It would be difficult for anyone currently practicing in nursing to not see the phrase "evidence-based practice" at least once during the course of a work week. But if asked for a definition, would you be able to provide one? As the first in the series "Tips and Tools", I thought it might be helpful to start at the beginning and "research" the history of this method of acquiring, making sense, and utilizing the wealth of information available to us as perioperative nurses.
The term "evidence-based practice", or EBP as it is commonly abbreviated, was first printed in an article in 1996 by Dr. David Sackett from McMaster University in Hamilton, Ontario. However, it can be argued that this type of practice has been in place for over a hundred years; Florence Nightingale, in her famous treatise on nursing, utilized research, observation, and expert opinion in her at that time revolutionary approaches to infection control, nutrition, and the impact of the environment on healing. "Evidence-based medicine" was the result of a change in teaching methods which utilized problem-based learning, a format that is commonly used in schools of nursing today.
Dr. Sackett stated that EBP is "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients (1996, p. 71 ). In addition to scientific evidence and expert opinion, patient preference has recently been added to the definition (Levin and Feldman, 2006).
This method of defining and driving practice has been embraced by governmental, regulatory, and professional organizations as the basis for their rationale for recommended practices, standards, and guidelines. Utilizing EBP has been found to improve patient outcomes, which is the bottom line for any change in our practice. That being said, from a specialty long steeped in opinions, traditions, and rituals, perioperative nursing has encountered a sometimes steep learning curve in adapting performance to reflect the best current research. Technology, information, and skills sets are constantly evolving and changing; if something has always been done this way, it’s probably not being done correctly now. It can be frustrating and overwhelming to try and keep up. Here are 5 easy steps to help get started on improving practice; each will be the topic of a future article on Tips and Tools.
- Ask a question
- Find the best evidence to answer the question
- Critique the evidence
- Integrate the evidence with clinical expertise and patient perspective
- Evaluate the effectiveness of the decision
References:
Definitions of Evidence-Based Practice. Retrieved Nov. 20, 2009 from http://www.shef.ac.uk/scharr/ir/def.html
Levin, R.F. & Feldman, H.R. (2006). Teaching Evidence-Based Practice in Nursing. NY,NY: Springer Publishing Co.
Sackett, D.L., et al. (1996) Evidence based medicine: What it is and what it isn't. British Medical Journal, 312,(7023), 71-72.
Recommended readings (if you have a favorite reference, send it to
jmower@cc-institute.org and I’ll post it with the next article):
Nightingale, F. (1969). Notes on Nursing: What it is and what it is not. New York, New York: Dover Publications, Inc. Originally published in 1860 by D. Appleton and Co.
Mohide, E. A., & Coker, E. (2005). Toward clinical scholarship: Promoting Evidence-Based Practice in the clinical setting. Journal of Professional Nursing, 21(6), 372-379.
Phillips, J. et al. (2006). Where’s the evidence? An innovative approach to teaching staff about evidence-based practice. Journal for Nurses in Staff Development, 22(6), 296-299.
CHECK IT OUT!
There is a very nice tutorial that walks through 5 steps for EBP. It can be found at
http://www.biomed.lib.umn.edu/learn/ebp/mod01/index.html
