Steps of writing an evidence-based practice
Research has shown that evidence-based practice leads to high-quality care and has improved patient outcomes while reducing treatment costs. Moreover, it has led to greater nurse satisfaction than the traditional approaches to nursing care.
With research being at the peak of the medical and healthcare field, it has become more important to promote new ideas that come up with innovations and changing technology to enhance the present clinical research.
For this reason, evidence-based nursing practice is aimed at improving clinical care delivery services, enhance patient outcomes, help other healthcare agencies, and improve health care delivery through published interventions.
Evidence-based practice papers are written to prove or modify a particular hypothesis. EBP is important as it helps keep up with current trends, evaluate the projected outcome, save cost, and get rid of outdated approaches in the clinical practice. EBP features various sections that are ideally written in a format the same as that of essays.
What is Evidence-based Practice (EBP)?
EBP is the approach by which clinicians across the healthcare profession review and assess the most current, highest-quality research to inform clinical decisions in the delivery of patient care. Even though there is no accurate standard for what the EBP process constitutes, the approach consists of three main components. So, if you are a clinician and what to clinical decisions according to EBP, utilize these three EBP components:
- Best External Evidence
Appraise and implement the most current, clinically relevant, and scientifically proven research. Research for EBP can be gotten from the following four categories:
- Randomized controlled trials
- Evidence from the cohort, case-control, or observational studies
- Expert opinions that are supported by experience, studies, or reports
- Personal experience
You can gather useful information from any of these kinds of research. However, strive to make clinical decisions based on the most reliable scientific evidence available.
- Individual Clinical Expertise
You can draw EBP on your personal experience of what has worked and not worked in your medical practice.
- Patient Values and Expectations
You can also consider and value the preferences of your individual patients
What is Evidence-Based Medicine?
Evidence-based medicine involves three main components that include; research-based evidence, clinical expertise and patient’s values and preferences. The practice of evidence-based medicine is crucial in today’s healthcare settings because it offers clinicians a way of attaining improved quality, improved patient satisfaction, and reduced costs.
To understand how evidence-based medicine works, consider the prostate cancer example. A healthcare provider can assess the strength of the evidence, the risks, and the benefits of ordering a diagnostic test and treatment for each cancer patient. This approach, coupled with the healthcare provider’s clinical experience, enables the clinician to better predict whether a treatment will do more harm than good. Moreover, this approach helps an organization establish a systematic approach to caring for patients with specific conditions.
Evidence-based medicine is not all about using evidence to design treatment plans, it also encourages a dialogue between patients and health care providers. With this, patients can freely share in the decision-making as well as make their values and preferences known.
Together, patients and healthcare providers can come up with appropriate course treatment on a joint decision. The benefit of the evidence-based approach is that clinicians listen to patient concerns and consider them when determining the most appropriate treatment plan.
Ways Evidence-based Medicine Adds Value to Health Care Systems
Evidence-based practice helps health care systems attain the Triple Aim’s Objective of care, health, and cost. As such, the approach is gaining momentum as a viable model of medical care. Here is how evidence-based medicine adds value to healthcare and patient outcomes:
- Helps Clinicians and Nurses Stay Current on Standardized, Evidence-based Strategies
An explosion of scientific knowledge being published in various journals, making it difficult for clinicians to stay up to date on medical, and healthcare best practices. Moreover, for primary care physician to stay current, they need to read available evidence-based articles regularly. With this, clinicians and other healthcare providers can stay up to date on the best practices
- Improves Transparency, Accountability, and Value
Patients, employers and payers are all driving the need for health care systems to show transparency, value, and accountability. For example, high-quality and safe care at the most affordable cost. Therefore, practising evidence-based healthcare can help the healthcare system attain these goals. Evidence-Based Practice Manual: Research and Outcome Measures in Health and Human Services argues that “evidence-based healthcare expresses commitment to improving the transparency of reasoning behind policies and enhance accountability by justifying decisions on the grounds of valid information that can stand up to scrutiny, gauge uncertainty by making explicit the strength of the evidence supporting policy, and make policy decisions driven by the best outcomes for the healthcare dollar.”
- Uses Near Real-time Data to Make Care Decisions
Healthcare providers have better access to data and more knowledge courtesy of improved technology in electronic medical records, built-in protocols, decision support systems, sophisticated analytics, and data warehouse. With this readily available and improved access to healthcare data, clinicians and nurses can use evidence-based medicine to provide quality patient care on near real-time data. As expressed in Evidence-Based Decision Making: Global Evidence, Local Decisions, these developments significantly reduce the time necessary to fill gaps in the evidence base and cut the doubt in the decision-making process.
- Improves Quality of Care
According to available evidence, U.S spends more money per person on health care compared to any other nation across the world. However, there is also broad evidence that Americans often don’t receive the care they need. But with evidence-based practice, care is improved since clinicians have unlimited access to previously unexploited data and best practices evaluated and agreed upon by peers.
