Unit Iv: Application in Evidence - Based Nursing Practice

UNIT IV
APPLICATION IN EVIDENCE –
BASED NURSING PRACTICE
EVIDENCE – BASED NURSING
PRACTICE
• Refers to the process of collecting,
processing and implementing research
findings for the improvement of patient’s
outcomes, clinical nursing practice and work
or environment.
PRACTICE
• Helps provide the highest possible quality
care at the most cost -efficient manner
• Enables the nurses to incorporate clinical
expertise and current research to the data
and turn it into a useful basis in the decision
making.
PRACTICE
• Helps provide the highest possible quality
care at the most cost -efficient manner
• Enables the nurses to incorporate clinical
expertise and current research to the data
and turn it into a useful basis in the decision
making process.
APPLICATION IN EVIDENCE – BASED
NURSING PRACTICE
• The use of information technology in evidence-based nursing practice
such as:
• A. Computerized Nursing Care Plan
• B. Clinical Pathways
• C. Clinical Practice Guidelines And
• D. e-journal
• Allows more efficient facilitation in evidence-based nursing practice
A. COMPUTER GENARATED NURSING
CARE PLANS
CARE PLANS
• Essential teaching tool to present the value of
planning patient care.
• reinforced by Joint Commission On Accreditation
For Hospital (JCAH)
CARE PLANS
• Problems in written care plan:
• incomplete
• outdated
• rarely used for determining care
• infrequently relied upon as a means of communicating
problem management from one shift to another
CARE PLANS
• Problems in written care plan:
• viewed burdensome
• time-consuming paperwork preparation
• revision of plan is low in practice setting
CARE PLANS
• Solution to the problem is:
• COMPUTER GENARATED NURSING CARE
PLANS
CARE PLANS
• Promotes the value of planning care
• Address the burden of workload NCPs can consume from
the nurses
• Works by providing template that nurse can work on and
modify based on the individual cases of their clients.
• B. CRITICAL/CLINICAL/CARE
PATHWAYS
B. CRITICAL PATHWAYS
• ALSO KNOWN AS:

• CARE PATHWAYS
• CLINICAL PATHWAYS
• CARE PATHWAYS
• one of the best tools of hospital to standardized quality
of care process
• promotes organized and efficient patient care based on
evidence
• proven that the implementation reduces the variability
in clinical practice and improves outcomes.
• CARE PATHWAYS:
• concept first appeared in1985
• inspired by KAREN ZANDER and
KATHLEEN BOWER at the NEW
ENGLAND MEDICAL CENTER in
BOSTON
• CARE PATHWAYS:
• USUALLY PRESENTED AS GANTT CHART
GANTT CHART
CHRONOLOGY / LOCATION
Day 0/Admission Day 1/Ward Day 2 /Ward
Consults
Test
Assessment
Groups of
Meds
Multidisciplinary
Nutrition
activities
Activity
Patient Information
Expected Outcomes
• Different systematization tools were being used for the

clinical process:
• Oldest are:
• Medical and Nursing protocols
• Then:
• Standartized Care Maps and Clinical Practice Guide
lines
Scope of Clinical Pathways
Clinical Pathways
Medical Protocols Standardized care maps
Nursing protocols Clinical Practice Guidelines
Systimatization tools for Clinical Processes

