Evidence-based practice in nursing
Simon, Jolene M
A new paradigm or methodology for clinical practice is emerging across the disciplines-evidenced-based practice. Evidence-based practice has been defined as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett, Richardson, Rosenberg, & Hayes, 1997, p. 5). Evidence-based practice does not rely on intuition, unsystematic observations, or pathophysiologic rationale; it emphasizes the use of research and evidence to guide clinical decision making. Evidence-based practice requires clinicians to learn new skills in order to use a different process for clinical decision making. These skills include applying the formal rules of evidence when evaluating the clinical literature. Thus, evidence-based practice combines the current research-based evidence with clinical expertise and patient preferences to make a decision about a specific patient.
Nursing is gradually building its base of knowledge. More and more clinical intervention studies are being conducted and published in the literature. The strength of evidence was categorized by five levels when the first Clinical Practice Guideline was published by the Agency for Health Care Policy and Research (1992). From most to least strength of evidence, these levels are 1) meta-analysis of multiple studies, 2) experimental studies, 3) quasiexperimental studies, 4) nonexperimental studies, and 5) case reports and clinical examples. These levels guide the degree of confidence clinicians may use to evaluate the literature of a particular clinical intervention or protocol.
The call for evidence-based practice emphasizes more than ever the need for the work being done in nursing language and classification. Outcomes research is needed to test the effectiveness of interventions and protocols; classification of outcomes facilitates the development of this type of research. Research-based interventions or protocols may be named and classified so that standardization across the country may occur in order to improve nursing practice by clinical practice guidelines. Clinical practice guidelines then may be used to evaluate the outcomes in a specific institution, thus completing the cycle of evidence-based practice to guide the care of patients. Evidence-based practice will be used to guide the education of new practitioners in health care as well as assist experienced clinicians to maintain clinical competencies. It will allow clinicians to provide research-based explanations to assist with clinical decision making with the patient. Savvy patients will be expecting their healthcare providers to practice the newest therapies or treatments. Standardized language and classification will be important contributors to evidence-based practice and, thereby, will contribute to the aims of improved care and quality of life of patients.
Acute Pain Management Guideline Panel. (1992). Acute pain management in adults: Operative or medical procedures and trauma. Clinical practice guideline (AHCPR Pub. No. 92- 0019). Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services.
Sackett, D.L., Richardson, W.S., Rosenberg, W.M.C., & Haynes, R.B. (1997). Evidence-based medicine: How to practice and teach EBM. Edinburgh: Churchill Livingstone.
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