Page 198 - Encyclopedia of Nursing Research

EViDENCE-BASED PRACTiCE n 165

management, and EBP implementation proj- in the United States, the U.S. Preventive
ects within clinicians’ own practice settings. Services Task Force, an independent panel of
internal evidence is important in evidence- experts in primary care, research, and pre- E
based decision making to demonstrate out- vention systematically reviews the evidence
comes from evidence-based interventions as of effectiveness and develops gold standard
well as when rigorous studies do not exist to recommendations for clinical preventive
guide best practices. Evidence for interven- services that include screening, counsel-
tions is leveled from Level 1 (i.e., systematic ing, and preventive medications (Agency for
reviews of randomized controlled trials), Healthcare Research and Quality, 2008). The
which is the strongest level of evidence to U.S. Preventive Services Task Force produces
guide clinical practice, to Level 7 (i.e., evi- a Guide to Clinical Preventive Services every
dence from expert opinion). The level of the year that includes its updated evidence-
evidence plus the quality of that evidence based recommendations for primary care
as determined from critical appraisal deter- providers.
mines the strength of the evidence, which in EBP, there are 7 steps that include the
provides clinicians the confidence to act following:
upon the evidence and implement best prac-
tices (Melnyk & Fineout-Overholt, 2011). 1. Cultivate a spirit of inquiry
Dr. Archie Cochrane, a British epide- 2. Ask the burning clinical question in PiCOT
miologist, is credited with starting the EBP format
movement when he challenged the public 3. Search for and collect the most relevant
to pay only for health care that had been evidence
supported as efficacious through research 4. Critically appraise the evidence (i.e.,
(Enkin, 1992). in 1972, he criticized the med- rapid critical appraisal, evaluation, and
ical profession for not providing rigorous synthesis)
systematic reviews of evidence so that orga- 5. integrate the best evidence with one’s clin-
nizations and policy makers could make ical expertise and patient preferences and
decisions about health care. He contended values in making a practice decision or
that thousands of low-birth-weight prema- change
ture infants had died needlessly because 6. Evaluate outcomes of the practice decision
the results of several randomized controlled or change based on evidence
trials were not synthesized into a system- 7. Disseminate the outcomes of the EBP
atic review to support the practice of rou- decision or change (Melnyk & Fineout-
tinely providing corticosteroid injections to Overholt, 2011).
high-risk women in preterm labor to halt the
premature birth process. Archie Cochrane Without a spirit of inquiry, clinicians
considered systematic reviews to be the may find it challenging to ask burning clin-
strongest level of evidence to guide practice ical questions about their practices (e.g., in
decisions (Cochrane Collaboration, 2001). intensive care unit patients, how does early
Although he died in 1988, Dr. Cochrane’s ambulation compared with delayed ambu-
influence was responsible for the launching lation affect the number of ventilator days?
of the Cochrane Center in Oxford, England, in orthopedic patients, how does analgesia
in 1992 and the founding of the Cochrane administered by the triage nurse compared
Collaboration (2001) a year later. The pur- with waiting for physician ordered analgesia
pose of the Cochrane Collaboration is to affect pain and length of time in the emer-
provide and routinely update rigorous sys- gency room?). Asking questions in PiCOT
tematic reviews of health care interventions (P = patient population, i = intervention or area
to guide best practices. of interest, C = comparison intervention or group,