Evidence Based Practice In Health Care Evidence-based practice (EBP) is a fundamental approach in nursing that integrates the best available research evidence with clinical expertise and patient values to guide decision-making and improve patient outcomes. This practice emphasizes the importance of using research findings as a basis for nursing interventions, ensuring that care is grounded in scientific evidence rather than tradition or anecdotal experience. EBP aims to enhance the quality of care and patient safety while promoting cost-effectiveness within healthcare systems.
Historical Overview
The roots of evidence-based practice can be traced back to the late 20th century when the need for a more scientific approach to healthcare became evident. During the 1960s and 1970s, key figures such as N. Caplan and Rich (1975) introduced the concepts of instrumental and conceptual utilization, highlighting the importance of research in influencing clinical practice. Caplan and Rich differentiated between two types of research utilization: instrumental utilization, where practice changes directly based on empirical evidence, and conceptual utilization, where research influences thinking but does not lead to immediate changes in behavior.
Over the years, this evolution has been characterized by terms like “knowledge creep,” where new information gradually influences practice, as described by C. Weiss (1980). The work of Estabrooks (1999) further refined this understanding by identifying three types of research utilization: indirect, direct, and persuasive. These concepts set the stage for the formalization of evidence-based practice as a distinct and essential aspect of nursing.
In the 1970s, notable initiatives like the Western Interstate Commission for Higher Education (WICHE) Regional Program and the Conduct and Utilization of Research in Nursing (CURN) project aimed to bridge the gap between research and practice. The CURN project specifically sought to enhance the utilization of research findings in daily practice through dissemination of information, collaborative research, and supportive organizational changes.
The Cochrane Collaboration, founded in the UK in the late 1970s, played a pivotal role in the evidence-based movement. Archie Cochrane advocated for the need for reliable clinical summaries to guide healthcare providers in making informed decisions. This led to the establishment of systematic reviews that synthesize evidence across studies, providing a foundation for evidence-based guidelines.
David Sackett further advanced the concept of evidence-based medicine (EBM) at McMaster Medical School, emphasizing the integration of individual clinical expertise with the best available external evidence. His definition of EBM laid the groundwork for evidence-based practices in nursing, as it underscored the need to use research findings in conjunction with clinical judgment and patient preferences.
Efforts Leading to Evidence-Based Practice
The push for evidence-based practice has continued to grow, fueled by a recognition of the limitations of traditional practices based solely on authority or expert opinion. Healthcare organizations, educational institutions, and professional nursing associations have increasingly embraced EBP as a standard for quality care.
In nursing education, the incorporation of EBP into curricula has become essential. Nursing programs now emphasize critical thinking, research appraisal, and the integration of evidence into clinical practice. This preparation is crucial for empowering future nurses to make informed decisions that enhance patient care.
Research organizations and funding bodies have also prioritized studies that focus on EBP, leading to a greater emphasis on conducting high-quality research that addresses clinical questions relevant to nursing practice. As a result, the landscape of nursing research has evolved, with more studies focusing on the effectiveness of interventions, patient outcomes, and the application of evidence in diverse clinical settings.
Evaluation of Evidence-Based Practices
Rigorous evaluation of evidence is a cornerstone of evidence-based practice. Various rating systems have been developed to assess the strength of evidence supporting different interventions. These systems categorize evidence based on methodological rigor, with meta-analyses and randomized controlled trials (RCTs) considered the highest level of evidence. Quasi-experimental studies, nonexperimental studies, and expert opinions follow in decreasing order of evidence strength.
The evaluation of evidence also extends to the application of findings in clinical practice. Implementing EBP requires careful consideration of the context in which care is delivered, including organizational culture, available resources, and patient characteristics. By systematically evaluating evidence and its applicability to specific patient populations, nurses can make informed decisions that improve care quality and outcomes.
Evaluation Models
Several models have been developed to guide the implementation of evidence-based practices in nursing. Two notable models are the Stetler Model and the Iowa Model, both of which provide frameworks for integrating research findings into clinical practice.
The Stetler Model emphasizes a systematic approach to evidence-based practice, encompassing the following steps:
- Identify a Clinical Problem: Recognizing a specific issue in practice that requires evidence-based solutions.
- Collect Evidence: Conducting a thorough review of the literature to gather relevant research findings.
- Review and Synthesize Evidence: Evaluating the quality and applicability of the evidence collected and synthesizing findings into a cohesive understanding.
- Plan the Change: Developing a plan for implementing the evidence-based change in practice.
- Pilot Project: Designing, implementing, and evaluating a pilot project to test the feasibility of the proposed change.
- Evaluate Larger Project: Expanding the successful pilot to a larger scale while continuously evaluating outcomes.
- Disseminate Results: Sharing findings and lessons learned with the broader nursing community.
The Iowa Model similarly emphasizes the importance of problem identification, evidence appraisal, and the integration of research into practice. It provides a structured approach to facilitate change in clinical settings and promote the adoption of evidence-based interventions.
Informatics and Evidence-Based Practice
In recent years, informatics has emerged as a critical contributor to evidence-based practice. The integration of technology into healthcare allows for the efficient dissemination of evidence, streamlined access to research, and improved decision support systems. Informatics tools, such as electronic health records (EHRs) and clinical decision support systems, facilitate the implementation of evidence-based guidelines at the point of care.
For example, when a patient is admitted for a specific procedure, reminders can be sent to healthcare providers regarding evidence-based practices, such as recommended antibiotic prophylaxis or adjustments in care based on laboratory results. By utilizing technology to enhance clinical decision-making, nurses can minimize errors and improve patient outcomes.
Challenges and Barriers to Evidence-Based Practice
Despite the advancements in evidence-based practice, several challenges persist in its implementation. One significant barrier is the lack of familiarity and training among nursing staff regarding EBP principles and research appraisal. Many nurses may feel overwhelmed by the volume of available research or lack the skills necessary to critically evaluate evidence.
Additionally, organizational culture can play a significant role in the adoption of evidence-based practices. Healthcare environments that prioritize traditional practices or are resistant to change may hinder the implementation of EBP. Leaders in nursing and healthcare must advocate for a culture that values evidence-based approaches and supports ongoing education and training for staff.
Conclusion
Evidence-based practice represents a paradigm shift in nursing care, emphasizing the integration of research findings, clinical expertise, and patient values to guide decision-making. As the healthcare landscape continues to evolve, nurses must remain committed to utilizing the best available evidence to improve patient outcomes and enhance the quality of care. Through ongoing research, education, and advocacy, the nursing profession can continue to advance evidence-based practices that address the diverse needs of patients in a rapidly changing healthcare environment. The future of nursing care lies in the effective implementation of evidence-based principles, ultimately leading to improved health outcomes and quality of life for patients.