Page 197 - Encyclopedia of Nursing Research

164 n EViDENCE-BASED PRACTiCE

changing health behaviors; they also are used attention to these aspects of the evaluation
to select measures for determining impact. process, evaluations become an effective
E Evaluation theories, on the other hand, focus means for extending nursing science.
on the purpose of the study—whether it is for
determining what goals or outcomes should Gail L. Ingersoll
be examined, how the treatment should be
developed and delivered, or under what
conditions certain events occur and what
their consequences will be. Measuring the EviDEncE-basED practicE
true effect of the intervention often is dif-
ficult. Evaluation studies are subject to the
same measurement and analysis problems Evidence-based practice (EBP) is the consci-
associated with other designs. in addition, entious use of current best evidence in mak-
ingersoll (1996) has summarized several oth- ing decisions about patient care (Sackett,
ers that are important to evaluation research. Straus, Richardson, Rosenberg, & Haynes,
Among these is the need to measure the 2000). it is a problem-solving approach to
extent of the intervention introduced, which the delivery of health care that integrates the
is frequently absent from reports of evalua- best evidence from research with a clinician’s
tion studies. This information assists in dem- expertise and a patient’s preferences and
onstrating cause-and-effect relationships values (Melnyk & Fineout-Overholt, 2011).
and clarifies what magnitude of the inter- When delivered in a context of caring and
vention is required before an effect is seen. in an organizational culture that supports
it also helps to prevent the potential for Type EBP, the best patient outcomes are achieved.
iii, iV, and V evaluation errors, which affect Although it is well recognized that EBP
statistical conclusion validity and generaliz- improves the quality and safety of health
ability validity. care as well as decreases hospital costs and
Type iii evaluation error is an error in patient morbidities, evidence-based care is
probability and results in solving the wrong not consistently implemented by point of care
problem instead of the right problem. it usu- clinicians and health care systems across the
ally occurs when the program is not imple- United States (McGinty & Anderson, 2008;
mented as planned and when insensitive Pravikoff, Tanner, & Pierce, 2005; Williams,
measures are used to determine effect. Type 2004). Unfortunately, it typically takes well
iV error occurs when the evaluator provides over a decade to translate findings from
information that is useless to stakeholders. research into clinical practice to improve
Type V error involves confusing statisti- care and patient outcomes. Recognition of
cal significance with practical significance, the long research-practice time lag resulted
which ultimately leads to Type iV error. in the institute of Medicine setting a goal
Evaluation is the key to measuring inter- that by the year 2020, 90% of clinical deci-
vention magnitude and effect. To assure that sions will be supported by the best available
evaluations are useful, however, steps must evidence (McClellan, McGinnis, Nabel, &
be taken to design them according to some Olsen, 2007).
meaningful conceptual framework, and For clinicians to use evidence to make
close attention must be paid to maximizing daily decisions about patient care, there
the rigor of the methods, analysis, and rejec- must be an understanding of the two types
tion of alternative hypotheses. Approaches of evidence in EBP: (1) external evidence
to quality control recommended for other that is generated through rigorous research
nonexperimental, quasi-experimental, and and (2) internal evidence that is generated
experimental designs are appropriate. With through quality improvement, outcomes