What are the benefits of nursing research and evidence-based practice to nursing practice?

1. Guyatt, G.H., Haynes, R.B., Jaeschke, R.Z., & Cook, D.J. (2000). Users' guides to the medical literature: XXV. evidence-based medicine: principles for applying the users' guides to patient care. JAMA, 284, 1290-1296. doi: http://dx.doi.org/10.1001/jama.284.10.1290

Inhaltsverzeichnis Show

Why is it important?
How can you implement evidence-based initiatives to improve outcomes for older people?
Identify a practice that could be improved
Barriers, enablers and issues
The intervention
What did and didn’t work
Maintaining the intervention

2. Sackett, D., Rosenberg, W., Gray, J., et al. (1996). Evidence based medicine: what it is and what it isn't: it's about integrating individual clinical expertise and the best external evidence. BMJ, 312, 71-72. doi: http://dx.doi.org/10.1136/bmj.312.7023.71

3. Mayer, D. (2010). Essential evidence-based medicine (2nd ed.). Cambridge: Cambridge University Press.

4. Hoffman, T., Bennett, S., & Del Mar, C. (2013). Evidence-based practice: across the health professions (2nd ed.). Chatswood, NSW: Elsevier.

5. Straus, S., Glasziou, P., Richardson, W., & Haynes, R. (2011). Evidence-based medicine: how to practice and teach it (4th ed.). Edinburgh: Churchill Livingstone Elsevier

6. Bushell, M. (2019). Supporting your practice: Evidence-based medicine. Australian Pharmacist, 38, 3, 46-55.

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The essential first step in the Evidence-Based Practice (EBP) process is the identification of uncertainty, or the need for information, and the translation of this uncertainty into answerable clinical questions. Developing the ability to formulate precise, structured, and answerable clinical questions has been identified as one of the key tasks for clinicians using the strategies of EBP in their clinical work. The question needs to be:

Directly relevant to the identified problem, and
Constructed in a way that facilitates searching for a precise answer.1

The investment of time to consider what you need to find out and construct a focused clinical question will yield a more effective and efficient search for evidence, helping you to more quickly locate the best available evidence to inform your patient care decision.2

EBP experts recommend the following steps in formulating a clinical question:

Analyse the question into components using the P I C O framework;
Rephrase your question using the concepts from your P I C O analysis;
Identify the type or domain of the question.

The next section in Module 1 explains these three steps.

Evidence-based practice (EBP) is an approach to care that integrates the best available research evidence with clinical expertise and patient values.1

It involves translating evidence into practice, also known as knowledge translation, and ensuring that ‘stakeholders (health practitioners, patients, family and carers) are aware of and use research evidence to inform their health and healthcare decision-making’.2

Why is it important?

Implementing clinical knowledge, and introducing new interventions and therapies, is an important way to minimise functional decline in older people.

Four in 10 adult patients receive care that is not based on current evidence or guidelines, including ineffective, unnecessary or potentially harmful treatments.2
Despite the availability of evidence-based guidelines, there are significant gaps in implementing evidence into routine clinical practice.3
Translating evidence into practice can not only improve outcomes and quality of life for older people, it can also improve productivity and reduce healthcare costs.1

How can you implement evidence-based initiatives to improve outcomes for older people?

Implementing evidence-based practice is a key part of improving outcomes for older people in hospital. When considering current best practice in the areas of nutrition, cognition, continence, medication, skin integrity, and mobility and self-care, a good first reference is the Older people in hospital website.

The National Safety and Quality Health Service Standards outlines the standards for providing best evidence care for older people in hospital.

The ‘how to’ guide: turning knowledge into practice in the care of older people identifies a five-stage process to implementing change, which can be applied to translate evidence into practice.

Identify a practice that could be improved

Select an area of interest in your clinical practice that could be improved – for example falls, medication errors or malnutrition.
Identify current best practice guidelines and evidence-based interventions associated with improved outcomes.
With your team, select an appropriate intervention and outcome measures that will influence your practice.
Collaborate with quality teams and researchers with expertise in the area you are focussing on.

Barriers, enablers and issues

Identify the barriers to implementing change. This includes anything that might obstruct or slow down the adoption of a new clinical intervention, such as feasibility, existing care processes or existing team culture.
Explore the enablers to implementing change. This includes anything that might assist or encourage take up of a new evidence-based practice, such as positive staff attitudes, funding or alignment with accreditation standards.
Consider issues for any data collection for measuring the effectiveness of your intervention.
Plan for sustainability to ensure the change can be maintained.

The intervention

Tailor the intervention to fit within the appropriate policies, standards and guidelines.
Engage and communicate with relevant stakeholders including staff, patients, family and carers to promote and facilitate adoption of the new intervention.
Consider implementing a plan-do-study-act cycle from the ‘how to’ guide in which interventions are introduced and tested in the real work setting, in a sequence of repeating, smaller quality cycles.

