The origins of evidence-based practice (EBP) go back to Florence Nightingale in the 1800s. EBP took a firm hold in the 1990s when breakthroughs in nursing research occurred. In 1993, the Cochrane Collaboration was established. The international network of individuals and institutions manages and updates systematic reviews of clinical interventions used in EBP. Students in RN to BSN programs are introduced to the concepts of EBP in nursing so they can learn how to apply it in a clinical setting.
What Is EBP?
EBP is a combination of the best current evidence and clinical expertise with a focus on patient preferences and values.
Why Is EBP Prevalent in Nursing?
The Institute of Medicine (IOM), renamed the National Academy of Medicine in 2015, published "To Err Is Human: Building a Safer Health System" in 2000 to discuss the alarming rate of medical errors occurring in healthcare. The IOM later released "Crossing the Quality Chasm: A New Health System for the 21st Century" which contained a guideline for reforming healthcare. One of the key recommendations was a call for the implementation of EBP. The IOM stated that the ability to deliver safe patient care was compromised because of a gap in translating knowledge into practice and a lack of understanding about how to incorporate new technology.
The application of EBP supports the Triple Aim in healthcare, which the article "The Triple Aim: Care, Health, and Cost" defines as:
- Improving the quality of patient care, experience and satisfaction.
- Improving population health.
- Reducing healthcare costs.
Another group of researchers added a fourth aim in their study "From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider." They concluded that there is a need to improve work-life balance and decrease burnout in nurses and other healthcare professionals.
What Are the Steps Involved in EBP?
EBP involves seven steps. Originally, EBP was described as a five-step process in the book Evidence-Based Medicine. How to Practice and Teach EBM and two additional actions were added in the publication Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice. The seven steps of EBP include:
- Cultivate an EBP culture and environment which encourages inquiry.
- Pose a compelling clinical question in the PICOT* format.
- Search the most relevant and exceptional information and gather the evidence.
- Critically appraise the evidence through careful and systematic examination, evaluation, synthesis and recommendations.
- Integrate the collected evidence with clinical knowledge and patient preferences and values to make a practice decision or change.
- Evaluate the practice decision or change based on the applied evidence.
- Disseminate the outcomes of the EBP decision or change in publications, presentations, health policy briefs and the media.
*PICOT is a formula used by nurses to compose a clinical question.
Is EBP Just a Trend?
EBP is a major component to the delivery of patient care. Based on EBP, some traditional methods of practice have been deemed ineffectual or harmful. For example,
- Aspirin should not be given to children when they have a fever or other symptoms of a viral illness because it increases the risk of Reye's syndrome, a rare but serious illness.
- After a bout with a gastrointestinal illness, children should resume eating a healthy diet as soon as possible instead of consuming only bananas, rice, applesauce and toast (BRAT) before introducing other foods. The BRAT diet is considered suboptimal for its low protein and fat content.
- To avoid skin ulcers, patients should be turned based on their individual condition rather than the habitual practice of moving them every two hours.
Even though EBP results in optimal patient care, it is not consistently applied in all healthcare systems throughout the country. Barriers exist for nurses who want to implement EBP. The 2016 report "A Study of Chief Nurse Executives Indicates Low Prioritization of Evidence-Based Practice and Shortcomings in Hospital Performance Metrics Across the United States" surveyed 276 chief nurse executives (CNE). The researchers found that while many CNEs believe in EBP, implementation is low and there is little money allocated for EBP, which may adversely affect key hospital metrics. The study concluded that CNEs need to invest in EBP in order to achieve quality healthcare and lower costs.
Outdated practices can be replaced by evidence-based approaches which may help relieve patient discomfort, decrease the chances of errors and increase the likelihood of positive outcomes. Nursing students in an RN to BSN program learn to incorporate EBP in nursing. Nurses need their healthcare systems to prioritize EBP so they can enhance patient care and assist in controlling expenses.
Learn more about UNCW's online RN to BSN program.
Sources:The History of Nursing Research: Foundations of Nursing Research
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