HealthDecember 01, 2015

The evolution of evidence-based practice

While not exactly a new concept in healthcare (Scottish physician, Archibald Cochrane, championed research-based care during the mid-20th century), evidence-based practice has transformed healthcare during the last decade and a half.

A response to quality deficits caused by a “that’s the way it’s always been done” mindset, the call for evidence-based practice is a call for healthcare providers to think, to research, and to find the most effective and proven ways to treat patients in their care.

Evidence-based practice, EBP for short, transcends care approaches based solely on tradition to find strategies based on science. EBP treats patients the way health care providers would want to be treated. And as patients, advocates, and policymakers continue to have a greater say in health care, EBP isn’t going anywhere.

What EDP intends to do

EBP owes much of its momentum to a series of Institute of Medicine (IOM) reports that rattled, sobered and then eventually inspired healthcare professionals to embrace evidence. Here’s a quick review summarized from a recent Online Journal of Issues in Nursing paper:

  • In 2000, the IOM’s To Err is Human report found that major deficits in healthcare were causing significant preventable harm.
  • A year later, the IOM’s Crossing the Quality Chasm identified EBP as a way to bridge the rift between the health care we have and the health care we could have.
  • EBP was championed repeatedly in subsequent IOM reports, such as 2003’s Health Professions Education: A Bridge to Quality, 2008’s Knowing What Works in Health Care: A Roadmap for the Nation and Training the Workforce in Quality Improvement and Quality Improvement Research, and again in 2011’s The Future of Nursing: Leading Change, Advancing Health.

“The intended effect of EBP is to standardize healthcare practices to science and best evidence and to reduce illogical variation in care, which is known to produce unpredictable health outcomes,” writes Kathleen R. Stevens, EdD, RN, ANEF, FAAN. ”Development of evidence-based practice is fueled by the increasing public and professional demand for accountability in safety and quality improvement in health care.”

How the nursing profession promotes EBP

Incorporating EBP throughout the health care organization is one of the key characteristics of Magnet hospitals, according to the American Nurses Credentialing Center. Besides requiring EBP of its top-of-the-line Magnet designees, ANCC shares successful strategies and practices for other hospitals to learn from.

In addition, professional nursing organizations, hospitals and even individual nursing units promote EBP through journal clubs, oral and poster presentations, and meetings where research is presented and discussed. Individual nurses, too, can promote EBP in their everyday work. Cynthia Johansen, MSN-Ed, PHN, RN, shares this example in a Nurse Together blog post:

“Let’s say that you have been assigned to care for a patient with a disease you aren’t familiar with. After the beginning of the shift settles down, you search online about the patient’s disease, and learn something important for the patient about his/her disease that was not mentioned during report. You can print the article and share it with your colleagues, write about it in the nurse’s notes section of the patient’s chart, and then resume your nursing duties all while feeling more confident about your ability to provide evidence-based nursing care for the patient.”

Fresh from the classroom and EBP-enhanced curricula, new nurses can also play a role in implementing EBP. Just don’t expect too much from new-to-the-workplace novices, who are often focused on learning organizational policies and procedures rather than transforming care approaches.

“New nurses frequently experience stress and lack of confidence,” advises Crystal Bennett, DNSc, RN, in an article in ADVANCE for Nurses. “Once confidence is gained, new nurses are better able to focus on patient needs, thereby facilitating implementation of evidence-based practice.”

How nurse leaders encourage EBP

Nurse administrators can go far in encouraging EBP, experts agree, by supporting inquiry, research, and suggestions for change. Staff nurses also need time and encouragement to dig deeper and discover science-based solutions for clinical questions that crop up.

EBP is a dynamic concept that requires ongoing effort. As new research is conducted and new conclusions are reached, processes based on EBP will evolve. Health care may never have all the answers. But actively basing care on what we know, rather than on how it’s always been done, is a huge step forward in modernizing and transforming patient care.

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