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A Look at Evidence-Based Practice

It sounds obvious. Shouldn’t all healthcare be based on the best possible evidence? Yes, of course.

But there’s much more to evidence-based practice (EBP) than the name alone implies. EBP is one of the most powerful modern movements in medicine because it changes the nature and culture of care delivery by adopting deliberate and painstaking team-based, patient-centered, analytics-driven processes. The nursing profession plays a crucial role for each of those parameters, and EBP is becoming an important cornerstone of advanced nursing education.

What exactly is EBP? The Academy of Medical-Surgical Nurses defines EBP as “the conscientious use of current best evidence in making decisions about patient care” (derived from Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000).

Defining EBP, however, is much easier than putting it into practice, which involves three steps:

  1. Generate a clinical question based on a patient’s symptoms, and then search academic and applied research to find current relevant evidence to answer the question without regard to “how we’ve always done it.”
  2. Be highly and deliberately aware of the clinical expertise of each team member addressing the patient question. The goal is to make the most of specialized experience, overcome any lack of relevant experience, and help filter out bias.
  3. Incorporate the patient’s preferences and life values into the treatment plan.

As you can imagine, applying these steps requires the buy-in of EBP from the highest-level policymakers to everyone who has interaction with the patient and their families–with nurses and attending physicians at the fulcrum.

EBP is also a living, constantly updated process as new scientific evidence is compiled and analyzed, treatment efficacy is re-assessed, clinician expertise and education improves, and the needs and opinions of patients change over time.

What EBP Looks Like in Nursing Practice

Evidence-based practice is often best used to break mundane healthcare habits that yield impressive measurable results when improved.

The American Association of Critical-Care Nurses, for instance, reports that 72 percent to 99 percent of clinical alarms are false. Worse, “Patient deaths have been attributed to alarm fatigue.”

That’s a situation ripe for EBP intervention. Why do patients who do not need to set off a clinical alarm do so? Perhaps they merely want some modest attention or help, or they’re momentarily frightened. Could the alarm system be re-engineered to have different levels, from low to extreme? Could patients be encouraged to trigger more modest alarms for most needs? Could nurses learn those different levels and respond more appropriately to the true needs at hand? Would doing so measurably reduce nursing stress and improve patient outcomes?

In another example, The Online Journal of Issues in Nursing points to the importance of nursing uniforms in the quality of care, noting that “patients and families often expressed that they could not differentiate the skill levels of staff members.”

Could patients’ opinion of the skill level of nurses affect their care outcome? Could it affect nurses’ self-perception enough to improve care? Do patients follow orders better if they perceive a nurse in a more professional or authoritative light? Can these effects be measured in ways that help to propagate improved outcomes throughout the healthcare system?

These are the types of burning questions that arise when the EBP mindset is applied to practical healthcare delivery.

One of the greatest benefits of EBP processes is that they scale easily for issues of care, ranging from mundane to highly critical.

For example, assessing pain in patients is particularly difficult when they cannot speak, such as when they are severely ill, injured or on a mechanical ventilator. Historically, vital-sign assessment has been used to evaluate patient pain, but American Nurse Today, the official journal of the American Nurses Association, notes that “Only limited evidence suggests vital-sign assessment alone should be used to gauge pain.”

With training (improved expertise, an important element of the EBP process), nurses can gauge pain in nonverbal patients by such things as watching changes in facial expressions and tightness of body language.

In short, EBP challenges the way things have always been done at every level of healthcare through questions that lead to improved patient outcomes, with answers provided by scientific evidence, measurements that prove the outcome value of new practices, accumulated practitioner expertise, and high-quality patient communication.

The Future of EBP in Nursing

The Institute of Medicine (renamed the National Academy of Medicine in 2015) published a report on The Future of Nursing in 2010 that delivers four key messages to nurses and nursing students:

  1. Nurses should practice to the full extent of their education and training.
  2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
  3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.
  4. Effective workforce planning and policy making require better data collection and information infrastructure.

RNs who earn BSN degrees that focus on EBP will be much better suited for current and future demands of healthcare. High value will accrue to those with the ability to perform nursing research, assess existing research, define and improve practice guidelines, understand and apply quality improvement data, and use case studies to communicate with peers and patients.

Learn more about La Salle’s online RN to BSN program.


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