Evidenced-Based Practice In Nursing

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.

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.

The following literature will define the term, “evidence informed practice”. It will discuss the benefits and limitations of integrating evidence informed practice in nursing. It will include information about how nurses can overcome these barriers. It will also illustrate the importance of utilising evidence informed practice to enhance the quality of service delivered within the healthcare profession.

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.

Conrad, A., Grotejohann, B., Schmoor, C., Cosic, D., & Dettenkofer, M. (2015). Safety and tolerability of virucidal hand rubs: a randomized, double-blind, cross-over trial with healthy volunteers. Antimicrobial Resistance & Infection Control, 4(1), 1. doi:10.1186/s13756-015-0079-y

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).

| For nursing practice our goal is to help to promote health for the whole patient. We must remember that our goal is to get them back to a level where they are functional in the environment. Not all patient will get to the point that they are free from disease but we must help them get back to the level in which they can care for themselves and be as sound as possible for them. Our practice would involve teaching in this aspect in order to help the patient maximize the health that they either have or to help them reach the level that they want to achieve.

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.

Over the last several years, nurses have been facing critical challenges. This is because there is a shortage of qualified individuals inside many facilities. At the same time, they are expected to serve a variety of roles in order to address the needs of stakeholders. To fully understand what is occurring requires focusing on the use of evidence based practices inside a clinical setting and formulating strategies for overcoming barriers to them. Together, these elements will highlight the underlying challenges and how they can be addressed in the long term. (Lundry, 2009)

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.

The definition of Evidence Based Practice (EBP) is “professional understanding and action that is based on the thoughtful use of knowledge and information from available, reliable, and dependent sources” (Brown, 2002). The definition also includes the balance of clinical experience, proven evidence from scientific studies with patient input. This input from patients will incorporate their culture, values and other preferences.. Evidence Based Practice is a fluent process that requires nurses to be current and correct on information as it pertains to their daily practice. The intent of EBP is to improve the quality of the care that is

The Johns Hopkins Nursing Evidence-Based Practice model (JHNEBP) is an evidence-based practice model (EBP) created by the health professionals of Johns Hopkins Hospital, and the nursing school at Johns Hopkins University (Schaffer, Sandau, & Diedrick, 2013). It was designed as a strategy to promote EBP and EBP projects that introduced and fostered EBP skills in nurses at all levels (Shivnan, 2011). The model serves as a tool to assist nurses with at the bedside care decisions (Schaffer et al., 2013). Reported in 2011, 80 hospitals and nursing schools have used this model (Shivnan, 2011). JHNEBP consists of three main phases: Practice, Evidence and Translation (Schaffer et al., 2013).

There are five levels of strength of the evidence on the Johns Hopkins tool, and I gave the article “Sleep in the Hospitalized Patient: Nurse and Patient Perceptions” a ranking of level III. I used the Johns Hopkins nursing evidence based practice research evidence appraisal scale tool to decide on my ranking level which breaks it down step by step to find the strength of the research. The description of level III is “nonexperimental study, qualitative study, or meta synthesis” (cite JHNEBP). Non-experimental studies consist of no manipulation of variables and randomization is not controlled, qualitative studies are made up of interviews or focus groups and have small sample sizes, and

Nursing research is imperative to providing safe quality care. I believe it is very important for nurse to perform patient care using evidenced based practice, instead of practices based on individual beliefs or beliefs of senior nurses who have an old outdated way of doing things. For example, older nurses may have flushed saline into the endotracheal tube when performing tracheal suctioning to help looses dry mucous that was stuck on the endotracheal tube. Through research studies have shown this practice can increase the risk for pneumonia. Hood 2014 states, “Because nursing is primarily a practice discipline, nursing must understand basic research principles and techniques of clinical practice.” (p.242).