Evidence Based Nursing Practice

On a daily basis health care professionals are confronted with difficult questions and situations while caring for patients. They want to know how to interpret diagnostic tests accurately, how to predict the prognosis of a patient, and how to compare the effectiveness of therapeutic interventions. As health care professionals we are challenged to stay familiar with any new information regarding health. This allows us to give our patients the highest quality health care available. In the recent decades, the nursing profession has developed a process of evidence-based research to incorporate in the scope of practice. Today, evidence based nursing practice (EBNP) has become a contemporary tool influencing the development of new policies and procedures in the nursing field. This paper will explore the history and purpose of EBNP, the process of developing EBNP research, and discuss the positive and negative aspects of incorporating and implementing EBNP in the field of nursing.

Since the 1920's, nursing profession has been conducting scientific research studies to identify effectiveness of nursing interventions (Brown, 2009). However, the general population of practicing nurses were not exposed to, nor aware of, these studies, and therefore did not incorporate the findings into practice. So in the 1970s, nurses started projects that encouraged the utilization of research-supported actions. Over time, a process and protocol of scientific, critiqued, systematically reviewed, and patient focused studies for EBNP was developed. (Brown, 2009). In the early 1990s, a faculty group from Canada started an evidence based practice movement, which took all the various research studies on the effectiveness of a particular intervention and put forth the best practice based on the evidence provided. It also encouraged nurses to guide their practice by drawing on and seeking out existing and current research and applying it (Brown, 2009). It is now an important part of nursing to actively participate in research and evidence based practice in order to continually improve the standard of the health care system.

Evidence based nursing practice is the application of nursing practice based on information gathered from research (McCann, 2007). This means that EBNP is a process involving the examination and application of research findings or other reliable evidence that has been integrated with scientific theories. For nurses to participate in this process, they must use their critical thinking skills and review the available literature on a particular area of research. After the information is evaluated, nurses use their clinical decision-making skills to apply evidence to patient care. As in all nursing care, patient preferences and needs are the basis of care decisions and therefore essential to EBNP (Lewis, Heitkemper, Dirksen, O'Brien, & Bucher, 2007). In general, the term "EBNP" describes a model of care whereby nurses, using current evidence on research knowledge, make decisions using clinical expertise and patient preferences to guide patient care.

In conducting evidence based nursing practice research, the basic steps involved are: clinical question formulation, searching and reviewing articles on that clinical question, critical evaluation and comparison of the articles, application of the information from the articles, and outcome evaluation of the changes made in local practice (Lewis et al., 2007).

Developing a nursing clinical research question requires four parts. A good research question includes a population of interest, an intervention, a comparison and an outcome. This is known as PICO question format (Lewis et al., 2007). After establishing clinical questions, the nurse will have to review relevant articles to use. Online indexes, published journals, books, and other references serve as databases and will help in broadening knowledge about the research topic. The next step is critical evaluation and comparison of the articles. In this step, the nurse must make sure that articles are published and peer-reviewed, that is, outside experts had reviewed the article prior to publication (McCann, 2007). Articles are examined for quality indicators such as validity and reliability. If the data from the article is valid and reliable, the information is then applied to answer the PICO question. Then, outcomes are further evaluated depending on the patients response.

For example, in 2008, Reavey and Tavernier conducted a study comprising a team of staff nurses, a unit nurse manager, a clinical nurse specialist, a nurse researcher, and an infection control nurse. The clinical question is to identify the best practice for frequency of central line dressing changes in severely neutropenic patients. The current policy, which is daily dressing changes, resulted in skin breakdown and increases the chance for infection. The patients were dissatisfied also with the frequency and discomfort due to skin breakdown. The team conducted a literature search of relevant evidence. Based on the review, the team came up with a proposal that central line dressings must be changed every 7 days or as needed, and gauze dressing changes every 2 days. The expected outcomes were reduced