NEW YORK NURSE: February 2008
by Joely Johnson
Nurses, like other health practitioners, must build on the experience of the past to deliver the best possible care in the present. But there is a big difference between doing something because “it’s always been done that way” and doing something because “we know this method is the most safe and effective one for these patients.”
Evidence-based practice (EBP) is an approach to nursing care that combines the best existing scientific evidence with the nursing expertise of today, always keeping in mind patients’ goals and values.
To many RNs, however, the concept of EBP can seem daunting. “Sometimes language stands in the way of doing what you need to do to improve practice,” said Rona Levin, nursing professor at Pace University in Pleasantville. When simplified, however, this important process is much easier to grasp.
One RN alone cannot put EBP into action. “Just as you would never change clinical practice based on one isolated study, you cannot develop an evidence-based approach to a problem as an individual in a vacuum,” said Levin.
The EBP process is carried out by a group of practitioners working together, supported by their facility’s administration. The group does not have to be very large; even three interested RNs can be enough.
In addition, you need a mentor, particularly if you are new to EBP. Seek out a nursing faculty member or nurse researcher to consult with your group. “He or she should be versed in EBP,” said Levin, “but does not have to be an expert in your content area.”
EBP grows from a clinical question that can be answered through research. Clinical questions may be triggered by something an RN reads in the literature, or by unsatisfactory patient outcomes encountered in practice.
“The description of the question should describe the extent of the problem, the affected population, and the outcomes we truly want,” said Levin. But remember that clinical questions can and should remain flexible and will need to be adjusted as you search the literature.
Next, the group must scan the literature to find the latest and best evidence that addresses the clinical question, ideally using online research databases. Staff RNs may have limited access to such information, making this step difficult, said Levin. The group mentor can help here, particularly if he or she has access to a health science library.
The group then reviews the gathered evidence to see if it is relevant to the clinical question. This is a time for critical thinking and organization. Systematically comparing and contrasting answers that have come from the evidence allows RNs to determine those that offer the best fit for the problem and patients in the setting at hand.
At this point, RNs may integrate the chosen evidence with clinical expertise, keeping the patient perspective in mind. This important step is called a “small test of change,” according to Levin. “You must evaluate the intervention on a small scale,” she said, to determine whether it is the correct protocol, tool, or procedure for your setting.
The EBP process does not end with integrating evidence into practice. It is important to evaluate the effectiveness of carrying out all of the above steps, both to ensure quality care and also to positively influence nursing practice beyond the small scale. Questions to ask at this point include: Was the change in practice successful? And if so, what is being done to share and diffuse this change in a broader sense?
Levin, R.F. (in press). Evidence-based practice: EBP by any other name is still a rose. Research and Theory in Nursing Practice.
Levin, R.F., Feldman, H.R. (2006). Teaching evidence-based practice in nursing. New York: Spring Publishing Company.
Some online research databases are only available to subscribers; ask your library or facility if they subscribe. Other databases offer free searching and will let you view an abstract, but may charge a fee for full-text articles.
Members may also consult the NYSNA Library for certain forms of research help; write to firstname.lastname@example.org.