How Does Evidence Based Practice Improve Patient Outcomes?

What is Evidence Based Practice in Nursing?

Question:

How Does Evidence Based Practice Improve Patient Outcomes?

Evidence Based Nursing Practice

My position statement: Evidence based practice links research evidence with clinical expertise to support a patient centered care through the inclusion of preference of the patients.

According to Fleiszer et al., 2016, Evidence based research may be defined as the explicit, judicious and conscientious use of the current evidences in taking decisions regarding the care of individual patients. The effect of the evidence based nursing has been felt in all the aspects of clinical practice. The concept of evidence based practice in nursing has gained momentum for the past few years. With the increasing demands of heath care over the world, the nurses now act in frontline with the doctors to give a patient centered care (Mitchell et al., 2015). In a simplified form it can be said that evidence based practice in nursing requires scientific reseaches, remaining updated with the current research techniques, efficient learning of the medical journals, application of the formal rules of the evidence, which can be useful in extending the conventional limits of the nurses (Hall & Roussel, 2016).

Assessing the patient, to determine the questions or the doubts that may arise from the case study of the patient, construction of a well built clinical question acquired from the case, conducting extensive research in relation to the case, Appraising the validity of the evidence found, Linking the evidence with the clinical practice and apply necessary interventions to the patient, obtained from the evidence based practice (Mitchell et al., 2015). EBP fills the gaps in patient care and brings about better outcomes in patients by collaborating clinical practice with research evidences. It supports the values of the patients to promote a better experience in patients. EBP assists the nurse to expand their horizon and modify patient care (Williams et al., 2015).

According to Boltz et al., 2016, EBP involve better outcomes in patients, enhancing patient safety by providing a culturally safer background to the patient. In today’s world patients are health care consumers and demand safer and skilled healthcare practice. The basis of EBP lies in research that would help in providing information regarding the treatment of the health care condition (Stevens, 2013).

With the increasing demands of the health care needs, healthcare organizations are now involving the nurses in the decision making process, due to which a large portion of nurses are proceeding their higher education in nursing. Higher education related to nursing, requires lot researches. It should be noted, that incorporation of evidence based practice by the nurses is also required for the growth of the organization (Stevens, 2013). As the hospitals are asking the nurses to become more innovative and improve the operations related to healthcare (Williams et al., 2015). In addition to that, the nursing students pursuing masters or researches are provided with opportunities to continue their research based work under the aid of the organization. Practice of evidence based research work helps the nurses to step into leadership roles. EBP also helps the nurses to reach the underserved population and implement strategies to reach them. Nowadays advanced education is required to enhance the skills, incorporate information technology, and greater care coordination across the care continuum (Stevens, 2013).

Benefits of Evidence Based Practice in Nursing

Throughout the 21st century the roles of the nurses have evolved drastically. The profession of nursing has become dynamic. They have to work in a variety of settings, which includes the hospitals, schools, businesses sector, and health department of the community, laboratory, home and health care. Each of these nurses has various responsibilities, but the primary concern of the nurses will remain the same (Stevens, 2013).

There are misconceptions in the nursing students regarding the nursing researches and do not have the ideas how to proceed with the research. Evidence based practice demands changes in the nursing education to be more dynamic, such that there is a closer working relationship between the clinicians and the caregivers (Williams et al., 2015). EBP helps the nursing practice to become more focused, individualized, streamlined and also helps in increasing the active judgment capability. The other effects of the EBP are cost containment, increasing availability of information’s and increasing customer savvy for the care and treatment options (Stevens, 2013).

There are different NMBA standards proposed by the nursing midwifery practice of Australia, which aligns with the evidence based research practices. All the registered nurses have to maintain certain codes of conduct and certain codes of ethics in nursing practice (Williams et al., 2015).  The purpose of this framework is to provide them with professional guidance and support on matters related to their clinical practice. This works as a framework to under pin the decision making in nurses (Stevens, 2013). It helps to understand the needs for professional development. It also promotes reflective practices to enhance self learning for providing a safer and quality care to the patient (Hall et al., 2016). The standards help the nurses to make decisions regarding their roles and responsibilities which is an empowering determinant for the practitioners. There are seven NMBA standards of nursing that is required to be followed by the registered nurses.

Critical thinking and analysis in nursing practice is required by an RN to make the best possible use of the evidences available (Stevens, 2013). As a nurse it is required to practice a culturally safe nursing, with special reference to the aboriginal population of Australia. It is the duty of the nurses to meet up to the legislations, guidelines and the policies associated to the nursing standards. Ethical frame woks should be maintained while taking any decisions. Melnyk et al., (2014) has argued that ethical frame work in nursing refers to beneficence and non malefiecience, which cannot be always used for the sake of the patients health.

Increasing Demands of Healthcare and Evidence Based Practice

Standard 2 refers to the engagement of the nurse in therapeutic relationship with the patient. Nurse can use the concept of EBP in providing a collaborative care to the patient.  As per the conditions of the evidence based practice, it is necessary to advocate confidentiality of the patient’s condition. A nurse should be able to maintain the patient’s dignity (LoBiondo-Wood & Haber, 2017).

