Clinical Reasoning: Combining Research and Knowledge to Enhance Client Care

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Making sound and client-centered clinical decisions in an area that demands accountability and evidence-based practice requires not only scientific knowledge, but also a deep knowledge of the practice of one’s profession and of what it means to be human in the world of combined strength and vulnerability that is health care. Every clinician must understand the importance of applying best research evidence to client care, the essence of evidence–based practice, to improve the overall quality of healthcare. Research continues to find that using evidence-based guidelines in practice, informed through research evidence, improves patients’ outcomes (Dykes et al, 2005). The literature is replete with definitions of evidence-based practice. Simply stated, evidence-based practice is the process of applying research to practice. Originating from the medical field in 1991, the term evidence-based medicine was established to ensure that medical research was systematically evaluated in a manner that could "inform medicine and save lives and that is superior to simply looking at the results of individual clinical trials" (Wampold & Bhati, 2004). An evidence-based practice is considered any practice that has been established as effective through scientific research according to a set of explicit criteria (Drake, et al, 2001). The term evidence-based practice is also used to describe a way of practicing, or an approach to practice. For example, evidence-based medicine has been described as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett, Rosenberg, Gray, et al, 1996). Evidence-based medicine is further described as the "integration of best research evidence with clinical expertise and patient values" (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Rather than a relationship based on asymmetrical information and authority, in evidence-based practice the relationship is characterized by a sharing of information and of decision-making. The clinician does not decide what is best for the client, but rather the clinician provides the client with up-to-date information about what the best-evidence is regarding the client’s situation, what options are available, and likely outcomes. With this information communicated in culturally and linguistically appropriate ways clients are supported to make decisions for themselves whenever and to the extent possible. According to Burns and Grove evidence-based practice is nothing more than a problem-solving approach to the care that we deliver that takes into consideration the best evidence from research studies in combination with clinical expertise and the patient’s preferences and values (Burns & Grove, 2004). Pierce described in “Evidence-Based Practice in Rehabilitation Nursing” that “making patient-care decisions with current information and one’s clinical expertise enhances the ability to provide the best practice”. The author added that “evidence-based practice is a process that begins with knowing what clinical questions to ask, how to find the best evidence, and how to clinically appraise the evidence for validity and applicability to the particular care situation”. Then, the best evidence must be applied by a clinician with expertise in considering the patient’s unique values and needs. As stated by Law& MacDermit, “evidence for practice is not only about using research evidence, but using it in partnership with excellent clinical reasoning and paying close attention to the client’s stated goals, needs, and values”(Law & MacDermit, 2008). Although the terms best practices and evidence-based practice are often used interchangeably, these terms have different meanings. Evidence-based practice can be a best practice, but a best practice is not necessarily evidence-based; best practices are simply ideas and strategies that work, such as programs, services, or interventions that...
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