Evidence-Based Clinical Practice In And Health Care
Evidence-BasedClinical Practice inNursing and Health CareAssimilating research, experienceand expertiseAlan PearsonJohn FieldZoe JordanflJBlackwellPublishing
20D7 by AhmP 1rson,John Field ilnd Zoe JordanBlackwell Publishing editorial offices:BLKkwcll Publishing Ltd, 9600 Carsington Road, Oxford OX4 2DQ, UKTel: -i-4J (0)1863 776863Blackwell Publishing Inc., 350 ?vlain Street, Malden, MlI. 02148-5020, U5ATel: 1 781 38!l 8250Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, AustraliaTel: 61 (0)3 835lJ 1011The right of the Author to be identified as the Author of this Work has b('en asserted inaccordance with the Copyright, Designs and Patt'llts Act 19fiK.All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, ortransmitted, ill an ' form or by any means, electronic, mechanical, photocopying, recording orotherwise, except as permitted by the UK Copyright, Desi b'11s and l'atenb Act 1988, without theprior permission of the publisher.First published 2007 by Blackwell Publbhing Ltd15B;-';-10; HOSk'i7-!0-2rSBN 13: 978-1-4051-5740-7Library of Congrt'ss Cataloging-in-Publication DdtdPearson, ivan, SR!\!.Evidence-based clinical practice ill nur ing and healthcare : assim.ilating research, experience, ,mdexpertise / Alan Pe8rson, Jolm Field, Zoe Jordan.p. ;("m.Includes bibliographical referl'l1ces md index.ISBN-U: 971\-H051-5740-7 (pbk. : alk. paper)rSBN-1O: 1-4051-5740-2 (pbk. : alk. paper)1. Evidence-based nursing. 2. Evidence-based medicine. l. rteld, John, Rl'N. IT. Jordan, Zoe.HI. Title. [DNLM: 1. JOillUlu Briggs Institute for Evidence Based Nursing and Ivlidwifery.2. Nursing Care methods. 3. Evidence-Based Medicine-methods. 4. Models, Nursing. WY 100P361e 2006]RT42.P412 2006610.73 - de222006013659A catalogue record for this title is available from the Britisl, LibrarySet in HJ/12.5 pt 1'"latinoby SNP Best-set 1),pe;;etter Ltd., Hong KongPrinted and bound i.n Singaporeby COS Printers Fte LtdThe publisher'S policy is to usc permanent paper from mills that oper 1te a sustainable forestrypolicy, and which has been manufactured from pulp processed using acid-free illid clementar 'chlorine-tree practices. Furthermore, the pllblisher ensnres that the text pap"]" illid cover boardused hewe met aCC(;Ttable environmental accreditation standards.For further information onl3] ck\\'ellPublishing, visit our website:www.blackwcllpublishing.colll,JAMES COOKt Iill.tt\ lr"nrol-rH
ContentsPrefaceAbout the authors1 The Evolution of Evidence-Based PracticeIntroductionEv'idence-based health care (EBHC)Evidence-based medicineEvidence-based practice around the worldEvidence-based praclice: beyond medicineA multidisciplinary affairThe roles of consumersCriticisms of the evidence-based approachConclusion2 A Comprehensive Approach to Evidence-Based Health Care:The JBI ModelIntroductionHealth care evidence generationEvidence synthesisEvidence (knmvledge) transferEvidence utilisationConclusion3 What is Evidence for Practice?IntroductionFeasibility, appropriateness, meaningfulness and effectivenessAchieving a balance between evidence of effectiveness and otherevi.dence interests for clinicians and consumersThe nature of evidenceEvidence for health professionalsEvidence for health consumersConclusion4 Health Care Evidence GenerationIntroductionGuiding paradigms in rescClrchThe qualitative/quantitative debateParadigm, methodology and methodThe quantitative research approachThe interpretive research approachThe critical research 234353637384243434445v
viContentsSources forSources forSources forSources forConclusionevidenceevidenceevidenceevidenceof feasibilityof appropriatenessof meaningfulnessof effectiveness5 Evidence Synthesis: The Systematic ReviewIntroductionOverview of the systematic review processThe importance of systematic reviews of evidenceFinding the evidenceStudy selectionConclusion4949505050525354636469706 Evidence Synthesis: Critical Appraisal, Data Extraction and theSynthesis of FindingsIntroductionCritical appraisal of evidenceThe limitations of critical appraisalDa ta extractionData analysis and synthesisPractical tools for systematic reviewsConclusion7 Evidence Transfer: Writing Up a Systematic Review Report andDeveloping Clinical GuidelinesIntroductionThe purpose of the systematic review reportWriting the reportWhat is a clinical guideline?Medicine-specific guidelinesNursing-specific clinical guidelinesAllied-health-specific guidelines'Consensus' versus 'evidence'Strategies for guideline developmentThe quality of the evidenceGrades of recommendationConsumer involvement in guideline developmentGuideline appraisalThe role of guidelines in practicePractical tools for guideline developmentConclusion8 Evidence Utilisation: Implementing Evidence-Based GuidelinesIntroductionBarriers to 5107108112113114115116118119120
