The Evidence Based Practice As Nurses Core Competency for Quality And Safety Education. The objective is to establish a set of core EBP competencies for nurses and the most important EBP learning outcomes, which include the dimensions of attitudes, knowledge, and skills.
The Evidence Based Practice As Nurses Core Competency for Quality And Safety Education
Evidence-based practice (EBP) is a core competency for nursing staff and essential for improving the quality and safety of patient care. The Quality and Safety Education for Nurses (QSEN) project and other initiatives underscore the importance of EBP in nursing education and practice. EBP uses the best available research to guide clinical decisions and ensures that care is based on the most recent knowledge, not on tradition or personal opinions.
Evidence-Based Practice
Evidence-based practice promotes best practices, clinical expertise, patients’ values, and patients’ circumstances in health-care decisions and avoids underuse, misuse, and overuse of care (Greiner & Knebel, 2003). The IOM defines evidence-based practice as “integrating best research with clinical expertise and patient values for optimum care, and participating in learning and research activities to the extent feasible” (pp. 45–46). The skills related to this competency identified by the IOM include the following (Greiner & Knebel, 2003, pp. 57–58):
- Know where and how to find the best possible sources of evidence.
- Formulate clear clinical questions.
- Search for the relevant answers to those questions from the best possible sources of evidence, including those that evaluate or appraise the evidence for its validity and usefulness with respect to a particular patient or population.
- Determine when and how to integrate these new findings into practice.
Patient safety and quality care require the use of evidence-based practice to guide nursing practice and reduce variations in care. With that in mind, the nursing core competency of evidence-based practice is defined as “integrating best current evidence with clinical expertise and patient/family preferences and values for de livery of optimal healthcare” (Cronenwett et al., 2007, p. 126).
Evidence-based practice also integrates methodologically sound evidence from nursing research, clinical expertise, and patients’ preferences to facilitate clinical decision making (DiCenso, Guyatt, & Ciliska, 2005). Nurses should use evidence-based clinical decision making to individualize nursing care based on a patient’s specific circumstances. To integrate evidence into practice, nurses must best identify searchable clinical questions by using the five-step approach outlined by Melnyk and Fineout-Overholt (2011).
First, nurses need to identify a clinical question. One technique is to use the PICOT method to ask a searchable question. (PICOT stands for Population/Patient Problem, Intervention, Comparison, Outcome, Time). Second, nurses must collect the best evidence relevant to the question using key words from the PICOT question to begin the search. Third, nurses should critically appraise the evidence before using it, by evaluating the studies for validity, reliability, and applicability. This step ensures the relevance and transferability of evidence to the specific population for whom nurses provide care (Melnyk & Fineout-Overholt, 2011).
Fourth, the evidence should be integrated with the other aspects of evidence-based practice. During this step, nurses need to incorporate the evidence using their expertise and the patient’s preferences to implement care. Finally, nurses should evaluate their practice decision or change to determine whether it affected the patient’s outcome. To use the evidence effectively to answer a clinical question and inform care delivery, nurses should also ask the following questions (DiCenso, Guyatt, & Ciliska, 2005, p. 51):
- Are the results of the study valid?
- What are the results?
- How can I apply these results to patient care?
It is important for nurses to remember that evidence can include a variety of research and non-research sources and that some sources of evidence are stronger than other sources. Sources of evidence are categorized into levels and are rated according to their strength (DiCenso, Guyatt, & Ciliska, 2005; Melnyk & Fineout-Overholt, 2011; Polit & Beck, 2014). There are numerous resources, preprocessed and unprocessed, available to nurses.
Studies included in preprocessed databases have been reviewed before inclusion, are updated regularly, and consist of the most methodologically sound and clinically important studies (DiCenso, Guyatt, & Ciliska, 2005). Popular pre processed databases include the Cochrane Library (www.thecochranelibrary.com) and Joanna Briggs Institute. Unprocessed databases consist of original studies of excellent to poor quality; examples of unprocessed databases include the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and the National Library of Medicine’s MEDLINE.
Evidence should inform all nursing care. Safe and quality care requires basing nursing practice on the most current and best available knowledge. Evidence based practice is critical in the quest for patient safety and quality care. The fundamental elements of evidence-based practice are nursing research, the relationship with quality improvement, clinical practice guidelines, and evidence based management.
