Question

Imagine that you have a colleague at work who exemplifies everything that you believe is good about evidence-based nursing practice. This colleague has applied for the position of Director of Evidence-based practice for your hospital (the job description appears below), and has asked you to write a reference letter on their behalf. Use what you know about evidence-based practice and letter writing to compose a reference letter for your colleague.

Position Summary

This position supports the integration of evidence-based practice (EBP) and research into clinical practice. Provides assistance and guidance in all activities that build a culture of inquiry and enhances the quality of care at this hospital. Provides education on EBP and research methodologies to facilitate collaborative and multidisciplinary research partnerships.

Answer 1

Evidence-based practice has become a commonly used term in health care in the past few years. It is important for nurses to know what it means, how to use it, and how important it is in protecting patient safety. This study will define evidence-based practice and provide examples of how evidence-based practice questions can be used to guide the delivery of safe patient care.

Evidence-based practice (EBP) is a problem-solving approach to health care clinical decision making that integrates the best evidence from well-designed studies with clinician expertise and a patient's preferences and values.

EBP is important because it aims to provide the most effective care that is available, with the aim of improving patient outcomes.EBP also plays a role in ensuring that finite health resources are used wisely and that relevant evidence is considered when decisions are made about funding health services.

Through the evidence-based interventions, we learn can improve patient outcomes, help to provide high-quality care, reduce costs and eliminate practices that have become obsolete or are not effective.

EBP continues to change the way nurses care for their patients. For example, during one of my clinical rotations, a seasoned nurse corrected me for not aspirating a syringe during an intramuscular injection. Current evidence-based research suggests that aspirating intramuscularly is no longer a standard of practice since no evidence supports its practice and it can cause trauma to patients.

One of the key points that learn in nursing school is about the importance of evidence-based practice. As students we are taught to be a generation that provides high-quality care. This high-quality care is supported by evidence, which took many years to become standards of care through translation from research to clinical practice. Nursing EBP continues to expand and several resources such as journals, models and books are available to help nurses understand the concepts and process. Gaining knowledge of EBP and learning strategies for implementation are critical skills for nurses, no matter the setting.

As nursing students and future nurses, we hold a promise of continuous learning, and it is essential to build evidence-based knowledge over time. As students, it is never too early to start thinking like a nurse who is driven by evidence-based practices.

To provide a higher level of care, look up evidence-based practices for that particular population.

• It’s important for student nurses to learn the value of evidence-based practice, in order to provide high-quality care. It is never too early.

• EBP is based on research, evidence on best practices, and the consideration of individual patient’s needs, preferences.

• During clinical, do research on the medical conditions your patients have. It will help you provide a higher level of care.

• Be proactive in suggesting EBP during clinical or helping to bring more attention to EBP research.

Nurses enter practice with a knowledge base that has been acquired through formal education, including opportunities for both didactic learning and clinical practice. This education forms the basis for beginning practice and serves as a springboard for future professional development. This is NOT the end of the learning process!

New evidence comes into play every day as research is completed, technology advances, and patients present with unique challenges and personal experiences. The nurse who bases practice solely on what was learned in basic nursing education soon becomes outdated and then becomes dangerous. Patients are not safe if they do not receive care that is based on the best evidence available to assist them at the time their needs arise.

Melnyk and Fineout-Overholt (2005) also address the fact that evidence-based practice is predicated on several factors: evidence from research, opinion leaders, and expert panels; evidence from the assessment of the patient and related healthcare resources; clinical expertise, and information about the patient’s preferences and values. Taken together, this framework empowers the nurse to plan and implement evidence-based clinical decision making.

Using Research When available, research studies that have been conducted in controlled circumstances provide strong evidence to support practice decisions. For example, research has been done to determine various types of wound care dressings that are most appropriate for different kinds of wounds. The nurse caring for a patient with a decubitus ulcer needs to thoroughly assess the patient and the wound, and then review the research to determine the best option to aid wound healing. As the nurse and the physician review the patient’s situation, they can develop a plan that incorporates recommendations based on research findings, the specific characteristics of the wound, and the patient’s situation – lifestyle, current self-care capability, availability of resources, and other factors that will determine how the treatment plan is carried out. There are many areas of nursing practice, however, in which structured qualitative and/or quantitative research has not yet been done. There may be anecdotal evidence from others’ experiences, or there may be some “soft” data generated by one or two research studies with small populations or with a different focus than the area of current concern.

While research is an important component of evidence-based practice, an important factor to remember is that one research study does not generally provide “evidence.” A nurse can search databases for individual articles. These include CINAHL, MEDLINE, and others. More valuable is a compendium of research studies that have resulted in the publication of evidence that comes from several sources. Three notable sources of this type of data are the Cochrane Collaboration, the National Guideline Clearinghouse, and the Agency for Healthcare Research and Quality. All three of these sources provide searchable databases that enable the user to collect evidence compiled from a number of sources in relation to a specific clinical problem.

Spector (2007) states in the NCSBN paper that it is important for nurses to recognize the difference between “research utilization” and “evidence-based practice.” While research utilization suggests that one adopt the findings of a research study as “standard practice,” evidence-based practice indicates that findings from multiple studies, in conjunction with thorough assessment of the current patient situation, form the basis for nursing plans and interventions. She states that goals of this process are to give nurses tools to provide excellent care, provide a valid and reliable way to solve clinical problems and encourage innovation and creativity in how evidence-based data is implemented to meet specific patient needs. As additional clinical problems and challenges are identified, there is an opportunity for more innovation as new strategies are implemented to address ongoing quality improvement initiatives.

The nurse who is able to do “what if” thinking explores options and alternatives and uses research-based evidence to support recommendations to modify a plan of care to meet the .unique needs of an individual patient.

Clinical expertise is a required element of evidence-based practice. That might be the expertise you have or the “borrowed” expertise of a colleague or mentor. Recognizing when you need help, and finding the appropriate person to provide that assistance, enables you to “data mine” to develop a strong evidence-based plan of care. Clinical expertise comes with clinical experience. The novice nurse is very focused on policy and procedure and “how to do,” rather than “what to do” or “why to do,” let alone “how and when to modify” based on a patient’s need at any given point in time. As clinical experience grows, the nurse transitions to higher levels of thinking and functioning (Benner, 1984).