If you’re a student nurse or work within the healthcare profession, there’s a lot of talk about evidence-based practice (EBP) within medical management, but what does that mean, in real terms, in clinics or hospitals?
In this article, we look at how EBP is combined with practical experience to determine the best possible proof-based approach to patient care while elevating standards.
EBP is a technique used within healthcare to combine research evidence and the patient’s values and preferences to provide quality healthcare. It emphasizes using scientific evidence from clinical trials, systematic reviews, and other research studies in conjunction with expert opinion.
This tried-and-tested method of healthcare relies on the best available evidence to make the right clinical decisions by integrating core evidence on what works best, rather than relying solely on personal experience or intuition.
Using EBP is about looking at the evidence and using it accordingly. That’s what the textbooks say, but nurses know that practical instinctive care goes hand in hand with successful patient outcomes.
Keeping standards high while raising the bar is the job of a clinical nurse leader. Nurses who wish to elevate their careers should look to enroll in an online MSN-CNL(Master of Science in Nursing – Clinical Nurse Leader)education program to advance and future-proof their careers. Institutions such as Cleveland State University prepare students to become effective leaders while upholding the important pillars of EBP to ensure quality care to patients.
EBP requires some study and digestion of research relating to your specialization, but if you’re serious about improving your practice and elevating standards, then this is one of the most robust ways that you can make a difference.
Nurses are often tasked with making decisions on behalf of patients and delivering quality care in a fast-paced environment. Taking the time to research and assess evidence helps inform these decisions so that change can happen.
Implementing change and updating policy is part of a clinical nurse leader’s remit. Once you’ve discussed your findings with your team and nurse manager and you’re certain that policy compliance is in place, you can use EBP practices alongside your patient’s values and request to create a speedier recovery environment.
There are many examples of EBP that may seem like second nature. For instance, oscillometric devices or blood pressure monitors are considered gold standard devices for measuring blood pressure.
The use of oxygen is a tried-and-tested treatment to help organ failure due to chronic obstructive pulmonary disease hypoxia in patients. You will likely use EBP without even giving it a second thought – second-nature reactions to everyday nursing events.
There are four recognized steps to implement and execute EBP effectively:
- Ask clear questions – Always ask questions and query answers, and double-check information before implementing an action or procedure.
- Acquire and appraise – Source your evidence – is it the latest research? Ask questions of those who implement policy around your specialism.
- Apply the theory to the practice – Use EBP and assess the outcomes.
- Present your findings – Use the information gained to elevate or change nursing standards.
Clinical nurse leaders learn to think critically, and it’s within these changes that your critical thinking skills come into play, along with the ability to understand the levels of evidence in evidence-based clinical learning and practice.
In point two of the steps to implement and execute EBP constructively, we discuss sourcing your evidence, and this is where the ability to understand the levels of evidence is crucial to positive patient outcomes.
Evidence levels are hierarchical, meaning that they are arranged in order of rank. The highest levels of evidence are used in evidence-based medicine (EBM), a standardizing system introduced by the Canadian Task Force (CTF) on the Periodic Health Examination back in 1979 to create a way to make recommendations and base those on evidence found in published medical literature and white papers.
The purpose of grading is to determine the effectiveness of procedures and interventions based on a periodic health examination asking the question, how accurate is my evidence that a strategy works?
The grading appears in the table* as follows:
|1/A||Level||At least one RCT (random controlled clinical trial) with strict randomization as a trial precursor.|
|2/B||Level||Well-thought-out cohort or case-control study.|
|3C||Level||Time series comparisons or dramatic results from uncontrolled studies.|
|4D||Level||Expert opinions – no matter how learned the experts are.|
Trials with random controlled traits were considered A-grade information, and while appearing on the list for consideration, the expert opinion did not fare so well, as experts’ opinions are just that – opinions are subject to change.
EBP in nursing is the bridge between the theory and the practice of any situation to deliver the most current and innovative patient care available at any given moment – for example, making the theory of drug administration come to life by using practical examples and showing a junior nurse how to follow the correct procedure to avoid mistakes.
The origins of EBP reportedly go back as far as Florence Nightingale and the Crimean War. Nightingale was the first to gather data and conclusions to link unsanitary conditions and illness. The findings were lifesaving, and the practice was life-changing.
In the case of Nightingale, the breakthrough came by studying the link between unsanitary conditions and infection. By noting the improvements in patients who were kept clean, with their wounds disinfected, and the effects on those who were not, Nightingale was able to document their improvement or decline and, in doing so, created a crude form of EBP.
In addition to maintaining up-to-date and pertinent healthcare practices, evidence-based nursing provides numerous advantages for all stakeholders and offers a practical baseline from which standards are raised.
For several reasons, EBP enhances the probability of better patient outcomes. EBP is an approach of combining the most up-to-date research evidence with the best clinical expertise, combined with informed decisions and patient values, to decide on the best course of action for patient care.
EBP ensures that healthcare providers and professionals base their decisions on the most current and credible research evidence. This means that treatments and interventions have been proven to work through scientific study – reducing the chance of administering ineffective or harmful treatments.
Standardization of care
EBP helps establish standard protocols and guidelines for treating specific medical problems or conditions. By standardizing, you can ensure that patients receive consistent high-quality care through departments and clinics, regardless of the healthcare provider they see.
EBP promotes constant learning and progress. As new research emerges, clinical nurse leaders encourage others to update their practices and procedures accordingly – joining up the thinking to provide ongoing improvements in patient care and results regarding their health.