ContentsChanging practiceEvidence-based health care and practice changeThe theory behind changeA process for changeTools and strategiesModels for changeKnowledge translationEvaluationConclusion9 Evidence Utilisation: Clinical AuditIntroductionClinical effectivenessClinical auditStrategies to promote successful auditingWriting an audit reportPractical tools for clinical auditClinical audit and researchConclusion10Evidence BasedPractice: Issues and 139148148149151152154In trod uction156Evidence-b ed156]58practice and the role of organisations"Legal and policy implications of evidence-based practiceHealth care takes the lead" " . and others followConsumer participationThe rise and rise of information technologyConclusionReferencesFurther ReadingAppendicesSystematic Review Protocol ExampleCritical Appraisal ToolsData Extraction ToolsIndex162]63]64166168172173173177183187
PrefaceEvidence-based health care (EBHC) is widely promoted internationally and isnow a fundamental component of health planning, health services funding andthe education of undergraduate and postgraduate health professionals in mostcountries. In medicine, nursing and the allied health professions, the CochraneCollaboration approach to EBHC (focusing on evidence of effectiveness throughthe meta-analysis of randomised controlled trials) is well accepted. However, asuseful as it is, this emphasis on evidence of effectiveness is recog11ised as a limitation by an increasing number of cliniciaI1S because it does not adequately takeaccount of the broader interest of health-care professions in the human condition and human experience.Most currerlt texts on EBHC concentrate largely on effectiveness and on the'Cochrane' approach to what constitutes usable evidence. There are, however,emerging alternatives and this book has as its organising framework the JoatmaBriggs Institute Model of Evidence-Based Health Care. This model, developedby the Joa.nna Briggs Institute, recognises tht{three spheres of research, theoryand practice as sources of evidence. OUT aim was to develop a source book forstudents and-practitioners of nursing and the other health professions that linksevidence from diverse sources to the core of professional practice in health care:clinical decision-making and practice improvement.Using the bookThis book takes a practical approach to developing, implementing and evaluating practice based on 'evidence' in its broadest sense. It does this by describingthe complexities of evidence-based practice without over-simplifying the issuesand processes involved. Where necessary for a comprehensive wlderstanding ofthe principles of evidence-based practice, the theoretical underpinnings areexplained and explored. A number of devices are incorporated in the book forthis purpose. For example, scenarios from practice are included to give the readeran opportunity to apply the principks and strategies exanuned in the book. Asan adjunct to this process, a toolbox approach is incorporated in the variouschapters to aid in the identificatiOll of the right tool for the particular task.As well as examining the concept of clinical effectiveness and the CochraneCollaboration approach to the meta-analysis of quantitative research findings,we consider other forms of evidence and describe how they can be used as legitimate sources of evidence for practice. The book also describes the developmentof condensed practice information sheets and clinical guidelines. It gives practical guidance on the implementation of evidence-based practice. Evaluation isalso addressed, utilising the mechanism of the clinical audit.IX
xPrefaceThe book has been written for those who are committed to basing their practice on the best available evidence. It gives practical gUidance to students andpractising health professionals on the processes involved in pursuing a broad,comprehensive approach to the identification, appraisal and implementation ofevidence for clinical practice. Thus, the book will be of assistance to peopleinvolved in the delivery of health care at every level from student health professionals through senior clinicians to those charged with the responsibility formanaging health-care senrices.Chapter 1 describes the development of evidence-based health care internationally and Chapter 2 overviews the JBI Model of Evidence-Based Health Care.Chapters 3 to 9 examine the components and elements of the JBI Model ofEvidence-Based Health Care (What is Evidence for Practice? Chapter 3; EvidenceGeneration, Chapter 4; Evidence Synthesis, Chapters 5 and 6; Evidence Transfer,Chapter 7; and Evidence Utilisation, Chapters 8 and 9). Chapter lO considers thefuture of evidence-based practice.Each chapter includes additional resources for those who wish to explorefurther particular aspects of evidence-based health care.Alan PearsonJohn FieldZoe jQrdan