- Improves Outcomes
One of the most significant reasons for the focus on evidence-based medicine is that it works. Available evidence shows that if healthcare organizations attentively use the best clinical evidence and expertise, and make sure treatments are consistent with patient values, they will attain better outcomes in all ways. In 15 case studies published in the Evidence Based Medicine Matters journal, the use of evidence-based medicine resulted in patients’ recovery improvements ranging from faster recovery times, especially after surgical procedures to safer ways to deliver breech babies.
Benefits of Evidence-Based Practice in Nursing
The inclusion of EBP in nursing practice provides nurses with the scientific research to implement well-founded clinical decisions. Through EBP, nurses are can stay updated about the current medical protocols for patient diagnosis. By implementing documented interventions that fit a patient profile, nurses can enhance proper diagnoses of patients and implementation of proper interventions for a speedy recovery.
Evidence-based allows nurses to evaluate research for them to understand the risks or effectiveness of a diagnostic test or treatment. The application of EBP enables nurses to involve patients in their care plan thus making patients take a proactive role in their healthcare. This is because they can voice their concerns, share values and preference while making suggestions on how they want their treatment proceeded.
EBP also benefits healthcare organizations in that it decreases the demand for healthcare resources with better patient outcomes owing to the application of evidence-based practice. For instance, outdated medical practices may require supplies, resources, equipment or products that are no longer necessary for particular procedures or techniques inpatient treatment and care.
How to Write Evidence-Based Practice (EBP): The 7 Steps of Evidence-Based Practice
Several articles have been written on how to write evidence-based practice for various medical practitioners. All of these articles define EBP as a problem-solving method to the delivery of health care that incorporates the best evidence-based from well-formulated research and patient care data and combines it with patient values and preferences and clinical expertise.
Even though there are 7 steps of evidence-based practice, these steps are numbers 0 to 6. In this article section, we review the 7 steps of evidence-based practice writing. So, let’s get into it!
Step Zero: Cultivate a Spirit of Inquiry
If you are looking forward to crafting evidence-based practice, then you would probably be asking yourself questions like, “what lay the foundation for evidence-based practice?” When a cultivated spirit of inquiry about the best evidence to guide clinical decision making and a tradition that supports it is lacking, clinicians are unlikely to embrace EBP.
Nurses who work across the care continuum undertake several interventions that should ignite questions about the evidence supporting their use. When nurses or clinicians possess a spirit of inquiry within a supportive evidence-based practice culture, they can frequently ask questions about clinical practice when delivering care. For instance, in patients with a head injury, how does elevate the head of the bed compared with keeping a patient in a supine position affect intracranial pressure? In a nutshell, without the spirit of inquiry, the next steps in the EBP process are unlikely to occur.
Step 1: Ask Clinical Questions in PICOT Format
The clinical question is in this format take into consideration the patient population of interest (P), intervention or area of interest (I), comparison intervention or group (C), outcome (O), and time (T). This format provides an efficient framework for searching the electronic database, this way you can retrieve relevant articles that are only relevant to the clinical question.
For instance, using a rapid response team scenario, the way to frame a clinical question would be: “In acute care hospitals (patient population), how does having a rapid response team (intervention) compared with not having a response team (comparison) affect the number of cardiac arrests (outcome) during a three-month period (time)?”
Step 2: Search for the Best Evidence
Search for best evidence for informed nursing practice is greatly streamlined, especially when questions are asked in PICOT format. If the clinician in the rapid response team scenario, simply types “what is the impact of having a response team?” into the search field of the database, you will find hundreds of abstracts, most of which are irrelevant.
However, by using the PICOT format, you will find keywords or phrases that when you successively enter and combine them, you can expedite the location of relevant articles in massive search online databases like CINAHL or MEDLINE.
Let’s take the PICOT question on rapid response teams, for instance, the first key phrase to enter into the online database would be acute care hospitals. This phrase is common and will likely yield numerous abstracts and citations. The second phrase you can search would be rapid response team, followed by cardiac arrests and finally the remaining terms in the PICOT question.
The last step of the search would be combining the outcome of the searches for each of the terms. With this approach, you can narrow down the results to relevant articles important to the clinical question while eliminating irrelevant articles.
Levels of Evidence
Being knowledgeable about evidence-based practice and levels of evidence is significant to every nurse since they need to be assertive about how much emphasis they should put on a report, study, nursing practice guideline or practice alert when making decisions about a patient’s care.
Evidence-based information comes from Level A – the strongest level of evidence to Level C – the weakest level of evidence. Additionally, there is Level ML, a multilevel that identifies clinical guidelines that contain recommendations based on more than one level of evidence.
