Administrative Challenges: Evidence Based Practice

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Administrative Challenges-Evidence Based Practice

Background

* Evidence Based Nursing started with Florence Nightingale. A firm believer in knowledge-based practice, she was a systematic thinker and passionate statistician, who believed in using the best possible research to elevate practice on the shoulders of knowledge.

* Since then, the nursing profession has more recently provided major leadership for improving care through application of research findings in practice.

* According to the University of Minnesota, Evidence-based nursing is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient preferences.

* To carry out EBN the following factors must be considered: * 1. sufficient research must have been published on the specific topic * 2. The nurse must have skill in accessing and critically analyzing research * 3. The nurse’s practice must allow her/him to implement changes based on EBN.

* Undoubtedly, nurses need help accessing and analyzing research. In a recent study of 3000 licensed US nurses, more than half of those responding (53%) had never identified a researchable problem, almost half were unfamiliar with the term “evidence-based practice,” and 43% sometimes, rarely, or never read journals or books. Eighty-two percent had Internet access somewhere in their facility, but fewer than 50% of them had it where they could access it easily, such as on patient units or at the nurses’ station. Most of those surveyed do not search MEDLINE (55%), the majority (73%) does not search CINAHL, and almost 38% believe that their colleagues do not use research findings in the practice environment.

* Nursing practice leaves little time for applying EBN processes. The realities of decreased staffing and increased acuity mean most nurses spend most of their time caring for patients as best they can. There is no time to conduct literature reviews, evaluate research, and form clinical decisions based on these findings. Organizational culture, in which nurses have little or no influence, is a leading determinant in nurses’ use of research in practice disease (Springer et al., 2006)

* During the 1980s, the term “evidence-based medicine” emerged to describe the approach that used scientific evidence to determine the best practice. Later, the term shifted to become “evidence-based practice” as clinicians other than physicians recognized the importance of scientific evidence in clinical decision-making.

* Various definitions of evidence-based practice (EBP) have emerged in the literature, but the most commonly used definition is, “the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients”(Sackett et al.,1996). Subsequently, experts began to talk about evidence-based healthcare as a process by which research evidence is used in making decisions about a specific population or group of patients.

* Evidence-based practice and evidence-based healthcare assume that evidence is used in the context of a particular patient’s preferences and desires, the clinical situation, and the expertise of the clinician. They also expect that healthcare professionals can read, critique, and synthesize research findings and interpret existing evidence-based clinical practice guidelines.

Is EBP the same as nursing research?

* Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions. Best evidence includes empirical evidence from randomized controlled trials; evidence from other scientific methods such as descriptive and qualitative research; as well as use of information from case reports, scientific principles, and expert opinion.

* Evidence-based practice provides a critical strategy to...
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