Nursing Education and Evidence What Is Evidence-Based Practice?
Evidence-Based Practice (EBP), sometimes referred to as evidence-based nursing, is a problem-solving approach to clinical care that combines the best current evidence from well-designed studies, a clinician’s expertise, and patient values and preferences. This practice model is aimed at achieving the highest quality of patient care outcomes by integrating scientific research into clinical decision-making.
Implementations of Evidence-Based Practice
When implemented effectively, EBP considers patient preferences and values, resulting in high-quality clinical decisions and improved patient outcomes (Melnyk & Fineout-Overholt, 2011). The process of EBP involves six consecutive steps:
- Asking the Clinical Question in PICO Format:
The first step involves formulating a clinical question using the PICO format, where P stands for patient population, I represents the intervention or area of interest, C denotes the comparison intervention or group, and O is the outcome. This structured question is critical for guiding the search process and establishing a foundation for retrieving relevant evidence from databases. - Searching for the Best Evidence:
The second step involves conducting a thorough search of electronic databases using relevant keywords and phrases to find articles that address the clinical question. The evidence is categorized into six hierarchical levels, ranging from the highest level (systematic reviews and meta-analyses, such as the Cochrane Reviews) to the lowest level (opinion of authorities or expert committees). - Critically Appraising the Evidence:
The third step requires a critical appraisal of the identified evidence, assessing its validity, reliability, and relevance to the specific patient context. This involves asking critical questions about the quality of the studies, the strength of their findings, and their applicability to clinical practice. - Applying the Evidence in Clinical Practice:
In the fourth step, the clinician combines the best available evidence with their clinical expertise and patient preferences to make informed decisions about care management. This step is crucial, as it involves tailoring evidence-based interventions to the specific needs and values of individual patients (Brenner & Leonard, 2005). - Evaluating the Outcomes of EBP Implementation:
The fifth step involves evaluating the outcomes of the implemented evidence-based interventions. This includes monitoring data on patient care and quality measures to identify what worked, what did not, and which patient populations benefited most. Continuous evaluation helps to refine EBP practices and enhance their effectiveness in different clinical settings. - Disseminating EBP Findings:
The final step is to share the outcomes of EBP initiatives with colleagues, both locally and nationally, through grand rounds, in-services, publications, and conference presentations. Disseminating the results prevents duplication of efforts and promotes the broader adoption of EBP as a standard for clinical decision-making.
Utilization of Evidence-Based Practice in Nursing Education
The utilization of EBP has gained significant emphasis in recent years, driven by multiple factors. One key reason is the explosion of information, with over 25,000 randomized controlled studies published annually. However, translating these research findings into clinical practice takes an average of 17 years. Accelerating this translation process has become a priority for many professional and healthcare organizations. For instance, the 2001 Institute of Medicine (IOM) report, “Crossing the Quality Chasm: A New Health System for the 21st Century,” emphasized the importance of evidence-based decision-making for healthcare management. The IOM has set a goal that by 2020, 90% of clinical decisions should be evidence-based (IOM, 2003).
Furthermore, organizations like the National Organization of Nurse Practitioner Faculty (2012) recommend that EBP be a core competency for nurse practitioners in their approach to client management. Hospitals aiming for Magnet designation must demonstrate quality nursing care through the use of EBP (American Nurses Credentialing Center (ANCC), 2013). Federal agencies, such as the Agency for Healthcare Research and Quality, have funded EBP centers to answer important clinical questions, ultimately improving healthcare delivery and patient outcomes.
When implemented, EBP leads to better patient outcomes by reducing mortality, morbidity, medical errors, and geographic variations in care (Pravikoff, Pierce, & Tanner, 2005). However, the adoption of EBP in nursing has been limited by various professional, organizational, and educational barriers. For example, a 2005 study indicated that some nurses were unfamiliar with EBP or did not see its value. Many nurses reported that their colleagues did not use research in practice and were not taught how to utilize electronic databases to find answers to clinical questions (Pravikoff et al., 2005).
Other barriers include a lack of time, limited access to resources, difficulty understanding statistical terms, and the persistence of outdated practices based on tradition rather than evidence. A culture within nursing organizations that does not value EBP can also hinder its use. Administration support is critical to provide nurses with the necessary tools, such as computer access, mentors, and dedicated time for EBP activities. If nurses face excessive clinical demands, they may not have time to engage in EBP activities.
Outcomes of Evidence-Based Practice
For the nursing profession to fully embrace EBP, several key groups need to be targeted: nursing faculty, nursing students, nurse educators in hospitals, and the existing nursing staff.
- Nursing Faculty:
Nursing faculty members play a crucial role in promoting EBP. They need to be well-versed in EBP processes to serve as role models for students. The framework of EBP should be integrated throughout both didactic and clinical courses to provide students with continuous exposure to evidence-based decision-making. - Nursing Students:
Students should be given opportunities to apply EBP principles during classroom discussions and clinical experiences. Educational programs at both undergraduate and graduate levels should shift from a focus on basic research to incorporating EBP in all aspects of the curriculum. - Hospital-Based Nurse Educators:
Nurse educators in hospital settings should develop programs such as journal clubs, where nurses can review current research, clinical guidelines, and participate in EBP skill development workshops. These activities can help less experienced nurses build the confidence and competence needed to engage in EBP. - Existing Nursing Staff:
All nurses must accept the professional responsibility of lifelong learning. Workshops and training sessions can help introduce experienced nurses, especially those who graduated before 1990, to EBP concepts and methods. Educators can serve as mentors to guide these nurses in developing the skills necessary to apply EBP in their daily practice.
Conclusion
Evidence-Based Practice is crucial for improving patient outcomes and advancing the nursing profession. It provides a structured approach for integrating the best available research with clinical expertise and patient preferences, resulting in high-quality, individualized care. For EBP to be successfully integrated into nursing practice, it requires a concerted effort from educators, students, healthcare organizations, and practicing nurses. By fostering a culture that values evidence-based decision-making, the nursing profession can ensure that its practices remain current, effective, and centered on patient care.