Evidence-based practice is “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.” (Sackett D, 2000). That is do the best in the client care and service delivery, and stay in contact with the literature to use it in the clinical decision making.
Evidence-based practice weighing the value of the research evidence with clinical data and informed client choice. We must know what the research has to say, share the knowledge with the clients, and make the decisions about care in base our evaluation. It is important to record both, the decisions made and the evidence used to demonstrate the clinical decision is helping reach the client’s goals. Evidence-based practice is based on understand and evaluate the available research evidence and their own practice. Evaluating all the evidence would be a time consuming process and therefore a systematic approach to interpreting the research is required.
Directions in nursing education in the 60s established nursing as a science. This was the entry of the new profession into a new age. By the 90s it become clear that producing new knowledge was not enough. For having a better effect in patient outcomes, new knowledge should be transformed into a new way, clinically useful, implemented across the care team, measuring the impact on performance and health outcomes. The future of nursing focuses on the convergence of knowledge, quality, and new functions in nursing. The recommendation that nurses lead inter-professional teams by improving delivery systems and care brings the necessity for new competencies that are requisite as nurses transform healthcare by using knowledge in clinical decision making and producing research evidence on interventions that promote uptake and use by individual providers and groups of providers.
For evidence-based practice being successfully adopted, healthcare professionals including nursing, recognize that it must be adopted by individual care providers, microsystem and system leaders. Federal, state, local, and other regulatory and recognition actions are necessary for Evidence-based practice adoption. The profession of nursing has been a leader in the rapid adoption of evidence-based practice and using it in health care perfection. Nurses has positive attitudes thru evidence-based practice and wished to gain more knowledge and skills.
Nurses still face significant barriers employing evidence-based practice in practice, and still has more to do to achieve evidence-based practice. One example of implementation of evidence-based practice points to the challenges of change. The evidence-based program, Team Strategies and Tools to Enhance Performance and Patient Safety (AHRQ, 2008) carries with it proven effectiveness of reducing patient safety issues and the program is available with highly-developed training and learning materials. Yet, because of the change necessary to fully implement and sustain the program across the system supported by organizational culture, a sophisticated implementation plan is required before the evidence-based intervention is adopted across an institution.
Basically, evidence-based practice has been around all along, we just didn’t call it that. For example, we’ve been taught for years that early ambulation prevents pneumonia and DVT after abdominal and other surgeries. Now, there is studies and research to actually back that theory up, hence evidence-based practice.
Nursing research has been impacted by recent far-reaching changes in the healthcare research enterprise. Never before in healthcare history has the focus and formalization of moving evidence-into-practice been as sharp as is seen in today’s research on healthcare transformation efforts. Nascent fields are emerging to understand how to increase effectiveness, efficiency, safety, and timeliness of healthcare; how to improve health service delivery systems; and how to spur performance improvement.
These emerging fields include translational and improvement science, implementation research, and health delivery systems science. Investigation into uptake of evidence-based practice is one of the fields that has deeply affected the paradigm shift and is woven into each of the other fields. Investigation into evidence-based practice uptake is equivalent to investigating Star Point 4 (integration of evidence-based practice into practice). Several notable federal grant programs have evolved to foster research that produces the evidential foundation for effective strategies in employing evidence-based practice. Among the new research initiatives are the Clinical Translational Science Awards and the Patient-Centered Outcomes grants.
When the public cry for improved care escalated, rapid movement of results into care was brought into sharper focus in healthcare research. The National Institutes of Health (NIH), including the National Institute for Nursing Research (NINR), developed the Clinical Translational Science Award (CTSA) program to speed research-to-practice by redesigning the way healthcare research is conducted (Zerhouni, 2005). The term, translational science, was coined, and the definition was provided by NIH.
Nurses are involved in each of the 60 CTSAs that were funded across the nation. Nurse scientists have been significant leaders in the CTSA program, conducting translational research across these two areas. Nurses are involved in each of the 60 CTSAs that were funded across the nation, contributing from small roles and large roles, ranging from advisor and collaborator to principal investigator. As part of the CTSAs, nurse scientists conduct basic research and applied research, adding significantly to the inter-professional perspectives of the science. In relation to EBP, nurses are valued contributors to the “T2” end of the continuum of translational science, applying skills in mixed methods and systems settings.