Level A Evidence
The Level A evidence is gotten from:
- Randomized control trails: The classic gold standard designed and RCTs, subjects are randomly chosen and assigned to groups for rigorous controlled experimental conditions or interventions.
- Systematic review or meta-analysis of all relevant RCTs. The systematic review comes in handy when assessing existing evidence that addresses a specific clinical question. This includes comprehensive literature search, appraising the quality of studies and reports outcomes systematically. On the other hand, Meta-analysis is a study design that utilizes statistical techniques to merge and analyze data from different RCTs.
- Clinical practices guidelines: This is based on systematic reviews of RCTs. For evidence-based, clinical practice guidelines offer the strongest level of evidence to guide clinical practice since they are based on rigorous reviews of the best available evidence on particular topics.
Level B Evidence
The Level B evidence is obtained from:
- Well-designed control trials without randomization: In this study, random assignment is not used to assign subjects to experimental and control groups. As such, the research is less strong in internal validity, since it cannot be assumed the subjects in the study are equal on main demographic and clinical variables at the start of the trial. However, there are frequent problems with this study and they include intentional or unintentional bias in sample enrollment, non-blinding, unclear criteria for participant choosing, or variable or invalid tools.
- Clinical cohort study: This is an examination of groups of people who have common characteristics or exposure experiences to compare outcomes in exposed vs. outcomes in non-exposed.
- Case-controlled study: This is the use of an observational approach in which subjects know to have an illness or outcome are compared with subjects known not to have that illness or outcome. Subjects are matched on characteristics so that they are as same as possible except for the disease or outcome. The case-control studies are generally designed to estimate the odds with the help of an odds ratio of developing the studied condition or disease and can determine whether an associated relationship exists between the disease or condition and risk factors.
- Epidemiological study: These studies aim at observing people over a long time to determine the risk or likelihood of developing diseases. These studies include prospective studies or retrospective online database searches that follow a population over time.
- Uncontrolled study: These are studies that do not control participant selection or interventions.
- Qualitative Study/quantitative study: Qualitative study is descriptive, word-based phenomena such as behaviours, symptoms, culture and group dynamics. Quantitative studies, on the other hand, is the use of statistical approaches to establish numerical relationships that are correlational or cause and effect.
Level C Evidence
The Level C evidence is gotten from:
- Consensus viewpoint and expert opinion: This is a study that obtains agreement about particular practices from all clinical professionals on a review panel. Professional opinion entails obtaining agreement from a majority of clinical experts on a review panel. Keep in mind that this level of evidence is used when there are no qualitative or quantitative studies in a specific area.
- Meta-synthesis: This is a systematic review that synthesizes findings from qualitative studies through an interpretive technique to bring small study findings like case studies to clinical application.
Step 3: Critically Appraise the Evidence
After choosing the articles for review, critically appraise the evidence to find the most relevant, valid, reliable, and applicable clinical question. The primary reason why most nurses find it difficult to set ample time to implement EBP is that many of them have been taught a laborious critiquing process, which may include the use of several clinical questions designed to reveal every element of a study. The rapid critical appraisal utilizes three significant questions to evaluate the research’s worth. These critical appraisal questions include:
- Are the outcomes of the research valid?
This question of research validity is based on whether the research approaches are demanding enough to render the outcomes as close to the truth as possible. For example, did the researchers randomly assign subjects to treatment or control groups and made sure they shared key characteristics before treatment? Were the instruments used to measure the key outcomes valid and reliable?
- What are the results and are they significant?
For intervention researches, this question research suitability addresses whether the intervention worked, the impact it had on outcomes and the likelihood of obtaining similar results in the clinicians’ individual practice settings. However, qualitative researches include assessing whether the research method is appropriate for the study, along with evaluating other various components of the research such as whether the outcomes can be established.
- Will the outcomes help me in caring for my patients?
This question of research applicability covers the clinical considerations lie whether subjects in the research are the same as one’s own patients, whether the benefits balance off the risks, viability and cost-effectiveness, and patient ethics and preferences.
Once you appraise each research study, the following step is to synthesize the studies to determine if they come to the same conclusions, hence supporting an evidence-based practice (EBP) decision or change.
Step 4: Incorporating the Evidence with Clinical Expertise and Patient Preferences and Values
Research evidence alone is not enough to justify a change in practice. Clinical expertise, founded on patient assessments, laboratory examination data, and information from outcomes management programs, coupled with patients’ values and preferences are crucial components of evidence-based practice.
Since there is no charming formula for how to weigh each of the EBP components, the implementation of EBP is significantly influenced by organizational and clinical variables. For example, if there is a strong body of evidence pointing to reduced incidents of depression in burn patients if they get eight sessions of cognitive-behavioral therapy before hospital discharge. You will religiously want your patients to receive this therapy and so do they.
However, the financial constraints at your health facility hinder the hiring of a therapist to provide this kind of treatment. Therefore, this resource deficit prevents the implementation of EBP.
