Discuss about the Interventions and Practices in Public Health.
Evidence-based practice is not a new concept in the field of nursing. With its application continuing to grow steadily across the globe, not many can argue against the idea that it has positively impacted the quality of care. The principles of evidence-based practice formally came into limelight in 1992 in medicine where it was referred to as evidence-based medicine before spreading to fields like nursing, dentistry, and psychology. Evidence-based practice in nursing encompasses infection control, oxygen use in patients with COPD, measuring blood pressure noninvasively in children, intravenous catheter size, and blood administration, among other examples. In the United States, evidence-based practice has been identified as a key factor in fulfilling Berwick et.al (2008) Triple Aim in healthcare which entails improving patient care experience, improving population health, and reducing the healthcare per capita cost. The Triple Aim currently entails a fourth goal which involves increasing work life and decreasing burnout in clinicians. What is evidence-based practice?
Evidence-based practice refers to the process of coming up with clinical decisions based on evidence, alongside clinical experience and expectations of the patient (Kirschbaum and Short 2018). It can also be defined as a clinical decision-making framework that inspires clinical practitioners to incorporate data from a high quality qualitative and quantitative research with the client’s values and background alongside clinical expertise. This practice entails evidence assessment using a hierarchy of various types of evidence (Sellman et al, 2016). To obtain an evidence upon which you can base your decision, you begin by phrasing your case as a specific answerable question. This may be done through PICO where P stands for your patient or population group. I stand for you intervention or indicator. C stands for your comparison or control. While O stands for the outcome you are looking for (Kirschbaum and Short 2018).
Evidence-based practice encompasses the following components. These are best available evidence, clinician’s knowledge, and skills, and patients want and need (Hall and Roussel, 2016). When all these three components are fully integrated into clinical decisions management, the prospect for optimal clinical outcomes and quality of life become greatly enhanced.
The transition to evidence-based practice has influenced nursing in a number of ways. One area affected by this transition is the nursing education (Schmidt et al, 2014) . Nursing program curricula have been altered by universities and colleges to create room for incorporation of the evidence-based practice. Currently, students who seek to pursue a nursing degree will encounter coursework that includes the significance of professional accountability alongside nurse’s overall knowledge base (Grove et al, 2014). These new programs put a lot of emphasis on critical thinking skills and advise the practitioner to look into the clinical, religious, cultural and socioeconomic background of the patient and apply related scientific research in their practice.
The increasing use of evidence-based practice has also attracted more interest in nursing research as well as an emphasis on the same. Although nursing programs may have a few courses detailing research, students find it beneficial honing their research skills further. Through nursing research, they become accustomed to new scientific data that may have a more direct influence on their nursing career.
Various research methodologies in evidence-based practiced may prepare nurses for careers outside the bedside. Nurses become exposed to diverse openings in the field of research upon completion of Master of Science Degree and ascend to more independent roles that require less patient contact (Cunningham et al., 2014). Nurse researchers may come up studies, conduct data collection, and author and publish whatever they find from their research management.
The application of evidence-based practice in the clinical setting has been proven to have several benefits for patients, healthcare, and nurses. Some of the general benefits of evidence-based practice to nursing practice include the following. EEvidence–based practice has resulted in better patient outcomes. It has helped keep practice current and relevant. It has contributed to the science of nursing. It has also increased confidence in making nursing decisions.
The hallmark of nursing practice lies in the provision of the best possible patient care. With the use of evidence based practice, nurses are able to direct nursing care in accordance with scientific research. This in turn results into more consistent clinical interventions and improved clinical outcomes to patients and families (Brownson et al., 2015). This will enable the patient to enjoy great treat from the expert hence good health.
The use of evidence based practice (EBP) has potentially lowered the cost of healthcare as EBP requires only a few heath care resources. The cost of care based on tradition and outdated policies has been very high as it not requires a lot of healthcare resources, but has also been wasted in the process of establishing modes of delivery competent client (Greenhalgh, 2014). Implementation of EBP would ensure available resources are managed properly as they would be utilized in an effective and efficient manner. When the cost is law, people will be able to have a great health care from the experts thus improving their health.
The use of evidence based practice also works to benefit the nurses. One way in which EBP has benefited the nurses is by increasing the nurse’s skills, adaptability, confidence, critical thinking and decision making as they are constantly required to assess the relevant research to their practice. Increase in nurse skill will also benefit the patient since the patient will get a proper health care. In addition to enhancing the clinical performance of nurses, EBP has also resulted into higher job satisfaction among nurses as well as creating better group cohesion leading to job retention in the healthcare.
The goal of adopting evidence based practiced in healthcare was to take current knowledge and link it to standardize care so as to enhance care processes and patient outcomes (Kirschbaum and Short 2018). Nurses came to understand that to achieve better patient outcomes, it was necessary that new knowledge was converted into clinically useful forms that could be easily applied across the entire care team and gaged based on the impact it has on the performance and health outcomes care (Mihalic and Elliot, 2015). The evidence based practiced enable health systems to achieve gains on all of the following three aims at a go. These are care, health, and cost. Evidence based practice has improved care quality in the following ways.
It updates clinicians on standardized, evidence based protocols. With many scientific knowledge published daily, clinicians need to read several articles on a daily basis to stay current on medical best practices. According to Nilsen et al. (2018), clinicians need to read at least 16 articles every day so as to stay up to date with the ongoing medical practices. This looks like an uphill task. However with evidence based practice, clinicians find a way through which they can stay up to date with the best practices making use of standardized evidence based protocols.
