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Nursing

Evidence Based Practice

Evidence Based Practice

 

The American Nursing Association states, "Evidence-based practice [EBP] in nursing involves providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs." EBP relies on research in clinical decision making. 

Bernadette Mazurek Melnyk, Lynn Gallageher-Ford, Ellen Fineout-Overholt, Implementing the Evidence-Based Practice (EBP) Competencies in Healthcare: a Practical Guide for Improving Quality, Safety, and Outcomes, 2016.

 

"Evidence-based practice is associated with improved patient outcomes, enhanced patient safety, and lower health care costs. The first step to achieving EBP in the nursing profession is to educate and empower RNs to develop a spirit of inquiry. Nursing professional development specialists are optimally prepared to develop CPD [Continuing Professional Development] activities that emphasize EBP."

Taken from: Cuzmenco S. Strategies to Achieve Evidence-Based Practice in Nursing. Critical Care Nurse. 2024;44(1):10-11. doi:10.4037/ccn2024359

0. Cultivate a spirit of inquiry within an EBP culture and environment.

1. As the Clinical question in a PICOT (patient, intervention, comparison, outcome and time) format.

2. Systematically search for and collect the most relevant best practice.

3. Critically appraise the evidence.

4. Integrate the best evidence with one's clinical expertise and patient-/family-valued preferences in making a practice decision or change.

5. Evaluate outcomes of a practice decision or change based on evidence.

6. Disseminate the outcomes of the EBP decision or change.

Taken from: O’Brien T, Hood A, Spalla King T, Brinkman B. Nurturing a Spirit of Inquiry: Fundamentals of Evidence-Based Practice in Nursing. Nephrology Nursing Journal. 2023;50(6):509-511. doi:10.37526/1526-744X.2023.50.6.509

  1. Ask a clear question about the patient's issue and determine an ultimate goal, such as improving a procedure to help their specific condition. 
  2. Acquire the best evidence by searching relevant clinical articles from legitimate sources.
  3. Appraise the resources gathered to determine if the information is valid, of optimal quality compared to the evidence levels, and relevant for the patient.
  4. Apply the evidence to clinical practice by making decisions based on your nursing expertise and the new information.
  5. Assess outcomes to determine if the treatment was effective and should be considered for other patients

You can find this information here.

Four primary levels of evidence come into play when you're making clinical decisions.

  1. Level A acquires evidence from randomized, controlled trials and is considered the most reliable.
  2. Level B evidence is obtained from quality-designed control trials without randomization.
  3. Level C typically gets implemented when there is limited information about a condition and acquires evidence from a consensus viewpoint or expert opinion.
  4. Level ML (multi-level) is usually applied to complex cases and gets its evidence from more than one of the other levels.