Nurses must increasingly incorporate evidence-based practice into their care routines. Based on the judicious use of scientific evidence, evidence-based practice provides nurses with a reliable method for ensuring the best possible patient outcomes. During a time of unprecedented healthcare system change and growth, it is essential that nurses use strong critical thinking skills and the best available scientific research.
What Is Evidence-Based Practice?
The term “evidence-based medicine” emerged in the 1980s as way to define how the use of scientific evidence can help determine best patient care practices, according to the authors of Evidence-Based Practice in Nursing: A Guide to Successful Implementation. As clinicians realized the value of incorporating scientific evidence into their own decision-making processes, the term evolved to “evidence-based practice.” Although the term first appeared in the 20th century, Lynn McDonald, writing for BMJ, theorizes that it has been in use since the 19th century. For instance, according to McDonald, the best possible research, statistics and expertise influenced Florence Nightingale’s work.
There are various definitions of “evidence-based practice,” but many accept David Lawrence Sackett’s interpretation. An early advocate of evidence-based practice, Dr. Sackett was also responsible for proving aspirin’s value in preventing heart attacks and strokes. Sackett and his colleagues described evidence-based practice as the “conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” As the authors of Evidence-Based Practice in Nursing explain, it is a tool nurses can use to provide the best possible care for their patients. Instead of basing care and treatments plans on past experiences, anecdotal evidence and outdated textbooks, nurses can instead rely on research and knowledge.
The Handbook of Behavioral Medicine describes evidence-based practice as a seven-step process that includes the following:
- Cultivating a spirit of inquiry and evidence-based practice culture.
- Asking a focused, searchable, clinical question designed to find the best data in an efficient manner.
- Searching for the best evidence to answer the question.
- Critically appraising the evidence to determine its value.
- Integrating the evidence with clinical expertise and patient preferences to make the best decision.
- Assessing the outcome of implementing evidence-based practice.
- Sharing clinical experiences with colleagues.
Why Is Evidence-Based Practice Necessary?
In 2001, the Institute of Medicine (National Academy of Medicine [NAM] as of 2015) released a report titled Crossing the Quality Chasm: A New Health System for the 21st Century. It requests a major overhaul of our healthcare system. The report describes a number of fundamental, system-wide issues, including “a highly fragmented delivery system that largely lacks even rudimentary clinical information capabilities” that “results in poorly designed care processes characterized by unnecessary duplication of services and long waiting times and delays.” Other factors, including an aging population and a rise in patients with chronic diseases, further complicate the system.
The IOM report contains several recommendations for redesigning the nation’s healthcare system. One is the emphasis on the development and application of several competencies — among them are collaboration, information sharing, waste reduction and evidence-based practice.
What Evidence-Based Practice Means for Nurses
According to the Academy of Medical-Surgical Nurses (AMSN), nurses are likely already implementing evidence-based practice. For example, by helping to determine what is wrong with a patient, deciding on treatment based on research, administering treatment, then reassessing the patient, a nurse is using evidence-based practice.
In one hypothetical scenario, a nurse is caring for a patient with an unfamiliar disease. After the shift settles down, the nurse searches online for information on the disease and perhaps learns something new. The nurse can then take action by printing the article, sharing it with colleagues or writing about it in the patient’s chart.
At St. Luke’s Health System, nurses have also used evidence-based practice to solve problems and improve patient care. Projects have included reducing hospital-acquired anemia, workplace violence and work-related injuries. Those nurses also created a peer evaluation tool.
The online RN to BSN program at Arkansas State University prepares students to effectively implement evidence-based practice. The program offers Evidence-Based Practice, a core course that focuses on the nurse’s role in the research process. It provides the skills to evaluate and apply research. Mandatory liberal arts courses also help build critical thinking — a skill that is essential to evidence-based practice and advanced nursing roles.
According to The Online Journal of Issues in Nursing, “evidence-based practice holds great promise for moving care to a high level of likelihood for producing the intended health outcome.” It offers a more reliable way for nurses to care for their patients — instead of relying on subjective or outdated data. As the nation’s healthcare landscape evolves and becomes more complex, implementing evidence-based practice on a system-wide level will be essential.
Learn more about the Arkansas State online RN to BSN program.
Sources:
Beyea, S.C., RN, PhD, FAAN & Slattery, M. J., RN, MS. (2006). Evidence-Based Practice in Nursing: A Guide to Successful Implementation. http://hcmarketplace.com/media/supplemental/3737_browse.pdf
McDonald, Lynn, Ph.D. (2001). Florence Nightingale and the early origins of evidence-based nursing. http://ebn.bmj.com/content/4/3/68.long
Roberts, Sam. (2015). Dr. David Sackett, Who Proved Aspirin Helps Prevent Heart Attacks, Dies at 80. http://www.nytimes.com/2015/05/20/us/dr-david-sackett-who-proved-aspirin-helps-prevent-heart-attacks-dies-at-80.html
Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. (2010). http://journals.lww.com/ajnonline/Fulltext/2010/01000/Evidence_Based_Practice__Step_by_Step__The_Seven.30.aspx
Crossing the Quality Chasm: A New Health System for the 21st Century. (2001). http://www.nap.edu/read/10027/chapter/1
Evidence-Based Practice. (n.d.). https://www.amsn.org/practice-resources/evidence-based-practice
Nursing: Evidence-Based Practice. (n.d.). http://www.saintlukeshealthsystem.org/nursing-evidence-based-practice
Stevens, K. (2013, May 31). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html