RESEARCH STEPS WITH THE BEST

EVIDENCE
DINI NUR ALPIAH , S.TR.FTR,MARS
CONCEPTS OF EVIDENCE-BASED PRACTICE

DEFINITION OF EVIDENCE-
BASED PRACTICE
Evidence-based practice is a strategy in get Service health that is evidence-based
knowledge and skills for could increase Act practice international has recognized as
positive behavior _ with combine proof study approach that is could complete problem as
best so that evidence-based practice can applied well as emphasizes on applying
to in practice and make something decision
the best research for help in service
more health _ good (Bostwick, 2013. Bloom et
professional and get current science ( Stokke
al., 2009. Azmoude , Elham et al., 2017).
et al., 2014 and Chang & Crowe, 2011).
OBJECTIVES OF EVIDENCE-BASED PRACTICE

According to Hapsari (2011) the objectives Evidence-based practice aim for reach
of evidence-based practice are : provide data something improvement in treatment
to nurses practitioner based on proof patient , consistency in give service to
scientific patient , result patient care and control _
in order to give care by effective with use cost .
results the best research , complete the
problem with giving _ service to patient ,
reach perfection in gift care nursing ,
insurance standard quality and trigger
innovation
COMPONENT KEY EVIDENCE-BASED PRACTICE

DRISKO (2017) MELNYK & OVERHOLT (2011

1. proof external in the form of results research , emerging
1. state clinical moment this theories _ from research , opinion from experts and
results expert panel discussion
2. Research evidence best relevant _
2. Internal evidence in the form of evaluation clinical ,
3. Values and preferences client results from project quality improvement
in skeleton increase quality service clinic ,
4. Skill clinical from practitioner use source power power health necessary
for _ To do service health
3. give benefit best for condition patient moment it and
minimize financing
 STEPS TO IMPLEMENT EVIDENCE-BASED
PRACTICE MELNYK & OVERHOLT (2011)
1. Grow spirit investigation
2. ask question clinic with using the PICO/PICOT format.
3. look for andcollect evidence ( article research ) most relevant to PICO/PICOT
4. To do evaluation critical to evidence ( article research )
5. integrate evidence ( article best research _ with one _ expert in clinic as well as notice wishes
and benefits for patient in make decision or change
6. evaluate the outcome of the changes that have decided based on evidence
7. spread results from evidence-based practice.
 STEPS TO APPLY EVIDENCE-BASED PRACTICE LEEN, BELL &
MCQUILLAN (2014) AND PAUL GLASZIOU & SALISBURY (2012

1. ask is patient and care focused questions _ _ individual . Mostly _ question clinical could
shared Becomes four abbreviated components _ become PICO/PICOT , namely , P ( patient ,
population and problem ), I ( intervention or indicator ), C
( comparison or control ), O ( result ) shows the result to be attention . T( time );
2. acquire that is get proof best available and relevant _
3. appraise that is evaluate proof
4. apply that is apply evidence and involve in taking decision with patient or group individual
5. assess that is assess and disseminate result .
EVIDENCE-BASED PRACTICE MODELS

JOHNS HOPKINS STETLER

1. identify evidence-based practice 1. preparation study proof

2. shape team 2. validation from findings

3. Obtain 3. synthesis from findings and cumulative

decision about conducted or no for change
4. Judging i
implement in practice
5. summarizing existence the evidence that
4. translation and practical application findings
will recommended in practice start from
implement until with evaluation 5. evaluation
ADVANTAGES AND DISADVANTAGES USE OF
EVIDENCE-BASED PRACTICE
help nurse or student in make decision clinical on the ground practice based on experience
personal or others as well cost used _ in implementation of evidence-based practice does
not a lot , while loss from evidence-based practice is time used _ more a lot and extra work
in
taking decision clinical
FACTORS INFLUENCING EVIDENCE-BASED PRACTICE (SHI,
CHESWORTH , LAW, HAYNES AND MACDERMID (2014)

• behavior the use of evidence-based practice refers to whether power health could apply
knowledge about evidence-based practice for problem clinical on the ground practice .
• Behavior use of evidence-based practice refers to the performance of practitioners from
related instrumental activities with evidence-based practice such as seek and
get proof more quality _ tall in practice they alone .
EVIDENCE BASED MEDICINE (EBM)
MINISTRY OF HEALTH RI

Evidence based medicine (EBM) is the process used by systematic for To do evaluate , find
, review / review, and utilize results studies as base from taking decision clinic .

