The International Council of Nurses defines evidence-based practice as “A problem solving approach to clinical decision making that incorporates a search for the best and latest evidence, clinical expertise and assessment, and patient preference values within a context of caring.”
Evidence-based practice (EBP) officially became a part of healthcare practice in the early 1990s. However, a 2001 report, Crossing the quality chasm: A new health system for the 21st century from the Institute of Medicine (IOM) accelerated the push for the implementation of EBP. The report stated that there was an “unacceptable gap between what we know and what we do in the care of patients.” A major part of the solution to that problem, according to the report, is EBP.
Studies support that conclusion, according to a 2016 article in Worldviews on Evidence-Based Nursing. Findings from multiple studies provide “irrefutable evidence” that indicates EBP, compared to patient care based on tradition, leads to the following:
- Higher quality and reliability of healthcare.
- Improved population health and patient outcomes, including the patient care experience.
- Reduced costs.
What Is EBP?
Evidence-based nursing practice is not the same as nursing research or quality improvement, although the processes interrelate, according to Evidence-Based Practice In Nursing: A Guide To Successful Implementation.
Quality improvement focuses on systems and processes as well as functional, clinical and financial outcomes. Nursing research is a systematic inquiry designed to develop, refine and extend nursing knowledge.
EBP goes beyond research to include clinical expertise and patient preferences as part of the decision-making process: “The use of EBP takes into consideration that sometimes the best evidence is that of opinion leaders and experts, even though no definitive knowledge from research results exists” (American Nurse Today). “Whereas research is about developing new knowledge, EBP involves innovation in terms of finding and translating the best evidence into clinical practice.”
EBP and Nursing Education
EBP is a paradigm shift that requires nurses to rely on more than what they have memorized. They must learn to ask questions and to retrieve, evaluate, integrate and use new evidence to make clinical decisions. Learning this process is an important part of nursing education.
One of the nine essential outcomes for a bachelor’s degree (BSN) education defined by the American Association of Colleges of Nursing (AACN) is “scholarship for evidence-based practice.” AACN states that, “[Graduates] will be able to recognize safety and quality concerns and apply evidence¬ based knowledge from the nursing profession and other clinical sciences to their practice.”
Integrating EBP into nursing education is an ongoing process. Some nursing programs, such as the Lamar University online RN to BSN program, include EBP in all nursing courses. Further, Lamar requires students to complete a specific course in nursing inquiry and evidence-based practice. This immersion prepares students to implement EBP in their jobs.
A Process for Evidence-Based Practice
Understanding processes for implementing EBP can guide nurses in their practice. Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice outlines the following steps for a successful EBP process:
- Nurture a spirit of inquiry that leads to questions about how to improve delivery of healthcare.
- Ask clinical questions. Use the PICOT format to search electronic databases:
- Patient population of interest (P).
- Intervention or area of interest (I).
- Comparison intervention or group of interest (C).
- Outcome of interest (O).
- Time (T).
- For example, a vague question such as “How effective is CPR?” is unlikely to yield good search results. A better question would be “In adults living in the community, what is the effectiveness of hands-only CPR compared to hands plus breathing?”
- Search for the best evidence using key words or phrases. Research databases such as MEDLINE or CINAHL are extensive. The more focused the search, the better the results.This step also involves recognizing that the strongest evidence usually comes from a systematic review, a meta-analysis, or an established evidence-based clinical practice guideline based on a systematic review. Other, but weaker, sources of evidence include randomized controlled trials (RCTs) and other types of quantitative studies, qualitative studies, and expert opinion and analyses.
- Critically assess the evidence. Nurses need to quickly evaluate articles to determine the most relevant, valid, reliable and applicable studies to the clinical question.Rapid critical appraisal involves three important questions:
- What are the results and are they important?
- Are the results of the study valid?
- Will the results help me care for my patients?
- After appraising each study, determine if the studies come to similar conclusions, thus supporting an EBP decision or change.
- Combine the evidence with clinical expertise — based on patient assessments, laboratory data and data from outcomes management programs — and patient preferences. According to the article, “There is no magic formula for how to weigh each of these elements; implementation of EBP is highly influenced by institutional and clinical variables.”
- After making practice decisions or changes based on evidence, evaluate the outcomes. An intervention that worked in a rigorously controlled trial may not work the same way in a clinical setting. Monitoring the effect of an EBP change can help nurses recognize implementation flaws and better identify which patients are most likely to benefit from EBP changes.
- Distribute EBP results. By sharing the results of an EBP implementation, nurses can prevent needless duplication. Ways to share these results include EBP rounds in the institution; presentations at professional conferences; and reports in peer-reviewed journals, professional newsletters and other publications.
Although this process may sound complicated, it does not have to be. The ABCs of Evidence-Based Practice in Nursing provides an example of how to use EBP in individual nursing practice. If a patient has a disease that their nurse isn’t familiar with, the nurse can search that disease online. If they find important information not mentioned in the patient’s chart, the nurse “can print the article and share it with colleagues, write about it in the nurse’s notes section of the patient’s chart, and then resume nursing duties. Using EBP at the bedside is the equivalent of looking up a medication in the formulary or a medication book to make sure the patient is receiving the correct medication.”
The implementation of evidence-based nursing is one of the most important changes in nursing practice of the twenty-first century. Nurses who make this shift can help improve patient care and outcomes.
Learn about the Lamar University online RN to BSN program.
(2008). The Essentials of Baccalaureate Education For Professional Nursing Practice. American Association of Colleges of Nursing
Beyea, S. C., and Slattery, M. J. (2006). Evidence-Based Practice In Nursing: A Guide To Successful Implementation. HCPro Healthcare Marketplace
Conner, B. T. (2014 June). Differentiating research, evidence-based practice, and quality improvement. American Nurse Today
(2012). Closing the Gap: From Evidence to Action. International Council of Nurses
Johansen, C. (2014, August 25). The ABCs of Evidence-Based Practice in Nursing. NurseTogether
Melnyk, B. M. et. al. (2010 January). Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. American Journal of Nursing
Melnyk, B. M. et. al. (2016 February). A Study of Chief Nurse Executives Indicates Low Prioritization of Evidence-Based Practice and Shortcomings in Hospital Performance Metrics Across the United States. Sigma Theta Tau International
Stevens, K. (2013 May). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. The Online Journal of Issues in Nursing
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