Nurses are required to make many decisions every day on aspects of patient care. They generally take a holistic approach to this, treating the patient as a whole, rather than simply a condition. As part of this patient-centered approach, they use the best available evidence to inform their decision making. By taking this approach, they can optimize outcomes for patients as well as improve their own practice and the standards of the medical facility in general.
The components of evidence-based practice
Using evidence-based practice in nursing means drawing on the most up-to-date, high-quality research when assessing or reviewing a situation and using it to decide on how to proceed in their delivery of care. In doing this, there are three main components they must consider.
The first of these is external evidence from the best possible quality scientific research. The best example of this is evidence drawn from randomized, controlled trials. Other forms of external evidence comes from observational, case control or cohort studies. Expert opinion can also be used, as long as it is backed up with reports, studies and experience.
The second component is to draw on the nurses’ own experiences in similar situations or working with that particular condition or patient. This is something that becomes easier the more experience the nurse has, as it is more likely they will have experienced a similar situation before.
The last main component is to consider the patients’ preferences. They may have their own views on the best course of action that will most closely fit in with their values and principles.
How evidence-based practice is implemented
When considering the evidence to make the best clinical decisions, the nurse runs through a number of steps:
- They must formulate the questionor questions about the patient, their illness, injury or symptoms, any treatment they have experienced so far and anything else that may be relevant. These questions need to be formulated in a way that they can be answered with evidence.
- They must acquire the evidence needed to answer those questions.
- The nurse must now appraise the evidence to ensure that they are only using evidence of a high standard to inform their decisions and that it is valuable and relevant to the questions.
- Now the nurse needs to apply the evidence to make and implement the decision on patient care.
- Having implemented the decision and taken the steps designed to improve the patients’ wellbeing and outcome, the nurse needs to assess the consequences of the decision to ensure that it is improving the patient’s situation.
- While the first five steps may need to be made quite quickly, there is less urgency on the sixth step, although it is still good practice to take it. And that is to share your evidence, decisions and evaluations to help spread the knowledge and facilitate the clinical decisions of other nurses. This may involve reporting the details to other nurses and medical professionals involved in that particular patient’s care or to share it more generally for use with other patients.
Learning how to deliver evidence-based practice
To anyone not in a medical profession, the thought of having to run through those steps and consider what may be a wide base of evidence, often under high-pressure conditions, can seem daunting. However, nurses become highly proficient at it, running through the steps as a matter of course. In fact, in emergency situations, having those steps to follow to make decisions is far easier than doing so in a more random fashion. For those considering entering the nursing profession, learning how to make evidence-based clinical decisions is generally part of the training curriculum.
Nursing courses can be widely accessed either in person or through online study. Online nursing courses are one of the most significant developments in nurse training of recent years and are just as thorough and challenging as their in-person counterparts. A good example of these high standards can be found at the University of Indianapolis, which offers a number of online nursing courses, including an accelerated Bachelor of Science in Nursing. On this course, you will gain competency in a number of themes, including holistic, evidence-based care, as well as undertaking clinical placements in your locality so you can put that evidence-based care into practice.
Lifelong learning
Medical research and studies are continually ongoing, and so nurses need to keep themselves up to date with the latest findings through training, further education, and their own reading — changing their evidence-based practices as new results come to light.
Current examples of evidence-based practice in nursing can be seen in the measures nurses take on infection control, including maintaining a clean environment, personal protective equipment (PPE) and handwashing to prevent hospital-acquired infections. Another example is giving oxygen to patients suffering from chronic obstructive pulmonary disease (COPD). This can run counter to beliefs that doing this can cause acidosis, hypercapnia, or even prove fatal. But the evidence shows that oxygen can benefit patients with COPD, helping to prevent organ failure and hypoxia and in doing so improving both the quality of life and the longer-term prognosis.
The advantages of evidence-based practice
Using evidence-based practice has several benefits. Firstly, and most importantly, it delivers superior care, improving outcomes for patients. Providing more consistent care, it also saves time, something that is a particular advantage for nurses on busy shifts. This consistent care also reduces costs, benefiting the healthcare facility and freeing up money for other aspects of medical practice.
Through using evidence-based practice, nurses contribute to that weight of evidence as they assess the results of using that particular type of care. In doing this, they contribute to the science of nursing and can help inform the decisions of others.
There is always a need to adapt nursing practices as new research is carried out, but for many nurses, that lifelong learning journey is something that has attracted them to the profession, as they relish the opportunities of learning more.