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The Impact of Evidence-Based Practice in Nursing: A Comprehensive Guide

1. Introduction to Evidence-Based Practice in Nursing

A formal workgroup commissioned by the American Academy of Nursing Expert Panel on the State of the Science in End-of-Life Care in October 2006 reviewed the scientific literature on evidence-based and expert practice for end-of-life care. Evidence-based practice is an integral strategy in closing the gap between knowledge and practice in nursing. For evidence-based practice to be fully realized in nursing, for all types of care and settings, current educational approaches require revision to include content on synthesizing evidence and other methods necessary to implement practice change.

The nursing knowledge base is unique in that many types of knowledge are created daily by nurses and biomedical and social data from diverse sources are incorporated into nursing practice. It is inevitable that many incongruities and some blatant contradictions emerge. At least the clinical part of evidence-based practice should and does use a variety of types of evidence. In this way, the links between clinical care and different kinds of knowledge are preserved, and that linkage is consistent with a practice model under development and application for centuries. Essential to the idea of educated nurses, it continues to expand upon nurse clinician, discovering and practice developer, and validating various other superior apparent dichotomies. Inductive care is practiced to be based on the best available evidence. Care is based on the best evidence when it is customized to individual patients’ preferences, concerns, and clinical circumstances. Without improvement of nursing practice, without tampering and cherishing, it becomes more than a technical enterprise of applying relevant biomedical and social studies information.

2. Key Components of Evidence-Based Practice

One of the key elements of evidence-based practice is that it requires the integration of the best research with clinical expertise. Clinical expertise concerns bringing your experience and judgment, as the nurse, and the patient’s preferences and predicaments to bear in care. Use your combined expertise when answering patients’ questions. If they ask you what the benefits and risks are of treatment A versus treatment B, summarize the best research on the topic and overlay your clinical knowledge, combining it with patient preferences. For example, in response to “What are the chances of survival if I undergo the surgery to remove the tumor?” you might say something to the effect of:

“Surgery offers the most effective form of treatment for your type of cancer. The best research suggests that the use of surgery to remove your tumor gives you a 47% chance of survival for 5 years. At the same time, you do have some heart problems and the surgeon is worried about your risk of complications. You have some difficult trade-offs to consider.”

3. Implementing Evidence-Based Practice in Nursing Care

To implement evidence-based practice in nursing, we should transform the attitudes of staff nurses so that they see research as integrated into their daily patient-care activities. Strategies that have been found useful in encouraging change include promoting an organizational vision, offering nurse-led inservice programs, promoting a sense of inquiry, using pointers as guideposts for practice change, and increasing access to knowledge by making it more convenient. Implementing evidence-based practice involves multiple methods to affect change. These methods include: 1) nurse-led inservicing; 2) staff nurse-practice feedback programs; 3) audit; 4) educating the educator; 5) collaborative ventures between academia and service; 6) use of clinical pathways as guideposts for practice change.

To promote translating current evidence into daily nursing care, nurse-administrators must deliberately support staff in this process. The first essential step is knowledge acquisition. In practice settings, it is unlikely that a large number of staff nurses are knowledgeable about nursing research in general, or that they read or use research. Once knowledge is gained, transformation of attitudes can follow. Staff nurses need leadership support, adequate resources, and a vision of change. Many hospitals are developing infrastructures and resources designed to support elevating nursing into an evidence-based practice setting.

4. Benefits and Challenges of Evidence-Based Practice in Nursing

One benefit of evidence-based nursing is that it can help guide decisions when a “right” answer is not clear. It fosters a systematic, researched, and objective review of the best available information to support a plan of care. Other benefits include promoting effective decision-making, effective relationships between all disciplines on a treatment team, and ongoing evaluation of the outcome of treatments. Researchers have stressed the need for assessing the effectiveness of one’s own clinical practice as a crucial skill for all health care practitioners. The primary objective of evidence-based nursing is to provide nursing interventions that are based on information that has been critically analyzed and proven to be effective. This process typically results in improved patient outcomes, as patients receive care based on the most recent scientific and well-researched nursing practices.

At the same time, evidence-based nursing also has its challenges. Time and pressure are two such challenges. Today’s health care setting with its stress on cost containment, hospital efficiency, and nursing and medical shortages make it challenging for nurses to demand and garner time for evidence-based practice knowledge. Health care is moving at an extremely fast speed with only certain types of information being available to nurses. The volume of knowledge has increased with information overload and no tangible evidence of improvement. Metasynthesis merges the best from qualitative and quantitative data to provide a foundation for meaningful research and clinical decision-making. Metasynthesis is designed to direct clinical decisions, reinforce clinical expertise, and integrate various aspects of a patient’s clinical picture. By definition, the end result is evidence-based practice. The implementation of evidence-based practice is continually reshaping health care.

5. Future Directions and Innovations in Evidence-Based Nursing Practice

Despite significant growth in the number of nursing studies evaluating particular interventions, the vast majority of clinical questions posed by nursing practitioners remain unanswered by rigorously conducted research. As a result, the application of research evidence in nursing practice is hampered by gaps in the evidence. Expert consensus is an important source of guidance for these questions. But consensus does not always convey the most current or tested information about the impact of nursing practice alternatives, nor identify potentially difficult trade-offs involved in a particular decision.

Committed and competent use of tools of evidence-based practice (EBP) entails embracing a stance of being inquisitive, accepting that “things aren’t always what they seem to be,” and that current answers to clinical questions/information available at the time may be readily shifted as new and stronger evidence accumulates over time. This willingness to dynamically adapt is invariably resisted, typically by healthcare professionals who worry that if current knowledge is incomplete or in doubt, then they must be doing something wrong.

As nurses become more aware of and skilled in the application of EBP concepts, unique and urgent questions of care that have not been previously considered amenable to evaluation by research can be posed, and consumer-focused research discovered or carried out, thus bringing consumers into the decision-making equation. Rapid direction in addressing the gaps with innovative research of potential care treatments is also provided by the ability of EBP to assist in developing and promoting nursing research methods and in compiling broadly concerned nurses for concrete studies useful to nurses and patients alike, thus potentially hastening the slow progress of nursing research currently in existence.

Accomplishment in attaining the current and future goals of nursing thus hinges on cultivating an environment for evidence-based research to flourish.