In addition to caring for fallen soldiers in the 1800s, Florence Nightingale, iconic founder of modern nursing, was also recognized for being an outspoken social reformer and steadfast statistician. The “Lady with the Lamp” kept careful record of medical stats connecting illnesses to injuries. From this chronicling, Nightingale was able to draw conclusions that would have a profound effect on modern medicine, such as linking unsanitary conditions and poorly ventilated spaces to a patient’s failing health. Her efforts comprise a prime example of evidence-based practice (EBP), the process of collecting, processing, and implementing research findings to improve clinical practice and patient outcomes. The ultimate goal of the evidence-based nursing problem-solving approach is to help nurses provide the highest-quality, most cost-efficient care possible. Today, evidence-based nursing practice is part of the curriculum for most nursing degrees, including RN-to-BSN programs.
Why is evidence based practice important?
Knowledge of evidence-based practice and its tenets, also known as “levels of evidence,” is of significant importance to every clinician, including nurses. According to nurse.com, EBP guides nurses and other clinicians in how much they should draw from “a study, report, practice alert, or clinical practice guideline in making decisions about a patient’s care.”
The benefits of EBP in nursing include:
Providing nurses with the scientific research to make well-informed decisions.
Encouraging nurses to provide individualized patient care.
Improving time management by driving efficiency in nursing.
Guiding implementation of new technologies into healthcare practice.
Helping nurses determine an effective course of action for care delivery.
Helping nurses stay updated about new medical protocols for patient care.
Increasing patients’ chances for recovery because decisions are based on documented interventions that align with patient profiles.
Enabling nurses to evaluate research so they can best understand the risks or effectiveness of treatments or diagnostic tests.
Improving patient outcomes, which can lead to decreasing demand for healthcare resources and reducing expenses.
The five steps of evidence-based practice.
Evidence-based practice in nursing is a lifelong learning technique driven by the following steps. Thorough, mindful application of these five steps has the potential to complete a cycle that’s destined to improve clinical practice and patient care.
Pose a question. Formulating a well-detailed, clearly worded question is the catalyst for EBP problem-solving. It sets forth what the ultimate goal is. Perhaps the goal is to improve a procedure that will help a patient with a particular condition. This step is crucial to the EBP process because the key words within the question will help pinpoint a course of treatment for clinicians to administer. The more detailed the question, the better—because it makes it easier and more likely to be found in a medical database. Here’s an example question: What are the treatment options and challenges to consider for a COVID-19 patient who has also been diagnosed with Bell’s Palsy?
Gather the best evidence. It is important to broadly seek out the best available evidence, including high-quality articles from legitimate sources and other supporting materials containing the highest possible levels of evidence. For instance, if it comes to choosing between evidence from a case report and evidence from a high-quality systematic review of prospective cohort studies, definitely move forward with the latter.
Analyze the evidence. Now it’s time to take a closer look at all of the evidence that’s been gathered to ensure it is indeed of optimal quality. In addition to providing a critical appraisal of gathered resources, this step also helps determine if the information or data is pertinent to the patient a nurse is treating and/or the clinical setting at which they work. Perhaps two sources both report on the findings of estrogen inhibitors to treat metastatic breast cancer. Let’s say both offer similar new information but draw dramatically different conclusions. In this case, it would be best to draw from one’s clinical experience in these treatments and conditions to identify which source to proceed with in moving on to the next step.
Apply the evidence to clinical practice. Now that the information has been carefully gathered and thoroughly analyzed, it’s time to put it into action. This step is all about integration, involving a combination of new information obtained with the nurse’s clinical experience to draw conclusions on how to apply the research findings to patients. At this point, the clinician should be especially mindful of patient profiles, individual preferences, and values. For instance, would a breast cancer patient want to proceed with more aggressive treatment like chemotherapy and surgery based on the conclusions of the information gathered?
Assess the result. This final step completes a cycle whose mission is continuous quality improvement in clinical care and practice. Let’s say a patient did decide to proceed with more aggressive breast cancer treatment and it turned out to be effective. This positive outcome naturally spawns further questions. Should this EBP then be applied to other patients with the same condition? Was the application of the new information or procedure effective? And how does this outcome relate back to the original question that inspired the path to reach this outcome?
Levels of evidence.
Along with the five steps, the EBP framework also employs four levels of evidence in its quest for quality improvement in a healthcare setting.
Level A: The most reliable level of evidence because evidence is acquired from randomized control trials. Example: administering convalescent plasma or placebo to determine the former’s effectiveness on COVID-19 patients with severe pneumonia.
Level B: Evidence is acquired from quality-designed control trials without randomization, clinical cohort studies, case-controlled studies, uncontrolled studies, epidemiological studies, and qualitative/quantitative studies. Example: studying the development of heart disease after exposure or nonexposure to 10 years of secondhand smoke.
Level C: Evidence is acquired from consensus viewpoint, expert opinion, and meta-synthesis. Typically used when there is no quality and quantity data yet available about a specific condition. Experts reach agreement by reviewing the limited evidence available. Example: determining treatment for an exceptionally rare condition; since there have been so few cases, there is very limited information to reference.
Level ML (multilevel): Evidence is acquired from more than one level of evidence as defined in the rating system. This level is usually applied to more complex cases. Example: concluding that invasive surgery to remove a malignant mass from an elderly patient’s pancreas would be extremely high risk not only due to the patient’s age but also because of the unusual position of the mass. While surgery risk in elderly patients has been studied extensively (Level B), information about a rare form of pancreatic tumor could be as rare as the condition itself, hence the course of treatment would have to rely heavily on consensus viewpoint (Level C).
What are examples of evidence-based practice.
For patient health and safety, it is essential that nurses follow evidence-based practice. Here are some examples of its application:
Infection control. Evidence-based infection-control policies exist in every medical setting and its importance has been continually reiterated during the COVID-19 pandemic. This EBP includes keeping the healthcare environment clean and disinfected, wearing personal protective clothing, using barrier precautions, and practicing correct handwashing.
Oxygen use in COPD patients. Based on well-researched evidence, the correct treatment to help prevent hypoxia (low oxygen in the blood) and organ failure in patients with chronic obstructive pulmonary disease (COPD) is to administer oxygen.
Treatment for angina. Extensive research has concluded multiple treatment options to effectively manage angina, including nitrates, clot-preventing drugs, beta blockers, statins, and aspirin.
The impact of evidence-based practice in healthcare.
EBP is a crucial component of safe, quality patient care. Utilizing the EBP approach helps nurses and other clinicians provide the highest-quality and most cost-efficient patient care possible. It is highly essential that nurses know the current practices so that they can provide care to patients with complex and debilitating conditions. Online degree programs provide EBP in their curriculum whether you’re just starting out in your nursing education or already working in nursing and looking to expand your EBP knowledge. From EBP courses, students in RN-to-BSN programs learn the role of research in the nursing practice, including its design, methodologies, process and ethical principles. They also learn to use critical thinking skills to evaluate research studies so that they can apply the findings to their nursing practice, and ultimately help our healthcare system for the better.
