What value do you see in evidence based practice in nursing?

Researchers at the Institute for Healthcare Improvement (IHI) developed three principles to improve both individual healthcare and the health of populations, while also reducing the overall cost of care. The “Triple Aim,” as it is called, became a priority for the United States with the passage of the Patient Protection and Affordable Care Act (ACA) in 2010. The Triple Aim is defined as “improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations.” A fourth aim, to reduce burnout and improve the clinical experiences of nurses, has since been added.

Índice 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

Research consistently demonstrates that EBP improves the delivery of healthcare, strengthens outcomes, diminishes geographical differences in care and cuts costs. Employing EBP has been found to increase overall job satisfaction, which in turn reduces burnout.

In spite of its efficacy in meeting the Triple and Quadruple Aims, EBP is only gradually becoming the standard of carehe United States. Given its proven ability to greatly improve the quality of care while simultaneously reducing costs, it is critical to advance the adoption of EBP. Armed with the necessary knowledge and skills, nurses can be an integral part of EBP implementation as members of interdisciplinary teams and healthcare systems.

As an empowering approach to care, EBP gives nurses the tools they need to become change agents for improved healthcare outcomes. Embodying an ethic of problem-solving and inquiry, it begins with observation and the formulation of a question, continues through studious pursuit of an answer through research and integration into care and ideally results in improved conditions and outcomes, both locally and globally, as the findings are shared.

Nurses employing EBP become the nexus between a wealth of medical research and practical experience on the ground. They are able to standardize care, decrease medical errors, and bring positive change to their patients, their communities and the world.

Ultimately, EBP gives nurses the opportunity to take a more active role in shaping the practice of nursing in concert with other healthcare professionals and clinicians. It means living up to the example that Nightingale set and creating a better healthcare system from the inside.

Many non-EBP practices continue in spite of the lack of solid research to back them up. Based on tradition rather than evidence, many such interventions and protocols are counter-productive at best, and actively harmful at worst. EBP offers a path away from increased costs, subpar care and unsatisfactory results. Ensuring nurses have the confidence and competence to evaluate medical literature as well as the judgment necessary to compose and carry out a trial is an essential aspect of the RN to BSN online program at the University of Maine Fort Kent (UMFK).

Healthcare is changing, and those who are able to navigate the demands of EBP will be positioned to facilitate that change in their own practice. Armed with your BSN, you are taking the first step to worldwide improvements in healthcare through evidence-based practices.

Learn more about the UMFK online RN to BSN program.

Sources:

Journal of Nursing Administration: Promoting Evidence-Based Practice Through a Research Training Program for Point-of-Care Clinicians

Journal of Professional Nursing: The History of Evidence-Based Practice in Nursing Education and Practice

Milbank Quarterly: Pursuing the Triple Aim: The First 7 Years

Reflections on Nursing Leadership: Improving Healthcare Quality, Patient Outcomes, and Costs with Evidence-Based Practice

Health Care for Women International: Evidence-Based Practice in the United States: Challenges, Progress, and Future Directions

Pediatrics and Neonatal Nursing: Evidence-Based Practice: Are We Getting There?

International Journal of Childbirth Education: Origins of Evidence-Based Practice and What It Means for Nurses

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