Evidence Based Practice In The Nursing Profession

Evidence-Base practice (EBP) is defined as: “based on problem identified from the practitioner’s area of practice; a combining of best evidence and professional expertise and an integration of this into current practice; about ensuring patients receive quality care, being part of quality improvement processes; about collaboration and requiring a team approach” (French, 1999). Scott and Mcsherry (2008) supported the French’s assertion, proposing the key elements of EBP are that it is a theory-driven process, which involves the use, evaluation and application of research; identification of best evidence; evaluation of care; problem solving; decision-making; clinical expertise; and requires patient involvement. Evidence-based practice is made of evidence, clinical expertise, patient preference, the context of care (Barker, 2013). In brief, evidence-based practice is the parameter in the nursing practice that it requires that the nurses gather and use clinical evidence to make decision for the patients so that in the nursing process they can deliver the quality of care for the patients (Ellis, 2013). In the other words, in the nursing practice all the nursing procedures performed by the clinical evidence supported.

As a provider of care, professional nurses depend on research, theories, and evidence based practice to guide the care they provide to patients. Nurses deliver care to their patients based on information they have learned through many years of school and training. Training for nurses and other providers of care is founded on theories, research, and evidence based practice in the healthcare field. Theories, research, and evidence based practice are all important for providing care to patients and each can be used in a different manner depending on the situation. Clinicians often use research based evidence to design and implement care that is high-quality and cost effective for patients. Evidence based practice can be used to provide care to patients in a steadily changing clinical environment. (PDF page 8-9). Nursing theories are frequently used as frameworks for establishing nursing care interventions and assessing

Evidence based practice is an integral part of nursing care. According to the Academy of Medical-Surgical Nurses, evidence based practice is defined as, “the conscientious use of current best evidence in making decisions about patient care.” (AMSN) The use of evidence based practice has drastically improved patient outcomes, increased quality and safety of healthcare, and reduced costs for facilities. (Melnyk, 2016) In this paper I will provide the history of evidence based practice, how it has already been incorporated and impacted healthcare, and why it is important to nursing and healthcare as a whole.

Evidenced Based Practice (EBP) is essential to enable all nurses to provide the most current up to date practises for their patients. This process involves research, systematic review of current practises, critical thinking skills, evaluation and application to the clinical setting. In addition to this, the nurse must take into account the patients’ preferences. For nurses to have professional autonomy they must be able to justify their actions and demonstrate an understanding of why they perform the tasks they do. This defines them as unique professionals judged by their knowledge and not simply by their hands on skills.

In order to develop nursing knowledge and establish evidence-based practice (EBP) in nursing, there needs to be a "concept model, one or more theories and one or more empirical indicators" (Fawcett & DeSanto-Madeya, 2013, p. 26). The theoretical framework can be advantageous in guiding and supporting the design and execution of an EBP change. Using a conceptual model (C) theory (T) and empirical research (E) provides the foundation for an intervention to an identified clinical problem. Known as C-T-E structure, the application of this system in nursing practice involves an elevated level of critical reasoning, which assists in knowing what data is important and how it relates to practice change (Chinn & Kramer, 2011; Fawcett & DeSanto-Madeya, 2013; Mazurek Melnyk & Fineout-Overholt, 2015). The doctoral level of nursing necessitates the need to combine the understanding and knowledge gained from using the C-T-E structure, and then integrate the concepts and theories into daily practice.

Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).

Evidence base practice is essential in nursing practice. It incorporates 3 key components which are clinical expertise, patient values, and best research evidence in order to provide the most effective and safe decision making for patient care. Neglecting a key component can affect the accuracy and efficiency of a research. Clinical expertise is based on a clinician’s experience, skill, education level and understanding in a certain area of nursing practice. Patient values can impact evidence base practice depending on their needs, preferences, expectations, values, understanding, and concerns. Best research evidence can be obtained from clinical research with supporting evidence base literature and sound methodologies. Each component will be discussed in further detail and how it links to clinical decision making by registered nurses in order to achieve the best evidence-based practice available.

