Quiz 10: Evidence-Based Practice

Nursing

United States (US) recently developed emphasis on evidence based practice (EBP) in health care delivery. Improved health outcomes can be attained by applying these practices in all health care settings. Evidence based practice is an important prospect for social and health care professionals working in health care settings. EBP refers to the incorporation of expertise in clinic practices with available clinical research evidence of patient findings. Active participation in learning and the research activities are two important components of this practice. Rychetnik et al (2003) stated that evidence based public health is an endeavor that uses informed, explicit and judicious evidences. These evidences are derived from science, social science methods of research and evaluation. The Honor society of nursing, Sigma, Theta, Tau, International, 2005 has also given the definition of evidence based nursing. The society defined evidence based nursing as a process that is a collection of the best available evidences, nursing experiences, values, preferences of the individuals, families and communities that are to be served. The evidences are categorized into two types that are the external and the internal evidences. Research and other evidences are kept in external evidence category while clinical experiences of nurse and clients are kept under internal evidence category.

Mid to late 1970s, there showed a bloom of using scientific knowledge in nursing practice. The United States public health service funded research utilization projects. Research utilization definition is the process that includes the transformation of research knowledge in practice as well as the use of research in guidance of clinical practice. The three projects funded by nursing division played a major role in shaping the nursing view of using research to guide practice are as follows: 1. The NCAST (nursing child assessment satellite training project). 2. The WICHE (western interstate commission for higher education). 3. The CURN (conduct and utilization of research in nursing project). Apart from nursing, medicine also started focusing on scientific evidences in clinical decisions. David Sackett, a clinical epidemiologist, in the late 1970s, published an article series in the Canadian medical association journal. Guyatt and Rennie described the goal of evidence based medicine. They stated the goal as 'aware of the evidence, upon which one's practice is based, the strength of inference, the soundness of the evidence as well as the evidence permits'. Evidence based medicine concept expanded and called a 'paradigm shift' in 1992 by evidence based medicine working group. A paradigm shift represents a change from old knowing ways to new knowing and practicing ways.

Evidence based practices provide a base to improve nursing practices and client outcomes. Nursing provides care on the basis like environmental, client assessment, critical observations, and development of questions or hypothesis to be explored. There are many factors represented in the literature that support evidence based practice implementation in nursing and other disciplines is as follows: a. Research and current evidence knowledge. b. Interpreting the meaning of evidence. c. A strong willingness to change. d. Commitment towards the time needed for evidence based practice implementation and engagement in education and directed practice. e. The hierarchy and the support level of managers and the engagement in autonomous practice. f. The practice environment, philosophy and willingness to embrace evidence based practices. Community focused nursing agencies generally lack the implementing resources that are applicable to clinical settings. Nurses are sometimes reluctant towards findings and feel hesitated when they are questioned about those practices. Cost also works as a barrier and funding matters for implementation.

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