or blue)Respiratory distress: RR 10 or 30 breaths/min, orUnexplained dyspnea, orNew-onset difficulty breathing, orShortness of breathCardiovascularTachycardia: Unexplained 130 beats/min for 15 minsBradycardia: Unexplained 50 beats/min for 15 minsBlood pressure: Unexplained SBP 90 or 200 mmHgChest pain: Complaint of nontraumatic chest painPulse oximetry: 92% SpO2Perfusion: UOP 50 cc/4 hrNeurologicSeizures: Initial, repeated, or prolongedChange in mental status: Sudden decrease in LOC with normal blood sugarUnexplained agitation for 10 minNew- onset limb weakness or smile droopSepsisClinical indicators of sepsis: Temperature 38ºCHR 90 beats/minRR 20 breaths/minWBC 12,000, 4,000Nurse’s concern about overall deterioration in patient’s condition without any of the above criteria.Scope of the RRTThe RRT can be expected to perform any/all of the following interventions:Nasopharyngeal/oropharyngeal suctioningOxygen therapy56AJN March 2011 Vol. 111, No. 3ajnonline.com
Initiation ofInitiation ofIntravenousIntravenousCPRCPAPnebulized medicationsfluid bolus(es)fluid bolus(es) with medicationThe RRT can be expected to perform any/all of the following invasive procedures:Endotracheal intubationIntravenous line insertionIntraosseous line insertionArterial line insertionCentral line insertionRRT Consult Procedure1. Assess patient relative to the above criteria.2. If any of the above criteria are identified, initiate the RRT consult by calling 5-5555. The operator will request the caller’s location,the patient’s name, the patient’s location, and the reason for RRT activation. This call will generate both pages to the RRT membersand an overhead announcement.3. The RRT will arrive within five minutes (or less) of the call.4. Be prepared to provide the RRT with appropriate information about the patient using the SBAR communication method. (See standardized communication protocol no. 7.)5. While awaiting the arrival of the RRT, consider initiating any/all of the following actions: C all for a colleague to help you S et up oxygen apparatus S et up suction apparatus C all for the code cart to be brought to the area C ommunicate with the patient’s family (if present); tell them what you’re doing and why and that someone will be here shortlyto help them O btain proper documentation tools to be used during the RRT consultRRT ArrivalWhen the RRT arrives:1. Provide information as indicated above.2. Participate in the care of your patient and remain with the patient and the RRT.3. Assist the RRT as needed.4. Document activities, interventions performed, and patient responses to interventions.5. Work with the chaplain to ensure that the patient’s family is informed of the situation at intervals.6. Assist in arranging for transfer of the patient to a higher level of care if indicated.7. Provide a detailed report to the nurse accepting the patient on the receiving unit, utilizing the SBAR communication method.ACLS advanced cardiac life support; cc cubic centimeters; CPAP continuous positive airway pressure; CPR cardiopulmonary resusci tation; hr hours; HR heart rate; ICU intensive care unit; LOC level of consciousness; MD medical doctor; min minute; mmHg millimeters of mercury; NP nurse practitioner; RN registered nurse; RR respiratory rate; RRT rapid response team; SBAR situationbackground-assessment-recommendation; SBP systolic blood pressure; SpO2 arterial oxygen saturation; UOP urine output; WBC whiteblood count.REFERENCES1. Choo CL, et al. Rapid response team: a proactive strategy in managing haemodynamically unstable adult patients in the acute care hospitals. Singapore Nursing Journal 2009;36(4);17-22.2. Winters BD, et al. Rapid response systems: a systematic review. Crit Care Med 2007;35(5):1238-43.3. Hillman K, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 2005;365(9477):2091-7.4. Sharek PJ, et al. Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a children’s hospital. JAMA 2007;298(19):2267-74.5. Mailey J, et al. Reducing hospital standardized mortality rate with early interventions. J Trauma Nurs 2006;13(4):178-82.6. Dacey MJ, et al. The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med 2007;35(9):2076-82.7. Benson L, et al. Using an advanced practice nursing model for a rapid response team. Jt Comm J Qual Patient Saf 2008;34(12):743-7.8. Hatler C, et al. Implementing a rapid response team to decrease emergencies. Medsurg Nurs 2009;18(2):84-90, 126.9. Bader MK, et al. Rescue me: saving the vulnerable non-ICU patient population. Jt Comm J Qual Patient Saf 2009;35(4):199-205.10. DeVita MA, et al. Use of medical emergency team responses to reduce cardiopulmonary arrests. Qual Saf Health Care 2004;13(4):251-4.ajn@wolterskluwer.comAJN March 2011 Vol. 111, No. 357