Discovering new information applicable to the field of nursing begins by asking a focused clinical research question. According to Stone (2002), asking the appropriate question is essential for the research process that follows. Although there are countless nursing problems that are worth investigating, it is imperative to narrow the focus of the problems so they can be empirically tested (Adams, 2012). Personal clinical experience, professional literature, previous research, and current nursing theories are a few examples of sources where research questions can be identified (Adams, 2012). The purpose of this paper is to explain the connection between research and evidence-based practice, discuss how

Nursing improves when Evidence Based Research findings can be utilized and implemented by nurses in their daily practice. J. Dracup (2006) stated what some nurses had identified as barriers to Evidence Based Research, namely: “accessibility of research findings, anticipated outcomes of using research, organizational support to use research, and support from others to use research.” Dracup believed that “evidence-based practice must include an assessment of the available resources” since the cost of implementation is yet another barrier and “will not be adopted if resources are insufficient to incorporate them into the daily routine” nursing care. G. Mitchell (1999) raised “ the lack of sufficient meaningful research” as an additional barrier.

Evidence based practice is an important priority in nursing because it ensures that the best quality and most effective care is being used. Restraint use is an intervention that is being minimized more and more. It can be an important intervention when necessary but there are specific circumstances and guidelines that must be followed. Evidence based practice is proving that restraint use may be eliminated due to safety concerns and more beneficial interventions being used.

Within this essay Evidence based Practice will be identified and the significant effect it has on the nursing profession, barriers will also be explored in the implementation of Evidence Based Practice.

As the nursing field grows, evidence-based practice is becoming more pragmatic. This is because people want to know the when, why, and how of diseases processes. Increasing knowledge on evidence-based practice has shown to improve health outcomes. Research translation models are utilized heavily in nursing to help transform findings into practice (Polit & Beck, 2012). Some models are more clinician oriented, while others are institution oriented. There are various models that are utilized by different entities. For the purpose of this paper, the Stetler Model of Research Utilization will be researched and discussed.

Schmidt and Brown (2012) defined evidence based practice as practice based on the best available practice, patient preferences and clinical judgement. Evidence based nursing is the collection, interpretation and use of research derived evidence to better patients care in the clinical setting (Nursing Research: Principle, Process and Issues, pp.447).It is very easy to see the significant changes that have transformed the nursing practice in recent years. It is no wonder, therefore, that evidence based nursing practice has been a central figure in professional practice (Rose and Glass, 2008). Hickman et al (2014) states that to have the best evidence based practice, a nurse must provide patients with the best, up to date evidence in contrast to care that is simply based on the traditional ways of nursing. However within evidence based research, Maloney et al (2016) found that it is extremely important to focus on knowledge based on the nurses own area of practice so that the best evidence based practice is given to their patients. Following the Briggs report in 1972, there has been more commitment within the health care profession to utilise evidence based

involves the use of research results to support a predetermined position. The nursing literature is replete with examples of limited use of research in practice and discussion surrounding perceived barriers to research utilization (Hunt, 1981; Gould, 1986; Closs & Cheater, 1994; Lacey, 1994). Despite this, the phenomenon of the research–practice gap, the gap between the conduct of research and use of that research in practice, remains an issue of major importance for the nursing profession. Many researchers have explored the barriers to research uptake in order to overcome them and identify strategies to facilitate research utilization (Kirchhoff, 1982; MacGuire, 1990; Funk et al., 1991a,b, 1995b; Closs & Cheater, 1994; Hicks, 1994, 1996; Lacey, 1994; Rizzuto et al., 1994; Hunt, 1996; Walsh, 1997a,b). Hunt (1981) suggested that nurses fail to utilize research findings because they do not know about them, do not understand them, do not believe them, do not know how to apply them, and are not allowed to use them. According to Hunt (1997), the barriers to research utilization and, therefore, to evidence-based practice fall into five main categories: research, access to research, nurses, process of utilization and

Evidence-based practice is “the use of the best scientific evidence integrated with clinical experience and incorporating patient values and preferences in the practice of professional nursing care” (Houser, 2015, page 12). Evidence-based practice is important to nursing care for many different reasons. One of the main reasons is that using evidence-based nursing care provides better patient outcomes verses using the traditional trial and error method. Evidence-based practice is based on scientific studies and desirable patient outcomes. Healthcare professionals who provide patient care using evidence-based nursing practice are acting in the best interests of their patients. Errors in clinical decision making have greatly been reduced by using evidence-based practice for providing nursing care to patients. Patients are often placed at a higher risk for harm or injury when using the traditional trial and error method of nursing care. Therefore, the trial and error method should be avoided at all costs because it is unethical and unacceptable from a nursing standpoint (Houser, 2015).