Chief nurse executives are always striving to deliver positive outcomes for patients in the healthcare industry. To this end, many believe that evidence-based practice (EBP) is the best approach to healthcare. It brings together clinical expertise, research evidence, and patient values and preferences for holistic, considerate and data-driven decisions that can literally change lives.
However, the model is not currently widely used in hospitals, and there remains an ongoing debate about how it should evolve to meet the demands of today’s healthcare industry. What is certain is that a number of leading experts and professionals see EBP as the most proven way to deliver excellent care and support to patients.
Academic dean Kathleen Williamson believes that EBP is proven to offer the best outcomes at lower costs across all healthcare and nursing environments. This viewpoint is widely shared because EBP is transformative in its trifecta of core tenets, which require nurses to analyze the best evidence, link this to a patient’s medical history, and take into account a patient’s personal values. This well-rounded evidence-driven approach means that patients get a higher level of care, whether they are in an emergency room or clinic.
What are the origins of evidence-based practice?
EBP is not a new theory. On the contrary, the Journal of Professional Nurses cites Florence Nightingale as the initial pioneer in the late 19th century. Nightingale was an adherent to a new math-based form of medical theory that prioritized science and empirical findings to help patients.
Often called the ‘founder of modern nursing’, Nightingale used evidence to highlight how handwashing, ventilation and other forms of cleanliness would reduce illness and save lives. She regularly presented this analysis in graphical forms. This research, combined with her humanitarian values and nursing expertise, is one of the first case studies for evidence-based practice in action.
Fast forward to today and EBP is still viewed as an excellent model for healthcare as it relies on hard data and conclusions supported by evidence for decision-making, rather than the hunches and preferences of a nurse.
According to a leading group advocating evidence-based medicine (EBM): “Evidence-Based Practice (EBP) requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources.”
What are the benefits of evidence-based nursing?
It’s clear that better patient outcomes are the major, overall benefit of evidence-based nursing, but its broader impact is also important, according to experts. Because EBP is cost-effective and able to deliver maximum results, it can transform healthcare as a whole and enable hospitals to improve discharge rates, reduce readmissions and support better use of available resources.
The Wisconsin Hospital Association implemented an EBP program and saw impressive results in the long term, with 30-day readmissions falling by 22% over an 18-month period. There is also evidence that similar programs can improve safety for patients overall, as EBP helps to reduce illness and infections and nurtures a culture that raises healthcare standards due to increased confidence in decision-making and decisiveness in taking action.
Another huge and welcome knock-on effect of better outcomes in healthcare is a lower mortality rate. A recent study found that evidence-based care played a pivotal role in reducing deaths in 11 European countries across a range of different healthcare units and wards. It is clear, then, that EBP can be beneficial in a number of ways.
How does evidence-based practice work?
EBP has evolved significantly over the years, and healthcare experts have now formulated an in-depth model that professionals with Doctor of Nursing Practice (DNP) degrees can follow to transform healthcare and deliver positive patient outcomes. This model was first set out back in 2004 in a book titled A Guide to Best Practice. While the debate about EBP continues, this model is a go-to resource for anyone aiming to deliver EBP in healthcare environments.
The first and arguably most important step is to create a culture where nurse executives are constantly inquisitive and eager to conduct research to get the best results. Healthcare providers should also value scientific truths based on evidence and have the skills and experience to implement EBP. Higher-ups must also provide the support and tools required to deliver EBP consistently and effectively.
When the environment is right for EBP, nurses can move on to the practical methods involved, which begin with asking a clinical question. This inquiry is made up of five key components in an acronym known as PICOT.
This stands for:
- Patient problem – What is the patient’s age, sex, race and health status?
- Intervention – What tests and treatments are you planning to use?
- Comparison – What alternative test and treatment plans are possible?
- Outcome – What positive outcome are you striving for?
- Time – How long will all of this take?
Next is the evidence-based part, which underpins the whole concept. Healthcare providers need to conduct exhaustive research and analysis to support their theories for the best course of treatment. EBP typically relies on several types of research, which include laboratory experiments and clinical trials. The digital age has made this process easier as it has increased access to up-to-date and relevant reports, including peer-reviewed scholarly journals.
Nurses work through the previous PICOT model using the evidence they find, which leads to the next step: critically appraising these findings. Another step-by-step process is required here to ensure that the evidence is authoritative, trustworthy and applicable. Providers need to ensure that the results are valid and can be implemented for the specific inquiry at hand. If they conclude that this is the case, then they can start integrating the evidence into a plan that can provide a positive outcome.
As there are three components to EBP, healthcare providers will also need to take patient preferences into account as they begin outlining a treatment plan. Those involved in the process need to consider the best course of action based on all the evidence and information they have available, as the model authors state that there isn’t a “magic formula” for the weight that each of the three components should have.
When an evidence-based decision has finally been put into action, it is time to take a step back and evaluate the outcomes to determine whether it worked as intended and identify any additional positive effects and flaws. The final step is to share the results of the research so that it contributes to evidence-based decisions in the future. Healthcare providers often use journals, conferences, newsletters and webinars to disseminate the results and discuss their importance.
Who is qualified to implement evidence-based practice?
A dearth of EBP skills and workplace cultures designed to cultivate and implement it has been the biggest barrier to its usage in healthcare settings. However, this is an issue that can be remedied by employing nurses with a DNP, who will be more able and willing to raise the standards of care. These nurses will also be more adept in leadership rules and capable of spearheading the changes required to deliver better outcomes.
In order to obtain a DNP, nurses must either have a Master of Science in Nursing (MSN) or Bachelor of Science in Nursing (BSN) degree. The DNP program will then teach nurses the knowledge and skills they require to undertake the tasks that are central to EBP, such as evaluating new science and linking it to patient-centered care. This highlights the importance of higher education in the industry, as graduates are the best equipped to deliver the upsides associated with EBP.
Fortunately, many nurses can acquire these skills and qualifications by completing courses while they are employed. There are universities that now offer flexible online formats for degrees such as the DNP, which means that workers in the healthcare industry don’t have to uproot their busy lives and visit a campus to complete coursework. The high-level curriculum will also prepare nurses accordingly for leadership, helping them to build critical thinking skills and develop soft skills that will enable them to lead from the front.
After a nurse has graduated from a DNP program, they can use their degree to secure a wide number of roles, such as nurse practitioner, nurse educator and nurse administration. From these positions, nurses can start educating others about EBP’s benefits and implementing the model in clinical settings. They can also foster further creativity and innovation to push EBP to the next level.
To conclude, EBP can transform healthcare by using evidence to make the best possible clinical decisions and then reap the benefits in terms of positive patient outcomes, lower healthcare expenditure and reduced mortality rates. While the model isn’t widely used in the healthcare industry, nurses with the skills, qualifications and experience have an excellent opportunity to put this advanced model into practice to help patients and save lives and ensure that EBP evolves to meet the demands of today’s healthcare industry.
