Evidence-based practice in professional nursing is a relatively new term in concept and in practice application. The use of this term was first associated with Gordan Guyatt and the Evidence Based Medicine Working Group in 1992 to describe a new approach to teaching the practice of medicine. (Evidence Based Medicine Working Group, 1992). Now, every health discipline has embraced this term including professional nursing, being the one that is the focus of this discourse. Although definitions carry some variation, evidence-based nursing generally describes the application of valid and relevant research information in context of patient preferences and nursing expertise to a variety of clinical problems and patient conditions (Cullum, Ciliska, Haynes & Marks, 2008). Since the turn of the 21st century, nurses entering to practice from baccalaureate nursing programs were introduced to evidence based concepts as part of their academic preparation. However, those who have been practicing for years may find this new paradigm for practice daunting and, perhaps, threatening to everything they have always known and done. In contrast to nursing knowledge gleaned from textbooks in the past, now we have so much evidence from the research literature to direct our nursing policies, protocols, and decision-making with patients, we need some new skills in our toolbox. The knowledge that we uncover through the exploration of the research enhances what we already know through our clinical experiences with patients. That triad of “knowing” (research data, patient preferences, and experiential knowledge) helps nurses individualize appropriate care that is patient-centered, not provider-centered or institution-centered. It allows us to be change agents within our chosen profession, and facilitates reaching the improved patient outcomes about which everyone keeps talking. So let us talk about that skills’ toolbox again!
Skill No. 1:
Know what evidenced based (EBN) nursing means, what components make up EBN triad and how practicing EBN will enhance patient care.
Skill No. 2:
Develop a questioning mind. Question everything. Start with silent questions like “why are we doing it this way?” “What part of the triad of EBN is not being considered in the care of this patient?” “Why is our unit not achieving better results?” “Where do I find the most current and reliable information that would inform me?”
Skill No. 3:
Learn about the “levels of evidence” found in the research literature. Some types of research provide stronger evidence than other types. Systematic reviews, meta-analyses and randomized control trials provide the highest level of evidence; single studies, author opinion papers, and convenience sample studies, not so much.
Skill No. 4:
Familiarize yourself with both quantitative and qualitative study designs and mixed designs. Randomized control trials (RCTs) if done well, are quantitative and generalizable to other like populations; qualitative studies have much smaller sample size and provide an in-depth look of particular phenomenon. Qualitative research using case studies, interviews and observation provide rich insight into patient experience but it is not intended for generalization.
Skill No. 5:
Learn some library search skills for electronic databases. “Googling” on the Internet is inefficient and many sites charge fees for articles. Researchers from many disciplines publish their study results in the Cumulative Index of Nursing and Allied health Literature (CINAHL), MEDLINE, and OVID. and the Cochrane Database of Systematic Reviews. All of these and more can be accessed through the Widener University Wolfgram Library online. As a Widener student, you can request copies of articles for free using “ILLIAD” and the research librarian can provide you with the “how to” instructions.
Skill No. 6:
Start small when problem solving. Most clinical /patient problems are complex. Do not try to fix everything at once. If there is a pressing issue with a certain patient/patient population, search what the literature has to say, query other staff and patients about their perspectives, and make small changes that can be measured for effectiveness.
Making the most of your student experience will help your professional career move forward and learning the skills to promote evidence-based practice is the foundation. Whether you are new to nursing or a seasoned veteran, staff nurse or management, raising your EBN skill level will gain you confidence in the care you provide and recognition as a leader among your peers, colleagues and supervisors.
If you would like to advance your nursing career and learn more about evidence based practice, Widener University offers an online RN-BSN program to help you achieve your goals. Contact a Program Manager at 844-386-7321 to learn how or apply now.
Written by: Lorraine C. Igo, Assistant Professor of Nursing
American Psychological Association (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.
Cullum, N., Ciliska, D., Marks, S., & Hayes, B. (2008). An introduction to evidence-based nursing, chapter1. (In Evidence-based nursing: An introduction, Cullum, N., Ciliska, D., Marks, S., & Hayes, B. Eds.), Massachusetts, Blackwell Publishing.
Evidence –Based Medicine Working Group (1992). Evidence-based medicine: A new approach to teaching the practice of medicine. Journal of the American Medical Association, 268, 2420-5.