About the AuthorsProfessor Alan Pearson PilD FReNA FAAG FRCN RNProfessor Alan Pearson has extensive experience in nursing practice, nursingresearch and academic nursing. Professor Pearson has been an active researchersince 1981 and is known internationally for his pioneering work on the establishment and evaluation of nursing beds in Oxford, UK, from 1981-1986 and forhis ongoing work, which emphasises the centrality of practice and evidencebased practice.Professor Pearson was appointed to Australia's first Chair in Nursing atDeakin University in 1986; was F01 ldation Professor of Nursing at the University of New England from 1992-1995; was Foundation Professor of ClinicalNursing at The University of Adelaide from 1995-1999; and was appointed as aChairperson of the Commonwealth Aged Care Complaints Resolution Committee in 1998.He has conducte a large number of competitively funded research projects.As well as his ongOing re'Search in the fields of aged care, nursing history, andbrain death and organ donation, Professor Pearson vas founder of the JoannaBriggs Institute. He is currently Executive Director of the Institute, and Professor of Nursing at The University of Adelaide. Professor Pearson is Editor of theIntematiolwl Journal of Nursing Practice and has authored over 40 books and over120 journal articles. He is active in developing and promoting evidence-basedpractice at the state, national and international levels.John Field DNE (CumbeHS) BLegSt (Macq) GCerlManag (NE) FRCNA FCN RNJohn Field is a nurse and a lawyer who has been involved in mental healthnursing and academic nursing for more than 30 years. With qualifications innursing, law, education and management, John is currently i1 Senior Lecturer atJames Cook UniverSity in Queensland, Australia, where his teaching andresearch are focused on health 1m\' and ethics, evidence-based practice, andnursing education in developing communities. Since being appointed as asenior lecturer at the University of New Enghmd in 1991, he has held suchposts as Head of School, Health Sciences, University of New England; Director,International and Flexible Learning Unit, The University of Adelaide; andDirector, International Programs Unit, School of Nursing and Midwifery, LaTrobe UniverSity. For much of the past decade his professional work has beenfocused on the development and administration of nursing education programmes in sLlch countries as Bangladesh, Bhutan, Hong Kong, Singapore, andSri Lanka.xi
xiiAbout the AuthorsZoe Jordan MA BAZoe Jordan has been actively involved in the field of health research and communication for the last eight years. She has a Master of Arts (CommunkationStudies) for which much of her work was focused on utilisation of the massmedia for the effective and accurate transfer of information. Having worked atthe Joanna Briggs Institute for six years, Zoe has been intrinsically involved inthe systematic review process, both as a reviewer and as a co-ordinator of thepeer review process. She is currently the Manager, Communications andConsumers, at the Joanna Briggs Institute. This service endeavours to providecurrent reliable, evidence-based health information to consumers of health care.Her work at the Institute focuses on contemporary approaches to health communication, specifically with regard to the emerging interrelationship and convergence of communication, media and culture in the context of a global society.
Strategies for guideline development 105 The quality of the evidence 107 Grades of recommendation 108 Consumer involvement in guideline development 112 Guideline appraisal 113 The role of guidelines in practice 114 Practical tools for guideline development 115 Conclusion 116 8 Evidenc
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.
“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical . expertise with the best available external clinical evidence from systematic research.” Sackett et al .
Clinical Practice Guidelines Accumulation of the best practices, current evidence "Provide a current and transparently analyzed review of the relevant research with the aim to guide clinical practice" -2018 PADIS Guidelines "The goal of these clinical practice guidelines is to recommend best practice for managing PAD to improve clinical outcomes in adult
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:
