Collecting Evidence Can Lead to Better Nursing

May 14th, 2012

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By , BSN, RN

From “Evidence to Action.” It sounds like a prime-time cop drama; solving mysteries with a few good shootouts and chases in between collecting clues and interpreting evidence to nail down an answer and a bad guy.

Well, it’s not quite as exciting as television — and there are hopefully no bullets flying or a real bad guy — but it is about collecting evidence, interpreting facts and putting that knowledge together to solve a problem. It is the 2012 International Council of Nurses (ICN) International Nurses Day (IND) kit. And, it is the project the ICN thinks nurses around the globe should be working on for the next year.

Each year, as May 12 (you know by now, Florence’s birthday) approaches, the ICN picks a topic to focus on for the next year. “Closing the Gap: From Evidence to Action,” a plan which empowers nurses to use Evidence Based Practice (EBP) in our daily care of patients is this year’s plan. The goal is to encourage nurses to identify what evidence to use, how to interpret that evidence, how to put that knowledge into everyday use, and how to identify whether the anticipated outcomes are sufficiently important to change practice and use precious resources that may be needed elsewhere.

“Each year the ICN chooses a new theme for International Nurses Day to highlight current health issues and to showcase the many ways nurses have served communities and delivered quality healthcare,” said David Benton, ICN CEO, in a special video message. “No matter where we work in the world, the quality of our care can be severely affected by the lack of informed decision making. This can also result in less efficient, ineffective inequities in the availability of health services.”

What is EBP?

That’s where evidence based practice comes in. It was the 1980s when the term “evidence based medicine” first emerged describing using scientific evidence to determine the best ways for physicians to treat their patient populations. As the process evolved the term shifted to “evidence based practice” as clinicians other than physicians recognized the importance of scientific evidence in clinical decision-making.

It is easy to get confused by the language associated with the EBP approach as it frequently uses academic terminology, which can be a barrier to the layperson’s understanding. It might help to develop a common understanding of what evidence is. In the ICN kit, “evidence concerns facts (actual or asserted) intended for use in support of a conclusion”. Additionally, a fact is something that is known through observation or experience. This means there are many possible sources of evidence using many different media, from traditional stories to visual images on the internet.

Here are some key definitions which address the basics of using research to gain evidence to improve quality of care—the essence of the 2012 ICN program.

  • Evidence Based Practice – A problem solving approach to clinical decision making that incorporates a search for the best and latest evidence, clinical expertise and assessment, and patient preference values within a context of caring.
  • Nursing Research – Nursing research involves the systematic inquiry specifically designed to develop, refine and extend nursing knowledge. The intent of nursing research is to answer questions and develop knowledge using a scientific method such as quantitative, qualitative, or mixed methods.
  • Quality Improvement (QI) – Quality, clinical or performance improvement focuses on systems, processes and functional, clinical, satisfaction, and cost outcomes .QI projects may contribute to understanding best practice or processes of care in which nurses are involved. QI is not designed to develop nursing practice standards or nursing science.

Once nurses have an understanding of evidence-based practice it is a matter of seeking out sources of evidence. The resources are many and varied, from people participating in all levels of healthcare.

  • Research by health professionals or academics
  • Research by companies e.g. pharmaceutical companies
  • Reviews of research and clinical guidelines
  • Opinions of colleagues
  • Clinical experience
  • Experience of patients, caregivers, or clients
  • Clinical audit data

All evidence has its value and the contributions of fellow practitioners and patients are equally important.

From Evidence to Action

Once the evidence has been synthesized and determined to be of sufficient quality it must be determined if it applies to the setting or problem at hand. The nurse needs to consider the following factors:

  • Do participants in the study have similar characteristics?
  • Is it possible to introduce the interventions described?
  • What are the possible financial implications?
  • Is there a patient acceptability consideration?

“The use of an evidenced based approach enables us to challenge and be challenged on our approach to practice and to hold ourselves accountable,” Benton said. “It allows us to constantly review the way we work and to seek new and more effective and efficient ways of doing things. This allows us to play our full part in the increasing access to effective services and during these times of financial challenge it enables us to use those resources we do have more efficiently.”

The challenge at hand, whether for nursing organizations or nursing research groups and committees, is finding the right topic, the issue that should be examined. There must be organizational support for both the research and the possible changes to the investigated technique or task or problem. Changes are rarely easy as it involves changing the way people and the system behave.

“National nursing associations have a leading role to play in ensuring that patients receive safe, effective person-centered care based on the best available evidence,” says Benton. “National nursing associations can actively promote evidence based practice by using different approaches and optimizing their ability to inform policy and to mobilize the actions of our profession.

”Selecting a small number of activities to demonstrate the benefits of translating evidence into practice is likely to lead to transformational change,” he continued. “Once success can lead to another, build momentum through engaging partners and through focusing on the things that really matter.”

So Nurses Week 2012 may be over, but we have been given our assignments. Evidenced based practice to improve quality of care…where do you think we will be come this time next year?

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