By linking evidence to measures or actions, you can consistently and confidently implement trusted procedures. Better evidence means more chance that a new policy or procedure will successfully promote patient care and well-being.
Reducing variations in practice is the holy grail of EBP. By following evidence-based guidelines, healthcare providers can minimize variations in patterns to ensure that all patients receive the same high-quality care based on the graded evidence available.
Reducing variation does not detract from patient-centered care. EBP takes into consideration the need to tailor to individual patient needs. The personalized approach that nursing has always valued remains intact, leading to greater patient satisfaction, which in turn leads to better cohesion between the patient and the treatment plan.
Better evidence and procedures lower the risk of complications, which reduces healthcare costs. In turn, cost reduction is an elevator to the growth of science in nursing.
In practical terms, effective risk management saves lives, not only lessening the emotional cost to staff and patients but also reducing the chances of lawsuits and negligence claims.
Learning and practices evolve, and so does EBP. Consistently in use, EBP must move with the times, and making sure EBP keeps up to date is the role of the clinical nurse leader.
In recent years, academics and medical educators have suggested that moving from EBP to evidence-informed practice(EIP) would benefit all concerned. EBP has been the holy grail of concepts since the 1980s and is offered as a tool for cost-cutting by reducing the risk of complications for better patient outcomes and successful delivery of services.
Since the mid to late 1990s, EIP has been offered as a step beyond EBP. An evidence-informed practitioner is a critical thinker and an active doer. While EBP strictly relies on prior research, EIP uses research as a foundation but does not confine itself to it. As a result, EIP is more comprehensive and inclusive than EBP.
EIP might seem like the death knell for EBP, but the opposite is true. Combining best practices – EBP and EIP – is the way forward for healthcare.
When the evidence allows it, technology will elevate healthcare practice by just the very nature of technological advancements. Part of a clinical nurse leader’s role is to take advantage of technological advancements to save time and money wherever possible.
New technology, such as artificial intelligence (AI), can provide scientifically supported research, helping to make educated decisions. According to an article for Nature Chemical Biology, AI can save lives by creating a new form of antibiotic to counteract the effects of a superbug threatening to critically affect human health.
Hospitals and clinics have been alerted to the danger of a bacterial threat, Acinetobacter baumannii, so dangerous to human life that the World Health Organization is on red alert. In the presence of a clear and present danger, AI scientists developed an algorithm to interpret mutations and, in turn, develop a cure.
It was AI’s ability to correlate and assimilate vital data quickly that saved the day. Clinical nurse leaders who understand the vital role that technology has in modern nursing can elevate their careers.
EBP inspires nursing autonomy but, more importantly, confidence in the daily course of action within the ward or hospital. It fosters shared care planning decision-making with the patient and other stakeholders to ensure the best results possible.
The evidence-based practice encourages continuous learning
To make the most of EBP, you must engage in continuous learning. As medicine and procedures advance, staying up to date with all the new evidence and practices is vital.
As a nursing professional, keeping abreast of advancements is second nature. Nursing is a vocation, and with that comes a commitment to best practice. The best practice is always being current with medical and clinical advancements.
Nursing will never go out of fashion and will never be replaced by robots or AI. Although advancements in practical technology mean that AI will automate the administration, this is no bad thing as so much time is taken up with paperwork.
Remote nursing and telehealth will appear, particularly when patients want to remain in their homes, or for people in rural or remote locations who can’t or won’t travel. This means that community nursing can be carried out for minor issues or pastoral care via the phone or laptop.
There are several things that a nurse can do to boost their career, from additional education to honing their soft skills and becoming an expert in their field.
No education, no matter how inconsequential it seems, is wasted. Learning for the benefit of your career is a lifetime commitment. A nurse should seek to develop their skills, and education in the form of a master’s degree is a great place to start.
The online Master of Science in Nursing (MSN) enables you to be a clinical lead nurse. It will prepare you to become an effective leader in medical management, addressing critical patient care consequences and outcomes, along with the effective integration of care in complex situations for a diverse population.
Clinical nurse leaders take their job home with them. Anyone who works in life-and-death situations knows that who they are and who they represent are intertwined in and out of the office. Even when you’re not on call, you represent your profession – so remember to represent your profession well.
You never know who’s watching – being a nursing advocate will always show that you are committed to your future-proofed career.
Medical technology is always advancing, and it’s a good idea to stay informed and on top of new technology designed to make your nursing life easier.
Smart beds, wearable health devices, electronic health records, central command locations, and automatic IV pumps are just some of the ways that technology is helping to lift the burden of day-to-day nursing practices.
By understanding how to use these technological advancements best, you can make life easier for yourself and others.
With the ongoing evolution of the healthcare sector, driven by technological advancements, nurses can adapt and grow alongside it – ultimately enhancing patient care outcomes, elevating standards, and promoting healthcare simultaneously.
It is crucial for clinical nurse leaders and nurses to stay informed and on top of the latest evidence and practices in the healthcare sector. In the ongoing evolution of healthcare, often driven by tech advancements, nurses should embrace new technology to remain future-proofed and elevated within their profession.
As with most things, balance is key. Your role as a clinical nurse leader is vital in making sure that nurses don’t become stressed or burnt out. By encouraging them to invest in work-life balance, nurses will remain at their best and be available to provide high-quality patient care.
*Table adapted from Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J 1979;121:1193-254.