What did and didn’t work

Monitor patient outcomes following the adoption of a new intervention.
Measure the impacts of translating evidence in your current practice.
Outline an evaluation to measure outcomes and demonstrate any improvement.

Maintaining the intervention

Adapt and integrate the new intervention within the current systems taking into account funding and resources.
Ensure all new staff receive ongoing training.
Maintain ongoing communication, engagement and partnerships with relevant stakeholders and the broader network.

1. Sackett D et al. 2000, ‘Evidence-Based Medicine: How to Practice and Teach’ EBM, 2nd edition. Churchill Livingstone, Edinburgh, p1.

2. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ & Squires JE 2012, ‘Knowledge translation of research findings’, Implement Sci, 7(50):50.

3. Runciman WB, Hunt TD, Hannaford NA, Hibbert PD, Westbrook JI, Coiera EW, Day RO, Hindmarsh DM, McGlynn EA & Braithwaite J 2012, ‘CareTrack: assessing the appropriateness of health care delivery in Australia’, Med J Aust, 197(2):100-5.

Reviewed 26 October 2021

In the University of Rhode Island's Registered Nurse to Bachelor of Science in Nursing Online program, nurses learn the importance of evidence-based practice (EBP) and how to implement EBP into care. As Dr. Bernadette Mazurek Melnyk explains, "EBP is all about using the best evidence to make the best clinical decisions to achieve the best clinical outcomes." Not surprisingly, achieving the best possible clinical outcomes is highly desirable from a patient perspective as well as an employer standpoint.

Yet, the benefits of EBP do not end there.

There is no question that EBP leads to better patient outcomes in nursing practice. One significant improvement in patient outcomes is patient safety. This can be seen as former practices of instilling saline in endotracheal tubes and putting babies to sleep on their stomachs have now been proven unsafe by research. Improved healing and shorter recovery times are other improvements in patient outcomes because of EBP. Nursing practices have changed, including previous practices like performing daily dressing changes and putting new moms on bed rest after delivering their baby.

Better use of resources including nursing time

Improved patient outcomes has also resulted in better use of healthcare resources. Former routine nursing practices such as monitoring vitals every four hours and performing daily dressing changes led to the unnecessary use of medical supplies and loss of valuable time nurses could have spent performing more beneficial care.

Improved professional accountability

The use of EBP also demonstrates professional accountability for the decisions that nurses make. EBP promotes "an attitude of inquiry in health professionals and gets them into thinking about questions such as: Why am I doing this in this way? Is there evidence that can guide me to do this in a more effective way?"

Understanding the importance of EBP is one step, but executing it is another. Nurses can implement EBP in their nursing care by following these six steps:

Ask: The first step begins by asking the right questions when the nurse lacks knowledge or is uncertain of the best course of action in a clinical situation. Nurses can use the acronym PICOT, which stands for population, intervention, comparison, outcome and timeframe.
Gather: In this step, nurses gather scientific evidence from credible sources such as organizational policies and procedures, professional nursing practice standards and scientific databases such as CINAHL, PubMed and National Guideline Clearinghouse.
Appraise: In step three, the nurse compiles all the information he/she has found. This requires "interpreting and synthesizing evidence and drawing conclusions about the usefulness of the information for the current situation."
Act: After analyzing the information, the nurse informs colleagues whether their current nursing practice aligns with best practice recommendations or if a change is needed. If a change is needed, the nurse determines the feasibility of the recommendation and formulates a plan to trial the new intervention and track patient outcomes.
Evaluate: After piloting the new recommendation, the nurse compares the trial outcomes with the desired outcome in the PICOT question above to see if they have adequately addressed the original nursing question.
Disseminate: If the nurse has discovered new knowledge, it is important to share this knowledge with colleagues where they work and with the wider nursing profession. They can activate change through professional presentations and written articles published in nursing journals and online sites.

EBP improves patient care quality when nurses "translate research findings into clinical practice" as explained in the six steps above. This ensures patients receive the most effective and safe care given the current body of nursing knowledge.

While the implementation of EBP involves many resources and nursing time, the benefits of improved patient outcomes and reduced healthcare costs make EBP an invaluable part of today's nursing care.

Learn more about the University of Rhode Island's Online RN to BS in Nursing program.

Sources:

American Association of Nurse Practitioners: Why Choose Evidence-based Practice?

American Journal of Nursing: EBP 2.0: From Strategy to Implementation

Florence Health: 6 Things You Didn't Know About the Benefits of Evidence-Based Practice

Nursing Answers: Benefits of Evidence Based Practice (EBP)

Nursing Center: Call to Action: How to Implement Evidence-Based Nursing Practice

Nursing Center: Evidence-Based Practice: Something to Celebrate (Really!)

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