Nursing Research
Evidence-based practice should not be confused with nursing research. Nursing research is a systematic inquiry that uses disciplined methods to answer questions or solve problems. The goals of nursing research include generating, testing, or evaluating knowledge and developing reliable evidence about issues important to the nursing profession (Polit & Beck, 2014).
Nurses have a duty to advance the profession through knowledge development and dissemination as well as application to practice. “All nurses must participate in the advancement of the profession through knowledge development, evaluation, dissemination, and application to practice” (ANA, 2015a, p. 27). Rigorous nursing research provides one of the best sources for evidence-based practice.
Relationship With Quality Improvement
Quality improvement is also not the same as evidence-based practice. Quality improvement is a cyclical process designed to monitor and evaluate workflow and work processes. It can include data collection and analysis but has no theoretical foundation. Quality improvement uses benchmarks to measure practice against established standards and provides methods to improve nursing practice continually.
Hedges (2006) discusses the “three-legged stool” of nursing practice—evidence-based practice, quality improvement, and nursing research— and breaks down each element as inquiry processes that support nursing practice. She suggests that nurses can strengthen the foundation of nursing practice by using quality improvement to monitor nursing practice and patient outcomes, systematically reviewing the evidence using evidence-based practice, and conducting scientific studies through nursing research.
Clinical Practice Guidelines
Clinical practice guidelines are tools for clinicians to improve the quality and process of care delivery and patient outcomes and to reduce variations in care and health-care costs. These guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances” (IOM, 1990, p. 38).
Clinical practice guidelines gather, appraise, and combine evidence and attempt to address issues relevant to a clinical decision. Moreover, they balance risk and benefits and inform health-care clinicians (DiCenso, Guyatt, & Ciliska, 2005). Nurses must be involved in developing practice standards “grounded in nursing’s ethical commitments and developing body of knowledge . . . reflect nursing’s responsibility to society” (ANA, 2015a, p. 28). The National Guideline Clearinghouse (www.guideline.gov) and the Registered Nurses’ Association of Ontario are two major sources of clinical practice guidelines for nurses.
Evidence-Based Management
Using evidence-based clinical practice when caring for patients is critical in providing safe and quality care. Best practices and advances in organizational, leadership, and management research when carrying out leadership and management roles should also be considered.
Evidence-based management is defined as “making decisions through the conscientious, explicit, and judicious use of four sources of information: practitioner expertise and judgment, evidence from the local context, a critical evaluation of the best available research evidence, and the perspectives of those people who might be affected by the decision” (Briner, Denyer, & Rousseau, 2009). The IOM asserts that evidence-based management is critical to achieving safety in health care (Page, 2004).
Evidence-based management includes management strategies informed by rigorous research and requires managers “to search for, appraise, and apply empirical evidence from management research in their practice” (Page, 2004, p. 113). Evidence-based management is discussed throughout this text.
Therefore, only a brief discussion as it relates to the core competency of evidence based practice and nursing leadership and management is included here. To foster an environment conducive to patient safety requires leadership capable of transforming both the physical environment and the beliefs and practices of health-care workers. The IOM identifies five management practices that consistently contribute to the success of patient safety initiatives in spite of a high risk for error (Page, 2004, p. 108):
- Balancing the tension between production efficiency and reliability
- Creating and sustaining trust throughout the organization
- Actively managing the process of change
- Involving workers in decision making pertaining to work design and flow
- Using knowledge management practices to establish the organization as a learning organization
Despite the evidence that these essential practices minimize threats to patient safety, they are not applied consistently. Therefore, the IOM recommends promoting evidence-based management practices to identify and minimize management decisions on patient safety (Page, 2004).
Read More:
https://nurseseducator.com/didactic-and-dialectic-teaching-rationale-for-team-based-learning/
https://nurseseducator.com/high-fidelity-simulation-use-in-nursing-education/
First NCLEX Exam Center In Pakistan From Lahore (Mall of Lahore) to the Global Nursing
Categories of Journals: W, X, Y and Z Category Journal In Nursing Education
AI in Healthcare Content Creation: A Double-Edged Sword and Scary
Social Links:
https://www.facebook.com/nurseseducator/
https://www.instagram.com/nurseseducator/
https://www.pinterest.com/NursesEducator/
https://www.linkedin.com/in/nurseseducator/
https://www.researchgate.net/profile/Afza-Lal-Din
https://scholar.google.com/citations?hl=en&user=F0XY9vQAAAAJ