EBP is an umbrella term that originated in the world of medicine. It is commonly described as “the conscientious, explicit, and judicious application of current best evidence in making decisions about the individual patient’s care.”

INTRODUCTION:

• Nurses and midwives play a significant role in addressing public health concerns in health-care systems around the world.
• Healthcare professionals represent the majority of the health workforce and play critical roles in providing effective, efficient, accessible, acceptable, patient-centered, equitable, and safe health-care services.
• Quality health-care services necessitate evidence-based clinical decision-making in nursing and midwifery, as well as care coordination.
• When improving areas of health care quality and enhancing evidence-based practise (EBP), the best available evidence should be used.
• Nursing and midwifery professions continue to be critical to achieving EBP in health-care settings, particularly in standardising and aligning health-care practises with evidence at the point of service.
• Nurses and midwives must understand the definition of EBP as well as the enabling criteria for successful implementation.
• They should recognise the motivation for implementing EBP and work to build the skills necessary to interact with evidence and apply it to daily nursing and midwifery practise.
• To consistently provide evidence-based treatment to patients, lawmakers, managers, health-care providers, educators, and researchers must define their roles and responsibilities.
• Only when all accountable parties accept their obligations will EBP as a standard of care be realised.

EVIDENCE-BASED HEALTH CARE AND PRACTICE:

Evidence Based Practices core concepts are frequently used interchangeably in health-care practise and the literature, emphasising the necessity for nurses and midwives to understand the concepts properly and recognise how they differ.

Evidence-based health care

• EBHC is an EBP a framework that covers nursing, midwifery, medicine, and allied health professions. It is defined as clinical decision-making that takes seriously the feasibility, appropriateness, meaningfulness, and effectiveness of healthcare practises.
• This may be informed by the best available evidence, the context in which care is administered, the individual patient, and the health professional’s professional judgement and skill.
• To enable evidence-based decision-making, all health-care professions will be given the opportunity to participate in the development of EBP and the integration of evidence into professional practise and education.
• The JBI model of EBHC was established by the Joanna Briggs Institute (JBI), an international nursing research organisation.
• This conceptualises: the processes to obtain an evidence-based approach to clinical decision-making; how the model’s component elements are operationalized; and how they might be implemented in practise.
• EBHC is not a pure, linear process; it can be bi-directional at times, as seen in Fig. 1 by the smaller arrows indicating the feedback cycle.

BENEFITS OF EVIDENCE BASED PRACTICE:

Beneficiaries	Benefits
General Population	Improved conditions for patient-centred care Patient preferences included in decision-making Consistent health services leading to better equity Reduction in geographic variation Reduction in patients’ length of stay Better patient outcomes Quality health-care services Increased patient safety
Nurses and midwives	Increased job satisfaction Empowerment Improved skills to integrate patient preferences into practice Support for professional growth Continuous career development through expert roles
Health-care systems	Improvement in the quality of care Better outcomes for patients Increased patient safety Reduced costs Stronger basis for health-care investment decisions Capacity-building through collaboration
Research and education	Increased need for production and synthesis of robust evidence Competence development Integration of nursing and midwifery expert roles in health systems

TYPES OF BARRIERS TO EVIDENCE BASED PRACTICE:

Type of Barrier	Examples
Organization	Insufficient support from management Lack of support structures and limited resources and tools Lack of organizational culture to support EBP Outdated organizational policies Hierarchical structures Lack of multi professional collaboration Outdated and unquestioned routines Resource shortages
Leaders and management	EBP not defined as an aim of the organization Insufficient commitment to EBP Insufficient support for staff Insufficient authority
Professionals	Inadequate knowledge and skills in EBP Unfamiliarity with guidelines Negative attitudes Preconceptions concerning EBP Lack of time Disagreement with guidelines
Evidence	High-quality studies not available Massive amount of information Unclear clinical-practice guidelines Guidelines not updated or incomplete

RESPONSIBILITIES AT DIFFERENT LEVELS OF HEALTH-CARE SYSTEMS FOR DEVELOPING CONSISTENT EVIDANCE BASED PRACTICE:

CONTENT	NATIONAL LEVEL	LOCAL LEVEL	ORGANIZATIONAL LEVEL	NURSES/ MIDWIFE
Producing, disseminating and implementing knowledge	Policy and strategies for EBP: Research policy (important research topics are described) Databases for synthesized evidence Responsibility to produce synthesized evidence National guidelines for nursing and midwifery	Plans for implementation and development of systematic reviews and guidelines: Local networks Structures for evidence dissemination	Participation in local networks: Evidence dissemination Availability of synthesized evidence	Evidence-based nursing/ midwifery practice: Evidence-based decision-making
Developing consistent practice	Support for evidence synthesis: Research and education Development projects Evaluation and follow-up of EBP	Responsibilities for consistent practices: Guideline implementation Evaluation and follow-up of EBP	Development of evidence-based consistent practices: Evaluation and follow-up of EBP Participation in development projects Benchmarking	Commitment to evidence-based consistent practice: Nursing/midwifery documentation Evaluation of patient care
Ensuring competence	Competence needed for EBP: Support for competence development Model for using different kinds of expertise in practice	Plans to strengthen competence for EBP: Collaboration with local research and educational institutions	Methods to evaluate nurses’/midwives’ competence for EBP: Collaboration with local educational institutions: e.g., curriculum development, continuing education	Development and evaluation of own expertise and competence

A VIEW TO IMPLEMENTING EVEDANCE BASED PRACTICE IN NURSING AND MIDWIFERY

• New innovations and practises for improving outcomes in nursing and midwifery are presented. The implementation of an innovative idea, service, process, or product to improve treatment, diagnosis, education, outreach, prevention, and research with the long-term goal of improving quality, safety, results, efficiency, and costs is an example of healthcare innovation.
• Health-care innovations might be classified as products, methods, or structures. Typically, products are made up of technology or services, such as clinical treatments. A process is a new change in the creation or delivery of service.
• Structures typically have an impact on the internal and external infrastructure of health-care organisations, resulting in the creation of new structural models.
• An idea must be repeatable and meet a specific need to be considered an innovation.
• To be effective EBP facilitators, innovations must be scientifically supported.
• In other words, when bringing new innovations, such as technology, in nursing and midwifery practise, careful assessment of expected and unexpected outcomes and effectiveness based on current data is essential.
• Innovations that have demonstrated to be viable, appropriate, beneficial, and meaningful should be encouraged to be implemented. Several models have been developed to aid in the implementation of health-care transformation.
• Currently, journals, databases, and referred to as grey literature transmit a wealth of scientific knowledge. To critically assess and synthesise current research into systematic reviews and clinical practise guidelines, collaboration is required.
• International partners including as Cochrane and the JBI have created approaches for synthesis of evidence from many forms of research to enhance evidence implementation and dissemination.
• Furthermore, numerous national organisations publish systematic reviews, clinical practise guidelines, and methodological guidance for evidence integration.

FACTORS ASSOCIATED WITH SUCCESSFUL EVIDANCE BASED PRACTICE (EBP) INFRASTRUCTURE:

Conclusion:

The purpose of EBP is to standardize and improve care procedures and, ultimately, patient outcomes by utilizing current information and connecting it with patient preferences and professional expertise.