Step 5: Evaluate the Outcomes of the Practice Decisions or Change Based on Evidence
After implementation of the evidence-based practice, it is necessary to monitor and evaluate any changes in the outcomes for ease of supporting positive effects as well as remedying the negative ones. However, because an intervention was effective in a rigorously controlled trial, it doesn’t mean that it will work the same way in the clinical setup.
Therefore, monitoring the effect of evidence-based practice change on health care quality and outcomes can assist clinicians to unravel flaws in implementation as well as identify more accurately which patients are more likely to profit. If the outcomes differ from those reported in the research literature, careful monitoring can help find why.
Step 6: Disseminate Evidence-based practice (EBP) Outcomes
Clinicians can attain exceptional outcomes for their patients through evidence-based practice. However, they usually fail to share their experiences with colleagues as well as their own or other health care organizations. This leads to needless duplication of effort and perpetuates clinical approaches that are not evidence-based.
Among ways to disseminate successful initiatives are evidence-based practice rounds in your healthcare institutions, presentation at local, regional, ad national conferences and reports in peer-reviewed journals, professional newsletters, and publications for broad audiences.
When the healthcare system adopts EBP as the standard for clinical decision making, these steps of writing evidence-based practice reviewed in this post will naturally fall into place.
Guidelines of Writing Evidence-Based Practice Paper
An evidence-based practice contains a few sections and is essentially written with the same formatting as essays. However, they have a few twists that we will take you through. Check the EBP writing process:
Without a doubt, you will need a title for your evidence-based practice. The title will primarily guide you on what you will be writing. Besides, it creates the basis for your premise. Your evidence-based practice title should be brief and clearly points out what your EBP will be on. The title can take a few forms; it can be in form of a question, a simple statement or an opposing fact.
With this, you will have set a clear direction right from the start and you will have provided your reader something to expect at the end of the paper. Simply think of the title to your EBP as a trendsetter.
Develop your Thesis
The thesis is essentially the controlling statement that you are standing with. With this in mind, the thesis is quite different from a hypothesis: A hypothesis is an idea that can either be proved or put claims against it. But a thesis is mainly what you stand for and it gives the agenda that you will be pushing all through. For this reason, any evidence-based practice without a thesis is considered an incomplete paper as it leaves the reader with a lot of imagination and guesswork.
The format of your evidence-based practice is essentially the eye-catcher and it snatches the attention of the reader. For that reason, it is always advisable to maintain a particular level of professionalism as you write your paper.
APA formatting style is the best-recommended formatting for the nursing EBP process and once you master this style, you will find that all you need to handle is the content and the rest will set in. APA is the most preferred type of formatting for social science as it gives a continuous flow. For the EBP process, you can divide your paper into the following four main sections:
The title provides a clue to what the paper is all about while giving the readers the direction to take and what facts use when evaluating the paper.
This section offers the basis of your thesis statement and you will make all the explaining in not more than 250 words and not less than 250 words. In the abstract, you let your reader know what you really are talking about in the paper.
- Main body
This is the heart of your evidence-based practice paper since it will contain all the facts and arguments. This is where you will argue all your ideas and arguments altogether to prove your practice.
Your evidence-based practice paper must have a reference section. The reference page is where you list all the in-text citations for your work. We’ll expound on this in a few.
The quality of your evidence-based practice will be determined by the kind of research you will conduct. You must research the most recent peer-reviewed sources and materials and should you quote information, make sure to indicate from where you quoted it from. You can follow this simple EBP process that goes as follows: the title gives birth to your thesis, the thesis brings about research, research generates evidence and evidence ultimately gives the evidence-based practice you are writing.
However, do not limit your research to several contexts that you can do your research. Consider covering a broad scope to get more credibility. As you write your evidence-based practice paper, make sure to get your facts right. Keep in mind that the quality of your paper is directly proportional to the quality of your research.
As we mentioned above, references help take the guesswork out of your EBP paper. References are the surest confirmation of research and they get even better when you connect them up together. When you get an inter-relation between your references, it strengthens your EBP process even more.
Although you are looking to prove your hypothesis, you can create an original piece from other authors works. You can do this by creatively borrowing their ideas while ensuring you give them the credit they deserve. With this, you would have put your best foot forward as far as evidence-based practice paper is concerned
Describe your Methods
Describing your methods is another important thing to always keep in mind. With this, you must be very careful as your credibility is critical. Therefore, make sure to ascertain that all measurements, interviews, surveys, figures, and observations are taken with accuracy and are transferred and appropriately. By doing so, you will firmly be anchored as far as evidence-based practice is concerned.
So, get the right research material, formatting, and ensure accuracy in all that you write and your EBP process will be perfect. If you are a nursing student looking to write the best evidence-based nursing practice paper and need online EBP writing service. We can offer you the best EBP writing services!