• CARE PATHWAYS:
• Main goal is based on the improvement of the following
areas:
• Quality in health care
• Coordination/cooperation among health professionals
• Efficiency and patient satisfaction
• CARE PATHWAYS:
• Purpose:
• Enhancement of care processes in the 3 areas:
• Quality
• Safety
• Efficiency
• CARE PATHWAYS:
• Powerful tool for care management process
• Permit to check the compliance of all interventions including
the healthcare plans
• Fix care standard
• Introduce clinical audits as a part of the process
• CARE PATHWAYS:
• Useful to identify improvement areas in the standard care
process for Continuous Quality Improvement culture.
• Development and implementation involves a change in
the organizational culture at any setting.
• CARE PATHWAYS:
• The activities to be done to develop and implement a care
pathway:
A. Preparing multidisciplinary documents
B. Reviewing the process by all the concerned staff
C. Holding care pathway meetings to facilitate the exchange of
opinions about patient care by different professionals
• CARE PATHWAYS:
• The activities to be done to develop and implement a care
pathway:
D. Conducting periodic reviews to monitor some defined indicators
E. Analyzing variances or deviations
F. Preparing common record documents for all the staff
• CARE PATHWAYS:
Barriers in developing and implementing a pathway:
A. The heterogeneity of patients and diagnosis,
B. The common reluctance among organizations and
professionals to change.
NOTE: Hospital managers must consider these barriers since they
may threaten a successful implementation of care pathways.
• How to document variances? (Institutional guidelines may apply and

not strictly confined to the guidelines below)
• 1. Similar to DAR (Data, Action, and Response) format, we utilize
VAO (Variance, Action, and Outcome) to document variances.
• 2. Variance - includes all subjective and objective data observed by
the nurse to be outside of the pathway management of the patient's
case.
• How to document variances? (Institutional guidelines may apply and

not strictly confined to the guidelines below)
• 3. Action - includes all interventions used to address the variance
• 4. Outcome -- includes all patient care outcomes after the
interventions were performed to address the variance.
Important Note:
• Variances are not something to be taken negatively.
• It may increase health care costs due to the management of these
variances that are outside of the clinical pathway, but over time as these
variances become common and established a pattern, then it can be
included in the clinical pathway depending on the institution's approval
and analysis of the situation.
Important Note:
• If sooner or later it becomes part of the clinical pathway,
then the health care costs will be controlled.
• Remember, the clinical pathways are not final. It always
gets revised frequently depending on the institution, as
our healthcare environment is dynamic.
Important Note:
• Collaboration within all members of the
healthcare team is a must to ensure a smooth and
proper implementation of these clinical pathways.
• Sample Document Using Clinical
Pathway( SHOWN IN WORD DOC.)
C. CLINICAL GUIDELINES
• Clinical Practice Guidelines are statements that

include recommendations intended to optimize
patient care.
• Informed by a systematic review of evidence, and
an assessment of the benefits and harms of
alternative care options.
• CPGs should follow a sound, transparent

methodology to translate best evidence into
clinical practice for improved patient outcomes.
• Additionally, evidence-based CPGs are a key
aspect of patient-centered care.
• Clinical practice guidelines should be feasible,

measurable, and achievable.
• Clinical performance measures may be developed from

clinical practice guidelines and used in quality
improvement initiatives. When these performance measures
are incorporated into public reporting, accountability, or
pay for performance programs, the strength of evidence and
magnitude of benefit should be sufficient to justify the
burden of implementation.
• Sample of the clinical practice guideline for

pneumonia by the Philippine College of Chest
Physician( shown in word doc)
• The differences between Critical Pathway
and Clinical Guidelines
(Shown in word doc.)
D. E-JOURNALS
D. E-JOURNALS
• E-journals or electronic journals are scholarly

publications in digital form, which are accessible on
the web.
D. E-JOURNALS
• In the Philippines, we have the Philippine E-journals (

ejournals.ph) where you can find an online bibliographic
database & repository of academic journals in different
disciplines from various resources.
• These are often used as acceptable review of related
literatures for research projects and evidence-based nursing
practice.
•Thank you!!!

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UNIT IV

• ALSO KNOWN AS:

• Different systematization tools were being used for the

Medical Protocols Standardized care maps

Nursing protocols Clinical Practice Guidelines

Systimatization tools for Clinical Processes

• How to document variances? (Institutional guidelines may apply and

• How to document variances? (Institutional guidelines may apply and

• Clinical Practice Guidelines are statements that

• CPGs should follow a sound, transparent

• Clinical practice guidelines should be feasible,

• Clinical performance measures may be developed from

• Sample of the clinical practice guideline for

• E-journals or electronic journals are scholarly

• In the Philippines, we have the Philippine E-journals (

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