According to Sackett et al. (2000), Evidence-based medicine (EBM) is something approach

evidence - based medicine _ scientific latest for interest service health sufferer . With so , in
practice , EBM combines Among ability and experience clinic with evidence scientific the
most recent trusted .
STEPS OF EVIDENCE BASED MEDICINE

1. Formulate question related scientific _ with problem disease suffered by the patient
2. Search information related scientific evidence with problem faced _
3. Review to evidence existing scientific _
4. Apply results study evidence scientific to in practice taking decision
5. Evaluate the efficacy and effectiveness of the intervention .
STEP I. FORMULATE SCIENTIFIC QUESTIONS

• Every moment a doctor face patient of course will appear questions scientific related _ a number of
things , such as disease diagnosis , type the most appropriate therapy , factors _ risk , prognosis, up to
effort what can _ conducted for resolve problems encountered in the patient .
• In situation the required ability for synthesize and analyze a number of existing problems . _ As
example , in scenario 1 presented something case and shape the study .
• Questions that initiate EBM other than could related with diagnosis, prognosis, therapy , can also be
related with risk effect iatrogenic , quality service (quality of care), up to to economy health (health
economics). ideal any issues that arise should character specific , related with condition patient
moment enter , form intervention possible therapies , and possible clinical outcomes _ _ expected .
STEP II. SEARCHING SCIENTIFIC
INFORMATION FOR "EVIDENCE"
• After formulation problem arranged , step next is search and try find evidence scientific that can
answer questions that . For this required Skills search information scientific (searching skills) as
well as convenience access to sources information . Search literature could conducted manually
in libraries _ _ Faculty Medical or hospitals education with look for titles related articles _ with
existing problems _ in journals .
• At the moment this there is more from 25,000 journals accessible worldwide biomedicine _ _ _ _
manually via _ form prints (reprints). With development technology information , then search
literature could conducted via the internet from libraries , offices , internet cafes ( internet cafes ),
even at home , with condition have computer and a set of modems, as well as channel phone for
access the internet
STEP III. REVIEW TO PROOF EXISTING
SCIENTIFIC EVIDENCE
• In Step this a clinician or practitioner sued for could To do assessment (appraisal) of
results existing studies . _ Destination main from study critical this is for see is the
evidence presented is valid and useful by clinical for help with the pick-up process
decision . This thing important , remember in reality no all published studies _ through
international magazines ( journals ) Fulfill criteria valid and reliable methodology .
• For capable To do evaluation by scientific , a clinician or practitioner must understand the
method called with “ critical appraisal ” or “ assessment critical ” developed by experts
from North America and England . Critical appraisal this be equipped with questions key
for catch is the articles we earn Fulfill criteria as articles that can used for reference
STEP IV. APPLICATION RESULTS STUDY TO IN
PRACTICE
• With identify evidence existing scientific _ that , a clinician could direct apply it to patients by direct
or through discussions for arrange something guidelines therapy . Based on existing information ,
then _ could only in Scenario 1 it was decided for quick start therapy with warfarin. This of course
just based on considerations the risks and benefits (risk-benefit assessment) obtained through search
evidence existing science . _
• In Levels of evidence table presented the degree of evidence, that is categorization for placing
evidence based on his strength .
• Level 1a evidence, for example , is evidence obtained from meta- analysis to various clinical trials
random with control (randomized controlled trials). This level 1a evidence considered as proof
scientific with the highest worthy degree _ for trusted
STEP V. FOLLOW-UP AND EVALUATION

Stage this must conducted for knowing what is the current best evidence used ? for taking
decision therapy beneficial optimally for _ patients , and provide minimal risk . Including in
Step this is identify more evidence new possible _ can different with what have _ decided
before . Stage this is also for ensure that the eventual intervention decided true, true give
more benefits _ big from the risk (“do more good than harm”). Recommendation about
decision the best therapy made based on experience clinic from group composing expert _
guidelines treatment