Some advantages and benefits of this new trend to professional nurses for this model is a strategy for research support clinical practice and mutually reinforcing, the best research underpinning the professional experience of clinicians. Supports ongoing professional training and encourages them to increase in-depth knowledge of the research methodology to be able to assess from the point of view critical research studies that find. Helps to increase the body of nursing knowledge to validate the scientific method as the best tool for understanding reality, able to generate valid and relevant to professional practice knowledge. It allows greater job satisfaction, to encourage teamwork.
You can facilitate effective and efficient practice nurse, to be based on rigorous studies. Health professionals reinforce security in the care they give their power and autonomy, thereby improving communication between health professionals and patients. The lack of training in research methodology that allows a critical reading of the same. Some collective professional nurse may have some difficulties to assume the characteristics of an autonomous professional responsibilities, given his previous career. In the knowledge society in which we live, knowledge is changing so rapidly that it is necessary that the professional skills available that allow you to stay current on what research results are concerned. The lack of these, as well as care work overload that is subjected prevented, on many occasions, that the knowledge acquired during their university education are reviewed.
The most important not to use the evidence in order of priority barriers, insufficient time for nurses to implement new ideas in their work, not enough time to read research organizations that do not provide the necessary structures to implement the evidence, followed by difficulty presented by the nurses to understand the statistics, sense of isolation nurses colleagues to discuss the findings and the lack of cooperation of doctors, among others, low motivation in the study, low professional development opportunities and lack of recognition become more visible lack of update in our discipline, deteriorating knowledge and clinical practice. Nurses have to use in daily practice evidence obtained through research is not easy, it’s a long way to be done through training and encouragement both nurses interested as future generations. It should not only teach research tools to deliver research methodology but also to use the results. Clearly, the more effectively achieved in care is directly related to the decrease in the costs of health care.
Barriers to evidence-based practice.
-Mis-communication among nurse leaders about the process involved. -Inferior quality of available research evidence. -Inability to access and use research evidence. -Unwillingness of organization to fund research and make decisions based on evidence. – Concern that EBP will cause a “cookbook” approach to nursing while ignoring individual client needs and the nurse’s ability to make clinical decisions.
When considering resources, it is important to understand how some research designs will produce stronger levels of evidence than others. This has led to the concept of hierarchy of evidence and levels of evidence. The hierarchy “provides a framework for ranking evidence that evaluates healthcare interventions and indicates which studies should be given the most weight in an evaluation where the same question has been examined using different types of study” (Akobeng, 2005).
Systematic Review: Once many studies have been published on a particular topic, researchers and clinicians will systematically gather, evaluate, and appraise the findings into one document. Systematic reviews are different from literature reviews because they have clearly prescribed criteria for each step of the review process and they only include the most appropriate types of studies/data, yet they also are based on very wide, extensive searches of information. (Brown, 2009)
Integrated Research Review (IRR): Type of systematic review in which reviewer extracts findings from original studies, uses analytical reasoning to make conclusions, and presents conclusions in the form of narrative summaries. (Brown, 2009)
Meta-analysis: Type of systematic review in which reviewer uses quantitative methods and statistical techniques to combine results from different original studies. (Brown, 2009)
Critically Appraised Topic: Summary and evaluation of multiple research studies that focuses on answering a specific clinical question. (Heneghan & Badenoch, 2006)
Critically Appraised Article: Summary and evaluation of a single research study that focuses on answering a specific clinical question.
Randomized Controlled Trials (RCT): Experimental studies that represent advanced testing of an intervention. They have defined study protocols and typically large, diverse samples. (Brown, 2009)
Cohort Study: A study in which a sample is drawn from a larger population. The sample is divided into two groups (called cohorts): one with the risk factor or exposure and one without. The cohorts are followed for a period of time and outcomes are assessed and compared. (Brown, 2009)
Case-Control Study: A study that identifies persons with and without a particular outcome of interest and looks backward in the history of the two groups to identify possible causes. Unlike cohort studies that identify risks and monitor outcomes, case-control studies identify outcomes and work backward to identify possible causes of those outcomes. (Brown, 2009)
Background Information / Expert Opinion: Use background information from textbooks and other medical books to better familiarize yourself with a topic before beginning your research or as needed throughout the research process.