INTEGRATING EVIDENCE-BASED PRACTICE

EBP (EVIDENCE-BASED PRACTICE) - is a process that has developed from a need to improve the
quality and manage the economics of healthcare delivery. The components of EBP include systematic
and critical evaluation and available resources, and patient’s values and preferences.
This information is used to make deliberate clinical decisions based on the theory and relevant research
that guide patient care.
The expected results of these carefully considered decisions are improved outcomes for patients,
efficiency and cost-effective care delivery for organizations.

1.EBP Basics
2. ask
3. acquire
4. appraise
5. apply
6. assess

CULTIVATING A SPIRIT OF INQUIRY

The process of EBP is best learned is sequence with distinct steps. The preliminary step, cultivating
a spirit of inquiry, means to be curious about the effectiveness of nursing interventions, to take
interest in changing nursing practice or questioning practice, and try new approaches.
Nurses with spirit of inquiry understand EBP as a way of thinking, not an additional burden to their
practice. Nurses who are passionate about EBP will likely become informal leaders, or be promoted to
leadership positions and can influence others to grow support for EBP.
Those who have spirit of inquiry will have questions and a desire to find the best evidence to support
their practice.

WRITING THE QUESTION

Nurses who use the steps of EBP to formalize their questions about practice should use the PICOT
format.
The term PICOT identifies the:
P- patient or population
I-issue or intervention
C- what will be compared
O- the expected outcome
T- and the time
That it will take to achieve and evaluate the outcome.
The PICOT format is a systematic method of questioning writing and helps decrease the time and
effort it takes to find evidence specific to the topic being investigated. Consistently using a set format
to write the questions ensures that all components of the question are addressed before the literature
search.
https://libguides.ggc.edu/NURS/PICOT

Questions may be written following a template and may focus on interventions, predictions or prognosis
of outcomes for a specific patient population, comparison of diagnosis or diagnostic tests, etiology and
associated risk factors for a specific condition, or meaning within a situation.
Nurses who embrace EBP may find support in forming groups interested in certain topics. Getting other
nurses involved helps to clarify clinical issues and to write clear and specific clinical questions. Once a
group is assembled and the individuals are comfortable in identifying issues and writing questions, the
second step, searching for evidence, can begin.
Using appropriate databases can be easier for nursing students during their coursework for nurses at
university-affiliated hospitals and clinics, with their many research subscriptions, but other options are
available.
Websites that…(kulang)

THE COCHRANE LIBRARY

Independent high-quality evidence for health care decision making

A collection of databases that include high quality independent, reliable evidence from Cochrane and
other systematic reviews, clinical trials and more.
 Brings together research on the effectiveness of healthcare treatments and interventions
from around the world.
 Based on the practice of evidence-based medicine
 Used by clinicians, policy makers, researchers, educators, students, patients and others.

Evidence-based medicine is “ The conscientious, explicit and judicious use of current best evidence in
making decisions about the care of individual patients.”
 SEARCHING FOR EVIDENCE IN RESEARCH LITERATURE

These terms are entered using BOOLEAN OPERATORS (and, or, not) to combine multiple search
items. In addition, many databases allow the use of quotation marks to search for phrases of multiple
words.

SYSTEMATIC REVIEWS AND CLINICAL PRACTICE GUIDELINES

Systematic reviews are literature reviews that follow a certain methodology to standardized the critique
of research findings.
McMaster Plus Nursing + and the Cochrane Collaboration.
COCHRANE
What are systematic reviews?

Clinical guidelines are valuable because they contain preappraised research.

USING FREE RESOURCE

PubMed
As a service of the National Center for Biotechnology Information(NCBI) at the US National
Library of Medicine (NLM).

Medical Subject Headings (MeSH)

Other feature of PubMed are the PubMed Advanced Search Builder, sidebar filters, LinkOut,
and My NCBI.
Google Scholar
A web based search engine for scholarly literature across a broad range of disciplines.
The “cited by” feature allows users to view a list of later works that have cited the original paper. This
ability to connect literature through citations has historically only been available through paid services.
Google Scholar is a valuable resource of researchers of all kinds, but as is true with all research tools,
it is the responsibility of researchers to verify the veracity of any resources they use.
 HUMAN FACTORS IN COMPUTING

KEY TERMS:
 Anthropometry
 Information Processing
 Task Design
 Dialogue
 Interactivity
 User Interface
 Ergonomics
 International Organization for Standardization (ISO)
 Visual Display Terminals (VDTs)
 Graphical User Interface (GUI)
 Voice User Interface
 Hardware Ergonomics
 Natural User interface
 Work Systems
 Human-computer Interaction (HCI)
 Software Ergonomics

CHAPTER OVERVIEW
Computer systems and computer applications are used in all areas of life, from leisure to work.
The systems range from computer workstations, notebooks, and smartphones, to networked household
appliances and medical devices.
To allow humans to comfortably interact with the various applications in a safe and efficient manner,
ergonomic principles must be applied.
This chapter described the physiological, psychological and social aspects of human interaction with
computer systems and the effects of computer technology on people at work, particularly in healthcare
settings.