Table 1. Plan for Measuring RRT Success (Draft for Discussion)OutcomeMeasurementSource/OwnerCRO Codes outside of the ICU EMRMortality rates:HMR and NIM Hospital mortality rates by unit Discuss at meetingUICUA ICU admissions planned unplanned E MR; ICU admissions database; checkbox needed to indicate planned andunplanned RRT personnel cost/hour B illing data RRT response time and end time as re corded on the RRT data documentation tool U ICUA cost/day LOS for average UICUA Number of UICUA prevented B illing data Disposition of RRT call as recorded on theRRT data documentation toolReturn on RRT investment(cost of RRT compared with savingsdue to RRT)1. C ost of RRT Personnel Supplies2. S avings due to RRT Cost of UICUA Number of UICUA preventedCRO code rates outside the ICU; EMR electronic medical record; HMR hospital-wide mortality rates; ICU intensive care unit;LOS length of stay; NIM non-ICU mortality; RRT rapid response team; UICUA unplanned ICU admissions.and Chen that he’s confident they’lldo a great job and shares his ex cite ment at how the team has pro gressed in planning an EBP practicechange.RRT protocol. Chen starts todraft the RRT protocol using oneof the hospital’s protocols as atem plate for the format, as wellas definitions and examples ofprotocols, policies, and procedures from other organizationsand the literature. She returns tothe articles from the team’s original literature search (see “CriticalAppraisal of the Evidence: Part I,”July 2010) to see if there is information, previously appraised, thatwill be helpful in this current stepin the process. She recalls that theteam had set aside some articlesbe cause they didn’t directly an swer the PICOT question aboutwhether to implement an RRT,but they did have valuable information on how to implement anRRT. In reviewing these articles,Chen selects one that’s a reviewof the literature, though not a sys tematic review, that includes58AJN March 2011 Vol. 111, No. 3many examples of RRT membership rosters and protocols usedin other hospitals, and whichwill be help ful in drafting herRRT protocol document.1 Chenincludes this ex pert opinion ar ticle be cause the informa tion itcontains is consistent with thehigher-level evidence alreadybeing used in the project. Usingboth higher and lower levels ofevidence, when appropriate, al lows the team to use the best infor mation available in formulatingtheir RRT protocol.As she writes, Chen discoversthat their hospital’s protocols andother practice documents don’t in clude a section on supporting evidence. Knowing that evidence iscritically important to the RRTpro tocol, she discusses this with theclinical practice council representative from her unit who advisesher to add the section to her draftdocument. He promises to presentthis issue at the next coun cil meet ing and obtain the council’s ap proval to add an evidence sectionto all future practice documents.Chen reviews the finished productbefore she submits it for the team’sreview (see RRT Protocol Draftfor Review1-10).Outcomes measurement plan.Based on the appraised evidenceand the many discussions Rebe cca and Chen have had about it,Chen drafts a document that liststhe outcomes the team will measure to demonstrate the success oftheir project, where they’ll ob tainthis information, and who willgather it (see Table 1). In draf tingthis plan, Chen realizes that theydon’t have all the informationthey need, and she’s concernedthat they’re not ready to movefor ward with the stakeholderkick- off meeting. But when Chencalls Carlos and shares her concern, Car los reminds her that thedocument is a draft and that there quired information will be ad dressed at the meeting.Education plan. Rebeccareaches out to Susan B., the clin icaleducator on her unit, and requestsher help in drafting the educationplan. Susan tells Rebe cca how muchajnonline.com
she enjoys the op portunity to workcollaboratively with staff nurses oneducation pro jects and how happyshe is to see an EBP project beingimplemented. Rebecca shares herRRT project folder (containing allthe informa tion relative to the pro ject) with Susan, focusing on theeducation about the project shethinks the staff will need. Susancommends the team for its efforts,as a good deal of the necessarywork is al ready done. She asksRebecca to clarify both the ultimate goal of the project and what’smost im por tant to the team aboutits rollout on the unit. Rebeccathoughtfully responds that the ultimate goal is to ensure that patients re ceive the best care possible. What’s most im portant aboutits rollout is that the staff sees thevalue of an RRT to the patientsand its positive impact on theirown workload. She adds that it’sim portant to her that the projectbe conducted in a way that feelspos itive to the staff as they workto ward sustain able changes intheir practices.Susan and Rebecca discusswhich clinicians will need edu cation on the RRT. They plan touse a variety of mechanisms, in clud ing in-services, e-mails, newsletters, and