Utilizes near real time data in making care decisions. Advancements in health system has seen more advanced technology like electrical medical records, built in protocols, sophisticated analytics, data warehouses, and decision support systems being used in healthcare to access data and gain more knowledge. Incorporation of evidence based practice here enables health care staff to deliver improved patient care based near real-time data. As outlined by ….(), this help fill cracks in the evidence base and lower the uncertainty that may arise in the process of decision making.
Evidence-based practice has enhanced transparency, accountability, and value in care (Mutters et al. 2018). Transparency, accountability, and value have been a major problem in the past few years with employers, payers and patients all advocating for them to be displayed in health care. For instance, people want to acquire care that is of high quality and the lowest possible cost. Incorporation of evidence-based healthcare has helped the healthcare sector achieve the goals. According to Shelton (2018), EBP has helped enhance transparency of reasoning behind policies, justifies the decision on the need for valid data that can withstand scrutiny thus increasing accountability, test the uncertainty by clarifying the strength of the policy used to support evidence, and coming up with policy decisions motivated by healthcare dollar outcome.
Improved quality of care. A lot of money has been spent in healthcare in many nations across the world. Unfortunately, no major quality improvements have been witnessed despite the big spending as evidence shows that people do not often get the care they need (Melnyk et al., 2014). The evidence-based practice has improved care as clinicians now have access to previously untapped data and best practices that have been reviewed and accepted by clinical associates.
Improved outcome. The most important thing about evidence-based practice is that it works. Information has it that if the best clinical evidence and expertise are diligently used by health systems, with consist treatments, better outcomes can be realized in whichever way.
Several studies have cited a number of barriers that hinder nurses from effectively using research in their everyday practice. The following are some of the barriers that are often reported by nurses (Kirschbaum and Short 2018). Lack of value for research in practice. Little time on the job to read the research. Lack of education about the research process. The complexity of research reports. Unavailability of research articles. Challenges associated with changing practice. Lack of awareness about evidence-based practice (Wong et al., 2015). Little time to carry out research. Lack of knowledgeable mentors. Lack of administrative support. Feeling overwhelmed by the entire process.
In spite of these barriers, nurses find evidence-based practice effective in improving patient outcomes. This has led to many nurses engaging in EBP (Harvey and Kitson, 2015). Most of the barriers highlighted by nurses can easily be overcome through organization efforts that places emphasis on integrating research in practice and making use of strategies like nursing grand rounds, journal clubs as well as having research articles ready for review.
Success with evidence-based practice requires one to be willing to challenge their own assumptions and show the will to collaborate with others to improve the entire process of care and patient outcomes. EBP makes use of time, effort, resources, as well as work. However, the outcome is worth it (Rousseau and Gunia, 2016). Each and every patient deserves to be provided with care that is of high quality and low cost and that which is based on the best scientific knowledge.
Conclusion
Evidence-based practice has had enormous impacts on the quality of care. Some of the benefits that EBP has had on nursing practice includes better patient outcomes, has helped keep practice current and relevant, and has contributed to the science of nursing as well as increase confidence in making nursing decisions. Evidence-based practice has been beneficial to nurses, patients as well as healthcare. Despite the few challenges that have been experienced in implementing the practice in a clinical setting, it has helped address three main goals which include care, health, and cost. Most of the barriers highlighted by nurses can easily be overcome through organization efforts that places emphasis on integrating research in practice and making use of strategies like nursing grand rounds, journal clubs as well as having research articles ready for review. To conclude, evidence-based practice has helped improve the quality of care.
Reference
Brownson, R.C., Deshpande, A.D. and Gillespie, K.N., 2017. Evidence-based public health. Oxford university press.
Cunningham, F., Leveno, K., Bloom, S., Spong, C.Y. and Dashe, J., 2014. Williams obstetrics, 24e. Mcgraw-hill.
Greenhalgh, T., 2014. How to read a paper: The basics of evidence-based medicine. John Wiley & Sons.
Grove, S.K., Burns, N. and Gray, J., 2014. Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences.
Hall, H.R. and Roussel, L.A., 2016. Evidence-based practice. Jones & Bartlett Publishers.
Harvey, G. and Kitson, A., 2015. Implementing evidence-based practice in healthcare: a facilitation guide. Routledge.
Kirschbaum, J. and Short, T.L., 2018. Evidence-based Nursing Practice: Promoting Best Practices Through Research: STUDY 2 (Kirschbaum & Short): A Policy Pertaining to Infection Control of Needless Intravenous Catheter Hubs:” Scrub the Hub”.
Melnyk, B.M., Gallagher?Ford, L., Long, L.E. and 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), pp.5-15.
Mihalic, S.F. and Elliott, D.S., 2015. Evidence-based programs registry: Blueprints for healthy youth development. Evaluation and Program Planning, 48, pp.124-131.
Mutters, N.T., De Angelis, G., Restuccia, G., Di Muzio, F., Schouten, J., Hoelscher, M., Antonelli, M. and Tacconelli, E., 2018. Use of evidence-based recommendations in an antibiotic care bundle for the intensive care unit. International journal of antimicrobial agents, 51(1), pp.65-70.
Nilsen, P., Wallerstedt, B., Behm, L. and Ahlström, G., 2018. Towards evidence-based palliative care in nursing homes in Sweden: a qualitative study informed by the organizational readiness to change theory. Implementation Science, 13(1), p.1.
Rousseau, D.M. and Gunia, B.C., 2016. Evidence-based practice: the psychology of EBP implementation. Annual Review of Psychology, 67, pp.667-692.
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