Introduction
Humans and computers form a complex socio-technical work system. If they are to distribute their
workloads in a meaningful manner, the different qualities and abilities of human and machine must be
considered.
The human recognizes problems and can draw on wide-ranging general and specific knowledge in
various areas to combine knowledge with experience to creatively apply them to problem solving.
The human is capable of complex decisions and accepting the resulting responsibility.
For example, nurses have knowledge, skills, and values developed by completing collegiate education
in nursing, participating in continuing education and by practicing in continuing education and by
practicing in work settings.
Nurses, equipped with education and experience, make complex decisions in noisy, fast-paced work
environments that have consequences for the safety of patients in their care.
In contrast, computer systems can process huge amounts of data quickly and error free, repeat
similar tasks multiple times without fatigue, extract important information, and exclude irrelevant data.
Computers can function under extreme conditions and endure factors that would be detrimental to
human health.
The conditions under which human work constitute significant factors that influence health and well-
being as well as productivity and successful outcomes of work.
The individual performance of the human is determined, on one hand, by external performance-shaping
factors such as environment, assigned task, technical feasibilities, time constraints and modes of
cooperation.
On the other hand, it is also influenced by internal factors, such as physical and psychological states of
human.
Computer applications that are well suited to human can ease and enrich human performance.
Standards, laws, and recommendations can be used to create a framework to prevent humans
from sustaining lasting harm by their work.

HUMAN FACTORS ERGONOMICS (HFE)

In 2000, the International Ergonomics Association (IEA), defined ergonomics as follows:
 Ergonomic (Human Factors) is the scientific disciplined concerned with the understanding of
the interactions among humans and other elements of a system and the profession that applies
theory, principles, data and methods to design in order to optimize human well-being and overall
system performance.
Practitioners of ergonomics and ergonomists contribute to design and evaluation of tasks, jobs
products, environment systems in order to make them compatible with the needs, abilities
and limitations of people.
Ergonomics is a dynamic,interdisciplinary field of study that continuously evolves through new
insights into the interaction between human and work.
It differentiated itself from other fields of study through its direct applicability.
Ergonomics is central to safety programs in many different fields including
manufacturing,aerospace and health care.
As new knowledge is applied, it should lead to greater humanization of work.
This implies that the human is at the center and that the work is being adapted to human
needs.
Besides increased safety, healthy and comfort for the worker, there are also economic
considerations included among the target parameters of applied ergonomics.
Productivity, quality, and efficiency can be improved by applying ergonomics production
processes, and costs can be lowered by decreasing work-related illnesses-related absences from
work.
The second part of the IEA definition of ergonomics indicates the breadth of the spectrum of
research in ergonomics: it spans from capturing work content and organizational aspects of
work, to environmental factors, to consideration of physical and psychological factors and
limitations that human face as they interact with various work equipment.
Ergonomics requires specialized education. The disciplines involved are primarily occupational
science, human and social sciences and humanities, computer and design science, and industrial
engineering.
There are differentiate areas of ergonomics, each with its own focus.
Physical ergonomics, the health consequences of working posture and repetitive motions are studied
as the origins of musculoskeletal disorders.
Musculoskeletal Disorders (MSDs) affect the muscles, nerves, blood vessels, ligaments and
tendons.
Workers in many different industries and occupations can be exposed to risk factors at work, such as
lifting heavy items,bending reaching overhead, pushing and pulling heavy loads, working in awkward
body postures and performing the same or similar tasks repetitively.
Exposure to these known risk factors for MSDs increases a worker’s risk of injury.

EXAMPLES OF MUSCULOSKELETAL DISORDER

Carpal Tunnel Syndrome

Tendinitis (Elbow strain)

Rotator Cuff Treatment

Medial Epicondyle
Trigger Finger

High Risk Occupations for MSDs

 Registered nurses, nursing assistants and psychiatric aides
 Firefighters and prevention workers
 Laborers and freight, stock and material movers
 Janitors and cleaners
 Heavy and tractor-trailer truck drivers
 Refuse and recyclable material collectors
 Stock clerks and order fillers
 Maids and housekeeping cleaners
 Light truck or delivery services drivers
 Telecommunications line installers and repairers
 Bus drivers, transit and intercity
 Production workers
 Police and sheriff patrol officers
 Heating, air conditioning, and refrigeration mechanics and installers
 Plumbers, pipefitters and steamfitters
 Maintenance and repair workers, general

Employers are responsible for providing a safe and healthful workplace for their workers. In the
workplace, the number and severity of MSDs resulting from physical overexertion, and their associated
costs, can be substantially reduced by applying ergonomic principles.