flyers. From theirconversation, Susan agrees todraft an education plan using atemplate she developed for thispurpose. The template promptsher to put in key elements forplanning an education program:learner objectives, key content,methodology, faculty, materials,time frame, and room location.Susan fills the template with information Rebecca has given her,adding information she knowsalready from her expe rience asan educator. When Rebecca andSusan meet to re view the plan,Rebecca is amazed to see howtheir earlier conversation hasbeen transformed into a com prehensive document (see the Education Plan for RRT Imple mentation at http://links.lww.com/AJN/A19).Agenda and timeline. Theteam meets to draft the meetingagenda, implementation timeline,and budget. Carlos explains thepurposes of a meeting agenda: toserve as a guide for the participantsand to promote productivity andefficiency. They draft an agendathat includes the key issues to beshared with the stakeholders aswell as time for questions, feedback, and discussion (see theRapid Response Team Kick-offMeeting Agenda at http://links.lww.com/AJN/A20).Carlos describes how the timeline creates a structure to guideTable 3. RRT Project Budget Draft (Draft for Discussion)Annual CostsItemProjected Cost/UnitNo. UnitsNeededCost/YearCost CenterApprovalNeededNotes:RRT pagers 30/month8/month 2,880AdministrationVP NursingData collectionRRT leader, 45/hour1 hour/month 540HospitalistVP MedicalAffairsData entryAdministrativeassistant, 15/hour1 hour/month 180Nursing isData manager, 21/hour1 hour/month 252QualityQuality managerAdvanced practicenurse, 45/hour6 hours 2703 North Nursing3 North Nursemanager2 Project leaders, 30/hour6 hours each 360Nurse manager, 40/hour2 hours 80Unit educatorswill schedule theirtime to providethe in-services.No additionalcost.80 Staff members, 30/hour (averagerate)1/2 hour This is the cost forthe pilot unit only.First Year Start-Up er.comTotal 710 1,200AJN March 2011 Vol. 111, No. 359
the project (see Table 2 at http://links.lww.com/AJN/A21). Theteam further discusses how it canmaintain the project’s momen tum by keeping it moving forward while at the same time accommodate unexpected delaysor resistance. There are a fewitems on the timeline that Carlosthinks may be underestimated―for example, the team may needmore than a month to meet withother departments because of already heavily scheduled calendars― but he decides to let it stand asdrafted, knowing that it’s a guideand can be adjusted as the needarises.be presenting. The clerical personon Rebecca and Chen’s floor (some times called the unit secretary)has kept a record of who’s attend ing the meeting and the team ispleased that most of the stakeholders are coming. Carlos informs the team that he receivednotification that their internal review board submission has beenapproved. They’re excited to checkthat step off on their EBP Implementation Plan.Carlos suggests that they discuss the kick-off meeting in detailand brainstorm how to preparefor any negative responses to theirproject that might occur. RebeccaWith the RRT protocol, staff will be intervening earlier to improvepatients’ outcomes.Budget. Carlos discusses thebudget with the team. Rebeccashares a list of what she thinksthey’ll need for the project and theteam decides to put this information into a table format so they canmore easily identify any missinginformation. Before they constructthe table, they walk through animaginary RRT call to be surethey’ve thought of all the budgetimplications of the project. Theyrealize they didn’t include the costof each employee attending aneducation session, so they addthat figure to the budget. Theyalso realize that they’re missinghourly pay rates for the differenttypes of employees involved. Carlos tells Rebecca that he’ll workwith the Human Resources Department to obtain this information before the meeting so theycan complete the budget (seeTable 3).REVIEWING THEIR WORKThe next time they meet, the EBPteam reviews the agenda for themeeting and the documents they’ll60AJN March 2011 Vol. 111, No. 3and Chen remark that they’venever considered that someonemight not like the idea of an RRT.Carlos says he’s not surprised; of ten the passion that builds aroundan EBP project and the hard workput into it precludes taking timeto think about “why not.” Theteam talks about the importanceof stopping occasionally duringany project to assess the environment and par ticipants, recogniz ing that people often have differentperspectives and that everyonemay not support a change. Carlosreminds the team that peoplemay simply resist changing theroutine, and that this can lead tothe sabotage of a new idea. Asthey explore this possible resistance, Rebecca shares her concernthat with everyone in the hospitalso busy, adding something newmay be too stressful for some people. Carlos tells Rebecca and Chenthat