What Is EBP?
Evidence-Based Practice (EBP) is a discipline for designing and administering healthcare that is consistently and reliably effective. It offers problem-solving approaches to clinical practice and administration that integrate scientific evidence with experiential evidence from healthcare settings.
One of the most widely accepted definitions of EBP is from Dr. David Sackett: EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” One of his most significant contributions to EBP was to develop the basic steps in the process, which have been incorporated into various models over the years:
- Assess the patient.
- Ask the question.
- Acquire the evidence.
- Appraise the evidence.
- Talk with the patient.
- Self-evaluate performance.
According to the widely adopted framework described in the landmark 2005 report Evidence-based practice: a practical approach to implementation, EBP accounts for internal (healthcare industry) and external (scientific) influences on practice. It lays the groundwork for critical thinking in the application of all evidence in healthcare practice. The evidence does not provide the solution itself; rather, it provides substantial support for decision-making. EPB improves the quality of healthcare for individual patients, the larger patient population and healthcare systems.
According to the abstract for this report, “The development of a framework to guide inquiry will have a positive impact on patients. This process may foster a higher level of professional engagement by nurses that may, in the long-term, help improve nurse retention and recruitment.” There is a general consensus in the healthcare community that this has come to fruition, which is why quality nursing education programs emphasize EBP.
Examples of EBP in Nursing
The Academy of Medical-Surgical Nurses (AMSN) values EBP as a method to improve patient care and close “the unacceptable gap between what we know and what we do in the care of patients.” According to the organization, “Development of Evidence-Based Practice is fueled by the increasing public and professional demand for accountability in safety and quality improvement in healthcare.”
EBP success stories are innumerable and come from every nursing discipline. The following stories exemplify the objectives of the AMSN in furthering the movement:
At the South Miami Hospital, the Hospital Acquired Pressure Ulcer Group cited EPB as instrumental in the improvement of a stage-four sacral ulcer patient. The group aimed to reduce pressure ulcer incidence rates by taking the problem from the bedside to research and back in a span of two years. Implementing the plan required the following steps:
- Presenting data to the staff and physicians.
- Discussion of pressure ulcer documentation.
- Promotion of participatory bedside learning.
- Presenting government regulations to staff and physicians.
- Presenting effects of pressure ulcers on patients and hospitals to nurses.
- Informing nurses how optimal care aligns with goals.
A staff nurse observed, “By implementing our EBP wound care set of orders and having our wound care team involved, this particular patient’s decubitus improved in a way I never imagined. The stage four decubitus has improved to a stage two and still has the potential to heal.”
Another case involved independent home care nurses’ use of EBP in the community surrounding the Saint Elizabeth Healthcare system in Ontario, Canada. The problem with implementing research in care was that there were no buildings to house the research and technologies. There was no staff room where nurses could share details about patients. This situation presented challenges in measuring and reporting outcomes objectively.
To address these issues, Saint Elizabeth adopted a tool called Health Outcomes for Better Information and Care. Four different sections of the tool assessed areas such as functional status, symptom management, patient safety and therapeutic self-care outcomes. Evidence established each of these assessments as valid and statistically reliable. The resulting precision helped nurses ensure a thorough assessment of client status and provided a reliable way of measuring progress toward specific health outcomes.
The benefits from this case are similar to those found in many EPB success stories:
- Precise tools to track patient progress toward health goals.
- Information that allows administrators to identify patterns, achievements and areas of improvement in practice.
- A record of objective, quantitative outcome measures to report on the effects of evidence in practice for the profession.
Two other studies from the Virginia Mason Medical Center in Seattle provided guidance for the implementation of an EBP protocol for delirium at the bedside. Delirium had been accepted as an unfortunate but unavoidable risk in nursing critical-care patients. Incidences were increasing, brought on by the confluence of acute illness, immobility and sedation in the hospital environment. Length of stay and costs, reintubation, lasting cognitive impairment and morbidity all increased the risk.
The resulting protocol proposal included a combined education intervention consisting of didactic learning and scenarios to assist with delirium assessment and the monitoring skills of the bedside practitioner. Educators eventually began teaching the protocol as a course throughout the U.S. and in multiple other countries. The protocol also resulted in eight articles in peer-reviewed journals and presentations at many conferences.
EBP Is the New Paradigm
With each success story, the impact of EBP grows. It continues to encourage new forms of evidence and systematic evidence reviews; new roles in the process, including knowledge brokers and transformers; and new practice cultures, including healthcare learning organizations. The paradigm shift is apparent in every medical discipline. It has changed the way practitioners think about research and frame each case for improvement.
Educators have an opportunity with Evidence-Based Practice to enable students to connect their developing knowledge of case studies with clinical best practices. As students graduate, they will invigorate the nursing profession with the confidence that comes from understanding and successfully applying evidence.
Learn more about the Colorado Mesa online RN to BSN program.
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