Implementing an ergonomic process is effective in reducing the risk of developing MSDs in high-risk
industries as diverse as construction, food processing, firefighting, office jobs, healthcare,
transportation and warehousing.

Organizational ergonomics deals with the optimization of work processes and structures, such as
time management, teamwork, communication within an organization, telecommunicating, and quality
control.

Also sometimes known as macro-ergonomics, focuses on optimizing sociotechnical systems and

organizing structures, policies and processes in order to maximize efficiency.
This domain addresses subjective aspects of the workplace.

✓Communication
✓ Crew resources and management
 Work schedule design
✓ Teamwork
 Participatory design
 Cooperative work
 Quality management

The goal of organizational ergonomics is the attainment of a fully harmonized work system that ensures
employee job satisfaction and commitment.

It also includes the study of technology's consequences on human relationships, processes, and
institutions. Typical interventions are as follows:
 Including workers in identifying and resolving ergonomic issues. This is also known
as participatory ergonomics.
 Improving total system processes, such as manufacturing value streams and
managerial processes
 Successfully installing safety as an integral part of the organizational culture

The most widespread application for organizational ergonomics is in the introduction and integration
of new technology into the workplace.
As companies implement new technologies, they must consider several factors of those tools:
 Functions
 Capabilities
 Capacities
 User-friendliness
 Integration

Cognitive ergonomics focuses on such issues such as cognitive and memory processes in the human
brain, decision making, recognition and elimination of work-related stress, reliability of human actions
and human computer interactions (HCI).

Cognitive ergonomics is the field of study that focuses on how well the use of a product matches
the cognitive capabilities of users. It draws on knowledge of human perception, mental processing,
and memory. Rather than being a design discipline, it is a source of knowledge for designers to use as
guidelines for ensuring good usability.

Products designed to match the cognitive capabilities and limitations of users are simple, clear, and
easy to use, contributing to a superior overall user experience. This is the ultimate goal of the designer
of any system.

But before we get to the disciplines to building a better user experience, first it's important to
understand what influences a user's experience:
https://ergo-plus.com/cognitive-ergonomics/

 Useful. As practitioners, we can't be content to paint within the lines drawn by managers. We must
have the courage and creativity to ask whether our products and systems are useful, and to apply
our knowledge of craft + medium to define innovative solutions that are more useful.
 Usable. Ease of use remains vital, and yet the interface-centered methods and perspectives of
human-computer interaction do not address all dimensions of web design.
 Desirable. Our quest for efficiency must be tempered by an appreciation for the power and value
of image, identity, brand, and other elements of emotional design.
 Emotional design strives to create products that elicit appropriate emotions, in order to create a
positive experience for the user. To do so, designers consider the connections that can form
between users and the objects they use, and the emotions that can arise from them. The emotions
a product elicits can strongly influence users' perceptions of it.

1. How do you select the clothes you wear? Is criteria a good fit or currently trending?
2. How do you choose to buy a car? By engine's efficiency or looks?
3. When the physical design of an object made you fall in love with it? Something that made
you joyous and comfortable when you used it?

"make products that are a joy to own and a joy to use”

 Findable. We must strive to design navigable web sites and locatable objects, so users can find
what they need.
 Accessible. Just as our buildings have elevators and ramps, our web sites should be accessible to
people. Today, it's good business and the ethical thing to do.
 Credible. Thanks to the Web Credibility Project, we're beginning to understand the design elements
that influence whether users trust and believe what we tell them.
 Valuable. Our sites must deliver value to our sponsors. For non-profits, the user experience must
advance the mission. With for-profits, it must contribute to the bottom line and improve customer
satisfaction.
 Human-computer interaction (HCI) is a multidisciplinary field of study focusing on the design
of computer technology and, in particular, the interaction between humans (the users) and
computers. While initially concerned with computers, HCl has since expanded to cover almost all
forms of information technology design.

Design of Activity
Activities should be designed so that they provide an optimal workload for the employee,physically
and mentally In ergonomics, the term workload has a neutral connotations as opposed to its meaning
in common usage.

Workload includes all external influences acting on humans. This means that degree of task difficulty
must be considered in addition to the environmental conditions under which the task is being executed.

The total workload can stimulate and challenge workers, promote learning, or fatigue workers.
The effect of the workload depends on many factors such as individual preconditions, experience,
attitudes and opinions.

The workload that is optimal provides neither too much nor too little challenge. Important elements
in avoiding either are appropriate rest periods, job rotation, and job enhancement and job enrichment
by assigning multiple sequential tasks rather than repetitive single tasks.

The workload of nurses is measured by counting the number of patients per nurses for inpatient care
and number of patient visits per day in ambulatory settings. There is a body of literature showing that
the number of patients per nurse is a significant predictor of inpatient length of stay, medication errors,
hospital acquired conditions, falls and other adverse outcomes.

Technology as a factor in nurse workload has been rarely studied as a predictor of patient outcomes.