Nursing Education and Evidence Base Practice

 Evidence Base Practice In Nursing Education

What Is Evidence Based Practice,Implementations of Evidence Based Practice,Utilization of Evidence Base Practice in Nursing Education,Outcomes of Evidence Based Practice.

What Is Evidence Based Practice

    Evidence based practice (EBP), sometimes referred to as evidence-based nursing, is a problem-solving approach to clinical care that utilizes current best evidence from well designated studies, a clinician's expertise, and patient values and preferences.

Implementations of Evidence Based Practice

    When EBP is applied in the context of caring that is, considering patient preferences and values the results are high quality clinical decisions for the outcomes of patients ( Melnyk & Fineout Overholt , 2011). The process of EBP consists of six consecutive steps. The first step is asking the clinical question in the PICO format, where P is patient population, I am intervention or area of interest, C is comparison intervention or comparison group, and O is outcome. A searchable clinical question is the driver for the second step, the search process, and provides a basis for searching the electronic databases to retrieve relevant articles. 

    Key words and phrases are used to narrow the search for relevant evidence in databases. There are six hierarchy levels of evidence for answering clinical questions, ranging from the highest level of systematic reviews of studies, such as the Cochran Reviews, to level 7, which evidence is obtained from the opinion of authorities and/or reports of expert committees. The third step is critically appraising the evidence uncovered in the literature. One needs to query: Are the results valid, reliable, and pertinent to my patient? Step 4 is a utilization, of clinical judgment, patient preferences, and values to decide on final management strategies (Brenner & Leonard, 2005). 

 

    These are important components of EBP, which can be highly influenced by institutional and clinical variables. A resource shortfall like budget restraints may hinder the realization of EBP. The fifth step is to carefully evaluate the outcome of the implementation of evidence in the clinician's institution. What worked, and what did not? Monitoring of data on the change in patient care and quality measures can pinpoint flaws unique to the environment and identify which patient population can benefit most. 

    The final step is to effectively distribute the information locally through grand rounds and in services, and nationally through publications and conference presentations. It is important to share EBP initiatives with colleagues to avoid duplication of efforts and promote integration of EBP as the standard for the clinical decision-making process.

Utilization of Evidence Base Practice in Nursing Education

    There has been a major emphasis on utilizing EBP. The reason for this change is multi fold. First, there has been an explosion of information with over 25,000 randomized controlled studies published last year. It takes an average of 17 years to translate research findings into clinical practice. Methods to hasten its use have been supported by major professional and health care organizations. The 2001 Institute of Medicine's (IOM) report: Crossing the Quality Chasm: A New Health System for the 21st Century, stressed evidence-based decision making for health care management. The IOM has set a 2020 goal that 90% of clinical decisions be evidence based (IOM, 2003). 

    The National Organization of Nurse Practitioner Faculty (2012) recommends that EBP is a core competency for the nurse practitioner's approach to client management. To obtain Magnet designation, a hospital must demonstrate quality nursing care through EBP (American Nurses Credentialing Center (ANCC), 2013). In order to accelerate the EBP movement, federal agencies in the United States such as the Agency for Healthcare Research and Quality have funded EBP centers to answer important clinical questions for the ultimate purpose of improving health care delivery and patient outcomes. 

 

    When used, EBP leads to improved patient outcomes by reducing mortality, morbidity, medical errors, and geographic variations ( Pravikoff , Pierce, & Tanner, 2005).Nursing has not fully adopted EBP because of professional/personal, organizational, and educational barriers. A 2005 study indicated that some nurses are not familiar with or see the value of EBP. Nurses reported that their colleagues did not use research in their practice or were not taught how to use electronic databases to find answers to clinical questions ( Pravikoff et al. 2005).

    Most nurses ask their nursing or medical colleagues or use a drug reference book or manuals when they have a query. The concept of "tradition" or "We have always done it this way" also plays a part in decision making Some practices have remained unit specific even though there is no evidence to support these practices. Nurses have cited lack of time and inability to understand statistical terms as other barriers for not considering research studies.More recently, Melnyk and Fineout  Overholt (2012) found that nurses were aware and interested in EBP, but identified nurse leaders as barriers. 

    An organizational culture that does not value EBP will prevent the use. Administration support is necessary to provide staff with the computer access, mentors, and dedicated time for EBP activities. If there are excessive demands in the clinical day, such as managing increasing numbers of patients, EBP activities cannot be pursued. The institution must be committed to fostering research efforts and then practice change activities. Nurse leaders must engage in EBP as role models, which will facilitate evidence-based care and encourage the use of EBP among staff members

    A barrier in nursing education has been that it has traditionally focused on basic research and the rigorous methods of how to conduct it. This can result in minimal interest in conducting research once nurse's graduate. Education programs have started to implement EBP in their teaching methods with curriculums in undergraduate and graduate programs to provide a strong foundation in EBP. Students in these programs have to be taught a rapid approach to effectively and critically appraise research and then put it to use in their clinical practice. This will require knowledgeable and skilled instructors who can teach EBP, along with preceptors as role models/mentors in the clinical setting that can reinforce this practice ( Ciliska , 2005).

    According to the 2013 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 55% of the registered nurse (RN) workforce is aged 50 years or older ( Budden , Zhong , Moulton , & Cimiotti , 2013). Seventy percent of nurses graduated from nursing programs before 1990. This presents a challenge in practice where nurses have never had the opportunity to develop the skills of EBP Nurse educators within hospital settings need to develop workshops that would introduce these nurses to EBP and mentor nurses who have never been exposed to EBP

Outcomes of Evidence Based Practice 

    For the nursing profession to embrace EBP, four populations must be targeted: nursing faculty, nursing students, nurse educators (hospital based), and existing nursing staff. Bachelors and master curriculum should be evaluated to shift from teaching basic research to incorporating EBP in all aspects of the programs. Nurse faculty has to be skilled and knowledgeable in the EBP process so they can act as role models. The framework of EBP then must be intertwined throughout both didactic and clinical courses. 

    Nursing students must be given the opportunity to use EBP as a foundation for discussion and during clinical experiences Hospital-based nurse educators need to establish programs such as journal clubs that include review of current research, clinical guidelines, and EBP skill development workshops for less experienced nurses. And all nurses must accept the professional responsibility of life-long learning American Nurses Credentialing Center. (2013).