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Evidence Based Practice Tutorial

EBP in Many Disciplines

Evidence-Based Practice in Nursing, informed heavily by the work of Stetler, Brunell, Giuliano, Morsi, Prince, and Newell-Stokes, emerged in the late-1990s as a way to encourage greater Research Utilization in Nursing Practice.

in Stetler, et al's 1998 article, they write:

Evidence, characterized as something that furnishes proof for decision making, encompasses the findings of formal research as well as the consensus of recognized experts; within an organizational setting, however, it realistically also includes facts or data related to operations and improvement activities.

Not all practice in a health profession can or should be based on science. In many cases within nursing, researchers have yet to accumulate a sufficient body of knowledge. In other cases, a different frame of reference provides the appropriate rationale for action. For example, although it may provide clarifying information, science does not drive ethical decision making.

Evidence-based nursing deemphasizes ritual, isolated and unsystematic clinical experiences, ungrounded opinions and tradition as a basis for nursing practices ... and stresses instead the use of research findings and, as appropriate, quality improvement data, other operational and evaluation data, the consensus of recognized experts and affirmed experience to substantiate practice.

In Nursing, EBP can be used in a variety of contexts:

  • Clinical practice
  • Quality Improvement
  • Program evaluation
  • Nursing Education
Stetler, C. B., Brunell, M., Giuliano, K. K., Morsi, D., Prince, L., & Newell-Stokes, V. (1998). Evidence-Based Practice and the Role of Nursing Leadership. JONA: The Journal of Nursing Administration, 28(7/8), 45.
 

According to the American Speech-Language-Hearing Association (ASHA), EBP is a core practitioner competency.

As of 2005 ASHA has required clinicians to possess "knowledge of processes used in research and the integration of research principles into evidence-based clinical practice (and) must demonstrate comprehension of the principles of basic and applied research and research design. In addition the [clinician] should know how to access sources of research information and have experience relating research to clinical practice."

ASHA Triangle: Client Perspective, Clinical Expertise, and External Scientific Evidence

Image from ASHA EBP

In making clinical practice evidence-based, audiologists and speech-language pathologists—

  • recognize the needs, abilities, values, preferences, and interests of individuals and families to whom they provide clinical services, and integrate those factors along with best current research evidence and their clinical expertise in making clinical decisions;

  • acquire and maintain the knowledge and skills that are necessary to provide high quality professional services, including knowledge and skills related to evidence-based practice;

  • evaluate prevention, screening, and diagnostic procedures, protocols, and measures to identify maximally informative and cost-effective diagnostic and screening tools, using recognized appraisal criteria described in the evidence-based practice literature;

  • evaluate the efficacy, effectiveness, and efficiency of clinical protocols for prevention, treatment, and enhancement using criteria recognized in the evidence-based practice literature;

  • evaluate the quality of evidence appearing in any source or format, including journal articles, textbooks, continuing education offerings, newsletters, advertising, and Web-based products, prior to incorporating such evidence into clinical decision making; and

  • monitor and incorporate new and high quality research evidence having implications for clinical practice.

According to the American Occupational Therapy Association, Inc. "Evidence-based practice (EBP) is based on integrating critically appraised research results with the practitioner’s clinical expertise, and the client’s preferences, beliefs, and values."

The process of evidence-based practice for Occupational Therapy is much like other health disciplines. Differences arise, however, with some of the practice environments and theory bases employed by OT practitioners. The graphic below helps present the framework of the Occupational Therapy EBP process.

EBP graphic for Occupational Therapy

At the center of the process is the patient, who has certain preferences and values as well as their environment and occupation. Surrounding them is the context of therapy, which  includes the clinical information, Practice setting, information resources, and financial resources. From there you proceed into the standard EBP process of Asking a clinical question, Acquiring Information, Appraising it, and Applying it.

Bennett, S., & Bennett, J. W. (2000). The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal, 47(4), 171–180. https://doi.org/10.1046/j.1440-1630.2000.00237.x

According to the American Physical Therapy Association, "The physical therapy profession recognizes the use of evidence-based practice (EBP) as central to providing high-quality care and decreasing unwarranted variation in practice. EBP includes the integration of best available research, clinical expertise, and patient values and circumstances related to patient and client management, practice management, and health policy decision-making."

Because Physical Therapy is highly individualized, it cannot follow protocol in much of the same way that other health professions, like Nursing does. However, like all other health professions it aims at improving patient outcomes through patient-centered approaches that look at the best available research and relate them to clinical expertise in order to make the best decisions in clinical situations.

In 2017 Bernhardsson et al wrote that "Consideration of the local context, clarity on the EBP initiative, and identification and engagement of intended users should inform strategies for effective EBP implementation, as no single strategy or implementation package will fit all target behaviors, populations, or contexts."

In Physical Therapy, Evidence-Based Practice can be used for:

  • Clinical Practice
  • Research
  • Assessment Tool Evaluation
Bernhardsson, S., Lynch, E., Dizon, J. M., Fernandes, J., Gonzalez-Suarez, C., Lizarondo, L., … Grimmer, K. (2017). Advancing Evidence-Based Practice in Physical Therapy Settings: Multinational Perspectives on Implementation Strategies and Interventions. Physical Therapy, 97(1), 51–60. https://doi.org/10.2522/ptj.20160141

Evidence-Based practice in Public Health is unique from other health fields because it does not occur in a clinical environment like many others do.

According to a 2017 work by Vanagas, Bala, and Lhachimi Evidence-Based Public Health composes of key elements that "include making decisions on the basis of the best available scientific evidence and using sound data collection and research methods together with engaging the community in the decision-making. An EBPH approach could potentially have numerous direct and indirect benefits, including access to more and higher-quality information on best practice, a higher likelihood of successful prevention programs and policies, greater workforce productivity, and more efficient use of public and private resources."

Of the 10 essential services of Public Health, Research is the 10th, and Evidence-Based Public Health plays a crucial role in that according to and American Public Health Association Policy Statement. Evidence-based work is essential to influencing policy locally and globally in Public Health.

Vanagas, G., Bala, M., & Lhachimi, S. K. (2017). Evidence-Based Public Health 2017. BioMed Research International, 2017. https://doi.org/10.1155/2017/2607397

In Social Work, a simple definition is treatment or interventions based on the best available scientific research. But a well thought out paper from Persons in 1999 argued that an evidence-based social worker does the following:

  • Provides informed consent for treatment
  • relies on the efficacy data (especially Randomized controlled trials) when recommending and selecting and carrying out treatments
  • uses the empirical literature to guide decision making
  • uses a systematic, hypothesis-testing approach to the treatment of each case

it is an approach that begins with careful assessment, sets clear and measureable treatment goals, develops individualized formulation and a treatment plan based on that formulation, and monitors progress towards the goals frequently and modifies or ends treatment as needed. It also centers the client in the practice, informing them of the evidence and research used in the treatment process.

Research indicates that EBP can be used in both Clinical and Macro practices, as it does have application to social action, social planning, and locality develop models to community problems. Similarly, administrative practice and policy practice cannot be done without EBP considerations, as it has a tremendous impact on human services.

Mcneece, CA, & Thyer, BA. (2004). Evidence-Based Practice and Social Work. Journal of Evidence-Based Social Work, 1(1), 7–25. https://doi.org/10.1300/J394v01n01_02