helping project participantsrealize they’ll be doing the samething they’ve been doing, just in amore efficient and effective way, isgenerally successful in helping themaccept a new process. He remindsthem that many of the people onthe RRT are the same people whocurrently take care of patients ifthey code or are admitted to theICU; however, with the RRT protocol, they’ll be intervening earlier to improve patients’ outcomes.The team feels confident that, ifneeded, they can use this approachat the kick-off meeting.CONDUCTING THE KICK-OFF MEETINGRebecca and Chen are both nervous and excited about the meeting. Carlos has made sure they’rewell prepared by helping them setup the meeting room, computer,PowerPoint presentation, andhandout packets containing theagenda and draft documents. Theteam is ready, and they’ve placedthemselves at the head of the ta ble so they can be visible and accessible. As the invitees arrive,they welcome each one individually, thanking them for participating in this important meeting.The team makes sure that themeeting is guided by the agendaand moves along through thepresentation of information tothoughtful questions and a livelydiscussion.Join the EBP team next time asthey launch the RRT project andtackle the real-world issues ofproject implementation. tLynn Gallagher-Ford is assistant direc tor of the Center for the Advancementof Evidence-Based Practice at ArizonaState University in Phoenix, where EllenFineout-Overholt is clinical pro fessor anddirector, Susan B. Stillwell is associate di rector, and Bernadette Mazurek Melnykis dean and distinguished foundation pro fessor of nursing at the College of Nursingand Health Innovation. Contact author:Lynn Gallagher-Ford, lynn.gallagher-ford@asu.edu.REFERENCE1. Choo CL, et al. Rapid response team:a proactive strategy in man aging haemodynamically unstable adultpatients in the acute care hospitals.Singapore Nursing Journal 2009;36(4);17-22.ajnonline.com
nurse, Carlos A., her hospital’s expert EBP mentor, and Chen M., Rebecca’s nurse colleague, began to develop their plan for implementing a rapid response team (RRT) at their institution. They clearly identified the pur-pose of their RRT project, the key stakeholders, and the vari-ous
about evidence-based practice [2] Doing evidence-based practice means doing what the research evidence tells you works. No. Research evidence is just one of four sources of evidence. Evidence-based practice is about practice not research. Evidence doesn't speak for itself or do anything. New exciting single 'breakthrough' studies
evidence -based approach to practice and learning; so, since 2005, the concept of evidence- based medicine was became wider in 2005 to “evidence -based practice” in order to concentrate on more sharing evidence -based practitioners attitude towards evidence -based practice paradigm .
point out that being evidence-based does not mean "evidence-enchained" or evidence-restricted.7 Evidence Based Practice is an important activity for medical practice, not just a definition. True evidence based practice involves more than just using research literature to determine or support a diagnosis or therapy.
7 CONTENTS Chapter 1 General introduction 9 Chapter 2 Towards an interactive approach to evidence-based 23 practice in social work in the Netherlands. Chapter 3 Social workers' orientation toward the evidence-based 39 practice process: a Dutch survey. Chapter 4 Exploring MSW students' and social workers' orientation 63 toward the evidence-based practice process.
Freshwater, Dawn, and Gary Rolfe. Deconstructing Evidence-Based Practice. Taylor and Francis, 2012. Lipman, Toby. "Evidence-based Practice in General Practice and Primary Care." Evidence-based Practice, 9 Mar. 2014, pp. 35-65. Mateo, Magdalena A, and Marquis D. Foreman. Research for Advanced Practice Nurses: From Evidence to Practice.
Types of Evidence 3 Classification of Evidence *Evidence is something that tends to establish or disprove a fact* Two types: Testimonial evidence is a statement made under oath; also known as direct evidence or prima facie evidence. Physical evidence is any object or material that is relevant in a crime; also known as indirect evidence.
Evidence-Based Practice – You may wish to limit your articles to only those which are evidence-based. When searching an EBSCOhost database for example, the Evidence-Based Practice limiter searches the Special Interest field for the value “Evidence-Based Practice.” Applying this limiter allows you to limit results to:
seeks to promote the adoption of evidence-based practices rather than actually engaging in and evaluate the use· of evidence-based practice (Mullen, Schlonsky, Bledsoe, & Bellamy, 2005). As a result, there are very few evaluations that examine the elements needed to successfully incorporate evidence-based practice into agency operations.
