What Is Evidence-Based Practice?

Florence Nightingale

Health practitioners today use evidence-based practice to guide their patient care decisions. Many sources attribute early evidence-based practice to Florence Nightingale, and since then, it has evolved into a crucial practice that improves patient care.

The History of Evidence-Based Practice

There are examples of evidence-based practice to varying degrees throughout history. In 1747, Sir James Lind, a young naval surgeon, conducted a controlled clinical trial to find preventions for scurvy, a condition that killed many sailors during that period.

During the nineteenth century, according to Evidence-Based Nursing, Florence Nightingale used evidence-based practice during the course of her work. After returning from the Crimean War, she wanted to understand why so many soldiers were dying of disease, so she teamed up with experts in sanitation, one of whom was also a statistician. The royal commission report recommended a statistical department, tasked with tracking and addressing diseases.

It was the advent of technology in the 1970s that helped propel modern evidence-based practice, according to the World Journal of Surgery. Computers and database software allowed providers and researchers to compile and extract data more easily.

In 1996, Dr. David Sackett and his colleagues more formally defined the term evidence-based practice. According to a New York Times article titled Dr. David Sackett, Who Proved Aspirin Helps Prevent Heart Attacks, Dies at 80, evidence-based practice “is defined as making a treatment less subjective by integrating a doctor’s clinical experience with the results of carefully controlled studies.”

Why Evidence-Based Practice Has Become Crucial

In 2001, the Institute of Medicine (renamed National Academy of Medicine [NAM] in 2015) called for an overhaul of our nation’s health system. In their report, Crossing the Quality Chasm: A New Health System for the 21st Century, they described a system that does not consistently provide high levels of care. A number of factors, including a more complex system, an aging population and an increase in patients with chronic diseases, have contributed to the inconsistencies.

To repair and redesign the system and make it more accessible, the IOM emphasized the need to implement a number of competencies. One of these is that clinical decisions should be evidence-based — that care should not “vary illogically from clinician to clinician or from place to place.”

Defining Evidence-Based Practice

Sackett and his colleagues defined evidence-based practice as “the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients,” according to Evidence-Based Medicine. Science should guide decisions rather than subjective data or anecdotal evidence.

According to the Academy of Medical-Surgical Nurses (AMSN), evidence-based practice is a “problem solving approach to clinical practice and administrative issues.” The process consists of three factors: systematically searching for and analyzing the most relevant evidence to a question, relying on one’s own clinical knowledge, and taking the patient’s preferences and values into consideration.

This process requires nurses to think critically. The online RN to BSN program at California State University-San Marcos helps students analyze data and develop non-linear thinking skills, which are essential to successfully implementing evidence-based practice.

Evidence-Based Practice in Action

Multiple models of evidence-based practice exist. Choosing one depends on an organization’s needs and the ease of implementation. The following case studies are examples of evidence-based practice in nursing.

1. Using Evidence-Based Practice to Guide Nurse Dress Code

The Online Journal of Issues in Nursing explains how a team of nurses at Pennsylvania’s Geisinger Medical Center used evidence-based practice to determine how attire affects patient experience.

Step 1: After refining their question, the nurses met with other nurses from the Nursing Research and Evidence Based Practice Council and reviewed available literature. One study included photos and patient preferences. Researchers determined that consistent attire conveys professionalism. Another study involved patients’ perceptions of nurses in inconsistent uniforms, tattoos and body piercings. They also studied literature on the challenges involved with changing dress code policies.

After compiling their data and sharing it with other nurses, they created a survey specific to Geisinger patients.

Step 2: The team developed a 14-question survey based on the input of patients and nurses as well as available research literature. The team then distributed the survey to adult patients at the Center, resulting in 400 samples.

Step 3: They analyzed and compiled the results. The survey found that 57 percent of respondents could identify registered nurses but had difficulty identifying the differences between RNs, LPNs and NAs. 74 percent thought uniformity in nurse attire conveyed professionalism. 95 percent preferred nurses who wear solid navy scrubs.

Step 4: Input from the Nursing Retention and Communication Council (NRCC) team suggested that a standard nurse and staff dress code policy conveys professionalism and uniformity more than an open dress code. The end result was a change in nurse dress code policy with regards to neatness, excessive jewelry and tattoos.

2. Using Evidence-Based Practice to Improve CAUTI Procedures

In another study published in The Online Journal of Issues in Nursing, nurses at the Deaconess Hospital in Evansville, Indiana wanted to address the issue of catheter-associated urinary tract infections (CAUTIs) responsible for most hospital-acquired infections. Up to 50 percent of patients who receive indwelling catheters lack evidence-based documentation. The ultimate goal was to seek improvements in catheter practices and a decrease in positive urine cultures.

They identified the problem: Nursing staff shortages and a faster-paced workplace contribute to undocumented care.

After reviewing research literature, they refined their question: “Can the Electronic Health Record (EHR) assist in driving evidence-based, catheter-care practices?” To find answers, they consulted numerous medical search engines, checked urologic nursing journals and studied epidemiological websites.

They used a five-phase process to develop and test the EHR.

  1. Project Organization and Coordination: The CAUTI Core Team formed to organize and plan the project.
  2. Data Collection and Analysis: The team conducted audits on 42 charts of 420 randomly selected ICU patients. They searched for documentation about the need for the insertion of a catheter.
  3. Project Development: After data collection, the team met to review and discuss the results and develop their next course of action.
  4. Implementation: They worked with their Information Systems Department to incorporate CAUTI components in the EHR.
  5. Evaluation: They developed an audit tool measuring the effectiveness of their project. Six weeks after implementation, they performed a monthly review on all urinary catheter patients during set hours.

They reviewed their results, which showed a significant improvement of Foley catheter care practices and documentation.

Their steps resulted in many beneficial changes, including the creation of an alert to remind physicians of a patient’s catheter and automated CAUTI reports to help their infection prevention specialist better evaluate CAUTIs.

Evidence-based practice in nursing applies the latest scientific knowledge to patient care and quality care initiatives. Nurses must also take their patients’ preferences and needs into consideration.

During a time when the nation’s health system is changing, strengthening these skills has never been so important. Online RN to BSN programs can help students expand their medical knowledge, giving them the tools they need to provide optimal care and contribute to meaningful change.

Learn more about the CSUSM online RN to BSN program.


Sources:

McDonald, L. (2001). Florence Nightingale and the early origins of evidence-based nursing. Evidence-Based Nursing

Claridge, J.A., & Fabian, T.C. (2005, June). History and Development of Evidence-based Medicine. ResearchGate

Roberts, S., (2015, May 19). Dr. David Sackett, Who Proved Aspirin Helps Prevent Heart Attacks, Dies at 80. The New York Times

(2001, March). Crossing the Quality Chasm: A New Health System for the 21st Century. The National Academies of Science

Haynes, R.B., Devereaux, P.J., Guyatt, G.H. (2002). Clinical expertise in the era of evidence-based medicine and patient choice. Evidence-Based Medicine

(n.d.). Evidence-Based Practice. Academy of Medical-Surgical Nurses

West, M.M., Wants, D., Campbell, P., Rosler, G., Troutman, D., & Muthler, C., (2016, January). Contributing to a Quality Patient Experience: Applying Evidence Based Practice to Support Changes in Nursing Dress Code Policies. The Online Journal of Issues in Nursing

(n.d.). Geisinger Medical Center. Geisinger

Welden, L.M., (2013, September). Electronic Health Record: Driving Evidence-Based Catheter-Associated Urinary Tract Infections (CAUTI) Care Practices. The Online Journal of Issues in Nursing

(n.d.). Deaconess Hospital. Deaconess


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