How evidence-based Practice improves outcome
Evidence based practice (EBP) is the clinical decision making process which is based upon the best available evidence, new research findings, clinical experience and patient preferences. Nurses are expected to implement research findings into their practice, but many are not trained on how to do this. Therefore, it should not be expected that nurses are at the forefront of EBP implementation in the clinical setting.
Continuing professional development (CPD) is a requirement for practice as a registered nurse (RN) as outlined by AHPRA. This acts to maintain, improve and broaden knowledge, expertise and competence to develop the personal and professional qualities throughout an RN’s professional life. To meet this registration standard, a minimum of 20 hours of CPD hours is required per registration year, yet this can be unattainable for many RNs practicing.
Nurses have a right to refuse to participate in procedures which they judge on strongly held religious, moral and ethical beliefs, to be unacceptable. Fear, personal convenience or preference, are not sufficient basis for conscientious objection.
How evidence-based Practice improves outcome
The concept of evidence-based practice is usually mistaken as the application of research outcomes to the exclusion of various core elements of practice, like practitioner expertise and patient preferences. Currently, patients are not only viewed as the recipients of care but are perceived as consumers of the health service (Chang & Daly, 2015). As such they have a right to receive clinically appropriate care, which making it crucial for nurses to use evidence-based practice. The evidence-based practice tries to fill the gaps in patient care for better outcomes and a healthier society by incorporating clinical experience and evidence (Moxham, 2012). The evidence-based practice takes into account the values to improve the patients’ experiences. The evidence-based practice uses a systematic approach in practices and emphasizes on the application of the best evidence and experiences as well as values and preferences of clients, in decision-making about patients treatments.
Examples of advantages of applying the evidence-based technique to care can be found in different clinical specialties. For instance, in neonatal care, the evidence-based practice of offering surfactant in the delivery room, immediately after birth, instead of the traditional process of administering the same after two hours, improves the outcome of the procedures. Similarly, use of preventive educational-behavioural intervention scheme has resulted in improved health outcomes for critically ill young children and their mothers. Such significant evidence from practical clinical settings illustrates how the use of EBP improves patient outcomes (Duff et al., 2016) It can also be argued that since EBP is based on evidence, the least performing interventions are not usually implemented reducing the chances of failures of the implemented interventions.
How is evidence-based practice applied theoretically and clinically?
The main way of theoretical application of EBP is in the academic field. In research studies, in schools, students, especially those undertaking healthcare related courses, are often given tasks where they are asked to undertake them using evidence to support their works (O’Brien et al., 2014) For instance, there are cases where students are given case studies on a patient suffering a certain disease and asked to determine the best intervention using EBP approach (Florin, Ehrenberg, Wallin & Gustavsson, 2012). In the clinical field is where the practitioners are presented with the actual patient or condition. They are then expected to make a clinical decision that is accepted and has a high probability of addressing the condition as stipulated by Standard 7 of the Nursing & Midwifery Board of Australia (NMBA) Registered Nurse Standards for Practice. The nurses will make these decisions based on their experience or the experience of others.
What Implementation of EBP in clinical setting entails
The implementation of the EBP approach in the practical field requires the practitioner to execute certain steps, these are;
- Ask clinical guiding questions: The role of the questions is to give the practitioner the insight of what he/she is dealing with. These questions are usually summarized as PICOT; i.e. P-Problem, population, or patient; I-intervention; C-comparison (intervention); O-outcome; Time-period. The questions should be valid and specific to eliminate other issues (Harvey & Kitson, 2015).
- Look for the appropriate evidence; this involves selection of information databases and resources that have a high probability of answering the questions asked (Hoffmann, Montori & Del Mar, 2014). Usually, concepts and keywords are used in doing the search. There are various, known, medical databases that can be used to perform these searches, and are accessible for free.
- Critical appraisal of the evidence; the collected evidence from the previous stage are evaluated for their validity, reliability, as well as applicability (Hoffmann, Montori & Del Mar, 2014). The strengths and weaknesses of these evidence pieces are evaluated based on their ability to address the dynamics of the current problem.