Evidence based practice involves professional development, which again aligns with the NMBA standard 3.  EBP requires conduction of patient’s assessment that is holistic and culturally safe to the patient, which is same as the standard 4 of NMBA. The standard 5 of the NMBA framework refers to the use of the assessment data to develop a plan for the patient. Harvey & Kitson (2015) have argued that planning is always not possible due to the resistances from the nurse managers and the doctor in charge. The standard 6 of the NMBA framework encourages the nurse to provide a timely and safe nursing care to the patient (Masters, 2015). It is the duty of a nurse to point out the potential risks and flaws related to the system. It often becomes very difficult to point out the flaws being in the same system. Thus, from this perspective it often becomes very difficult in implementing evidence based practice (Ossenberg et al., 2016). The standard 7 of the NMBA framework, it is the duty of a nurse to measure the progress and the deterioration in a clinical setting to proceed more towards the expected goals.

Ackley et al (2016) has argued that it is not possible to implement evidence based practice in all the aspects of healthcare without a proper training.  Researchers have shown that only 34.5% of the nurses in a clinical setting use EBP in their nursing practice (Stevens, 2013). Majority of the nurses feel that it is required to have enhanced knowledge and skills in EBP, which is due the lack of proper educational scopes. According to Levin & Feldman (2012), the two most important factors that can act as barriers to evidence based practice are organizational support and time. Sometimes it becomes very difficult to incorporate any change in the old setting and getting past the workplace resistance as that is the way the nurses have been doing so far. In most of the cases the nurse students gets resistance from the nurse leaders and the nurse managers (Melnyk et al., 2014). Furthermore, it cannot be expected that nurse would sit and look after articles instead of taking care of the patients. Even if they are self motivated to the necessary researches, time will not allow them to do that.

NMBA Standards and Evidence Based Practice

Education is the biggest barrier as people educated many years ago have no idea about the EBP approach of care. While many organization are supporting the EBP method of practice, there are few that still that follows the conventional methods of nursing (Masters, 2015). 

Some of the organizations who are in support of the evidence based practice needs to understand that a one or two days workshops will not be able to bring about any sustainable change in clinical settings (Melnyk et al., 2014). In order to make things feasible it is necessary to appoint enough EBP mentors, who will be able to work beside the clinicians to have in-hand experiences. Another important factor may act as a barrier to the EBP implementation is the limited access to information technologies and computer systems (Melnyk et al., 2014). It cannot be expected from the nurse to perform EBP without proper availability of the IT resources, as it is required to remain updated regarding the various scientific journals and articles. (Flodgren et al., 2014) have argued that there are lots of loops and holes to jump through for making a thing implemented in a clinical setting.

According to author Brownson et al., 2017, many nurse practitioners have felt that the patients have often refused the new evidence based treatment plans and wanted to stick to the old methods. In case of older or mental patient, it becomes very difficult to get them convinced regarding the change (Melnyk et al., 2014). It is evident that EBP can lessen the burden on the doctors and reduce their invested time over individual patients. However, Jacob et al., 2012, have argued that there are certain doctors who feel that their treatment methods are evidence based, even if they are outdated. Hence that becomes a challenge for practicing EBP.

Hence it can be rightly said that it is not feasible to expect the registered nurses to implement evidence based practice in all aspects of clinical setting. Lot of researches is yet to be done and awareness regarding EBP is still needed to be disseminated to make it successful throughout the clinical setting.

References

Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2016). Nursing Diagnosis Handbook-E-Book: An Evidence-Based Guide to Planning Care. Elsevier Health Sciences.

Boltz, M., Capezuti, E., Fulmer, T. T., & Zwicker, D. (Eds.). (2016). Evidence-based geriatric nursing protocols for best practice. Springer Publishing Company.

Brownson, R. C., Baker, E. A., Deshpande, A. D., & Gillespie, K. N. (2017). Evidence-based public health. Oxford University Press.

Fleiszer, A. R., Semenic, S. E., Ritchie, J. A., Richer, M. C., & Denis, J. L. (2016). Nursing unit leaders’ influence on the long?term sustainability of evidence?based practice improvements. Journal of nursing management, 24(3), 309-318.

Flodgren, G., Rojas?Reyes, M. X., Cole, N., & Foxcroft, D. R. (2012). Effectiveness of organisational infrastructures to promote evidence?based nursing practice. The Cochrane Library.

Hall, H. R., & Roussel, L. A. (2016). Evidence-based practice. Jones & Bartlett Publishers.

Harvey, G., & Kitson, A. (2015). Implementing evidence-based practice in healthcare: a facilitation guide. Routledge.

Jacobs, J. A., Jones, E., Gabella, B. A., Spring, B., & Brownson, R. C. (2012). Peer reviewed: tools for implementing an evidence-based approach in public health practice. Preventing chronic disease, 9.

Levin, R. F., & Feldman, H. R. (2012). Teaching evidence-based practice in nursing. Springer Publishing Company.

LoBiondo-Wood, G., & Haber, J. (2017). Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.

Masters, K. (2015). Role development in professional nursing practice. Jones & Bartlett Publishers.

Melnyk, B. M., Gallagher?Ford, L., Long, L. E., & Fineout?Overholt, E. (2014). The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence?Based Nursing, 11(1), 5-15.

Mitchell, M. L., Henderson, A., Jeffrey, C., Nulty, D., Groves, M., Kelly, M., … & Glover, P. (2015). Application of best practice guidelines for OSCEs—An Australian evaluation of their feasibility and value. Nurse education today, 35(5), 700-705.

Ossenberg, C., Henderson, A., & Dalton, M. (2015). Determining attainment of nursing standards: The use of behavioural cues to enhance clarity and transparency in student clinical assessment. Nurse education today, 35(1), 12-15.

Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas. Online Journal of Issues in Nursing, 18(2), 4-4.

Williams, B., Perillo, S., & Brown, T. (2015). What are the factors of organisational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review. Nurse education today, 35(2), e34-e41