- Integration of evidence with the clinical expertise of the individual; after considering the pieces of evidences and selecting the most appropriate ones, what follows is the linking of the pieces of evidence to the current realities. The practitioner will consider, among other things, the epidemiologic, biologic as well as the socioeconomic issues related to the intervention. For instance, the ability of the patient to support the intervention, financially, must be considered. Also, the preference and vales of the patient must be considered.
- Evaluation of the outcome of the EBP decision; the practitioner should then monitor the changes in the client after implementation for the selected intervention to determine whether the intervention is working as stipulated in the Nursing & Midwifery Board of Australia (NMBA) Registered Nurse Standards for Practice. When the condition of the patient is improving it shows that the intervention is working. However, when the conditions remain the same or are deteriorating, it indicates the poor performance of the selected intervention. There are different factors that may interfere with the potential of an intervention. For instance, when the intervention was not effectively or successfully implemented.
- Disseminating the outcome; Information sharing is crucial in the nursing field. It is crucial that the practitioners share their experiences with using various interventions (Hoffmann, Montori & Del Mar, 2014). For instance, when a nurse implements an intervention and obtains that it is working, it crucial that the individual share this information. Similarly, the individual should share his/her sentiments when an intervention fails to work (Hoffmann, Montori & Del Mar, 2014). The information sharing improves the overall quality of service delivery.
Is it feasible to expect RNs to Implement EBP in a clinical setting without training?
There are various principles that guide the use of EBP. These principles are key in successful operations of the approach. However, RNs who are not trained on EBP may not know the principles the approach. As such, they may find it difficult to apply. For instance, a non-trained person may not know the correct databases to use and how to incorporate the research findings in the practical setting. The non-trained individuals may not know how to appraise evidence critically, and this may lead to the poor selection of intervention, affectivity the quality of healthcare delivery. There are certain structures that are needed to support ERP. These structures may include the Internet and the devices for accessing the databases. When these support systems are not available, the ability of the RNs to implement evidence-based practices is negatively influenced.
The role of RNs in implementing the EBP
RNs are expected to offer leadership when it comes to implementation of the
EBP. The RNs are the ones who are faced with circumstances requiring
evidence-based practice. There are many cases where questions of validity and
effectiveness of the current practices are raised (Scanlon et al., 2016). The nurses should, therefore, develop a
habit of asking for the best pieces of evidence that the interventions are
working (Malik, McKenna & Griffiths, 2016).
The nurses have the mandate to undergo training and understanding the best
techniques and approaches to using evidence-based practice.
Chang, E. and Daly, J., 2015. Transitions in nursing: Preparing for professional practice. Elsevier Health Sciences.
Duff, J., Butler, M., Davies, M., Williams, R. and Carlile, J., 2016. Factors that predict evidence use by Australian perioperative nurses. ACORN: The Journal of Perioperative Nursing in Australia, 29(2), p.24.
Florin, J., Ehrenberg, A., Wallin, L. and Gustavsson, P., 2012. Educational support for research utilization and capability beliefs regarding evidence‐based practice skills: a national survey of senior nursing students. Journal of advanced nursing, 68(4), pp.888-897.
Harvey, G. and Kitson, A., 2015. Implementing evidence-based practice in healthcare: a facilitation guide. Routledge.
Hoffmann, T.C., Montori, V.M. and Del Mar, C., 2014. The connection between evidence-based medicine and shared decision making. Jama, 312(13), pp.1295-1296.
Malik, G., McKenna, L. and Griffiths, D., 2016. How do nurse academics value and engage with evidence-based practice across Australia: Findings from a grounded theory study. Nurse education today, 41, pp.54-59.
Moxham, L., 2012. Nurse education, research and evidence-based practice.
Nursing & Midwifery Board of Australia (NMBA)
Registered Nurse Standards for Practice.
O’Brien, A., Giles, M., Dempsey, S., Lynne, S., McGregor, M.E., Kable, A., Parmenter, G. and Parker, V., 2014. Evaluating the preceptor role for pre-registration nursing and midwifery student clinical education. Nurse education today, 34(1), pp.19-24.
Scanlon, A., Cashin, A., Bryce, J., Kelly, J.G. and Buckely, T., 2016. The complexities of defining nurse practitioner scope of practice in the Australian context. Collegian, 23(1), pp.129-142.