Evidence-Based Practice: Integrating Research Into Daily Nursing Duties
As medical experts and industry leaders focus on healthcare quality improvement, there has been an increased emphasis on evidence-based practice in nursing. All nurses — regardless of their current nursing role or specialty area — need to be aware of the nursing best practices for evidence-based care, as this approach is the key to continuous quality improvement in the healthcare field.
Understanding Evidence-Based Practice
Evidence-based practice in nursing is defined by the American Nurses Association (ANA) as the process of providing personalized care for individual patients based on the most recent nursing research and medical findings. Leveraging the best practices in evidence-based care, nurses are able to ensure that patients receive holistic care that takes into account their personal health data as well as the most recent research findings.
Nursing continuing education plays a central role in implementing evidence-based practice in healthcare settings, largely because nurses have to work to overcome traditional practices or previous beliefs as new research findings are uncovered throughout their careers.
Core Elements of EBP
According to the American Physical Therapy Association, the core elements of evidence-based practice in nursing include:
- Applying the best available evidence. Nurses need to continuously review healthcare policy and research in order to ensure that they can apply the best available evidence to the individual situation.
- Relying on the nursing scope of practice. After considering the best available evidence, nurses must be able to rely on their own nursing foundation and clinical skills to determine the next best steps for the individual patient.
- Reviewing the preferences of the patient. Patient autonomy and cultural competence are vital elements of evidence-based practice. Nurses should always consider the wants and needs of the individual patient before taking action.
The EBP Process in Nursing
The process of implementing evidence-based care into nursing practice consists of five key steps, defined by the ANA as:
- Asking the patient clear and understandable questions about their concerns, and determining a healthcare goal for the patient.
- Using nursing PICO questions — which stands for patient/problem, intervention, comparison, and outcome — while reviewing peer-reviewed nursing journals in order to uncover the best evidence for the next best step to take for the patient.
- Evaluating resources and findings to determine that the evidence matches the needs of the patient.
- Applying the evidence during the decision-making process to ensure that the patient is getting the best possible care.
- Assessing the patient's outcomes after the treatment has been performed in order to evaluate the evidence-based care practices at the facility.
Staying Current With Nursing Research
To fully implement evidence-based care within the healthcare setting, nurses have to make a commitment to stay informed about the latest nursing research findings. By investing in ongoing nursing continuing education, nurses can easily access the most recent findings and learn more about emerging trends in evidence-based care.
Reliable Information Sources
When seeking evidence to support the patient's individual treatment plan, nurses must use reliable information sources. Nursing peer-reviewed journals are considered one of the leading sources for evidence and nursing research findings, as these journals only publish information that is supported by scientific research and has been reviewed by other leading experts in the nursing profession.
Time‑Efficient Strategies for Busy Nurses
According to research published in the National Library of Medicine, one of the most efficient ways that nurses can implement evidence-based care into their practice is to utilize nursing PICO questions. These allow you to quickly determine a clinical question and uncover the most relevant evidence.
The nursing PICO questions include:
- Who is the patient, and what is the problem?
- What intervention is required?
- What alternative can be compared to the intervention?
- What outcome is most desirable?
Translating Evidence Into Clinical Practice
Uncovering the best available evidence is the first step in implementing evidence-based care, but once nurses have extracted that evidence from reliable sources, they must be able to apply it to their clinical practice. The process of translating evidence begins with clinical appraisal and requires nurses to use specific frameworks to implement the evidence into the treatment plan.
Critical Appraisal and Decision‑Making
After searching for evidence within nursing peer-reviewed journals and other reliable information sources, nurses should work to evaluate the information and appraise its value within the context of the patient's needs.
According to the ANA, there are four levels of evidence to consider within the decision-making process:
- Level A evidence, which comes from randomized, controlled trials. This evidence is considered the most valuable and reliable within evidence-based care.
- Level B evidence, which comes from controlled trials that are not randomized.
- Level C evidence, which comes from an expert opinion.
- Level ML, defined as multi-level evidence that comes from various sources; it is only used in the most complex cases.
Implementation Frameworks
Once evidence has been collected and has been properly appraised, nurses are able to use implementation frameworks to create an evidence-based care plan for the individual patient. Nurses typically rely not only on these frameworks but also on nursing clinical guidelines in order to make a decision regarding patient care.
Measuring Outcomes and Continuous Improvement
In order to fully enact nursing quality improvement initiatives, nurses who implement evidence-based care within their practice must regularly evaluate and assess outcomes in a way that allows for continuous improvement. Through collecting data and measuring outcomes, nurses can collaborate with other healthcare providers to enhance patient outcomes and the overall patient experience.
Setting Key Performance Indicators (KPIs)
Through interdisciplinary collaboration in nursing, nurses can work together to establish key performance indicators, or KPIs, that can be monitored as part of their commitment to continuous quality improvement. Some KPIs that can help track the outcomes of evidence-based practice in nursing include:
- Patient satisfaction rating
- Hospital readmission rating
- Patient fall rating
- Hospital-acquired infection rating
The KPIs used may vary based on the individual needs of the patient, requiring nurses to evaluate the KPIs they are using to measure outcomes.
Data Collection and Analysis
Through ongoing data collection and analysis, nurses can monitor the outcomes of evidence-based practice within their healthcare facility and improve their approach in the future. Data-driven decision-making plays a key role in evidence-based practice nursing.
Overcoming Common Barriers
The healthcare field is rapidly evolving, which is highlighting the importance of effective change management in nursing. Ongoing change and emerging trends can make it difficult for nurses to implement evidence-based practice optimally, but it's essential that they remain aware of the common barriers in order to overcome them.
Organizational and Cultural Hurdles
Both patients and providers can be resistant to change, particularly if evidence-based care strategies challenge traditional beliefs or approaches to healthcare. To address organizational and cultural barriers, nurses need to be able to uncover valuable evidence from reliable sources and share information about why it will improve the patient's outcomes.
Resource and Skill Gaps
Continuing education for nurses is crucial to effectively implementing evidence-based care within a healthcare facility. However, some facilities do not have the resources available to provide their staff with ongoing training, which can lead to skill gaps that prevent providers from properly implementing evidence-based practice. Nurses should prioritize continuing education and professional development throughout their careers in order to continuously improve their clinical as well as critical thinking skills.
Building a Sustainable EBP Environment
Nurses can play a powerful part in creating and sustaining a clinical environment that supports evidence-based practice. Through interdisciplinary collaboration in nursing, they can work with healthcare professionals across specialty areas to share evidence, report outcomes, and develop evidence-based care strategies that best support their patient population.
Leadership and Mentorship Roles
Equipped with positive and effective nurse leadership, healthcare facilities may create a workplace culture that supports evidence-based practice in nursing. Nurse leaders can often serve as mentors to nurses with less clinical experience, helping them learn where to look for the best available evidence and become familiar with the implementation frameworks needed to utilize that evidence in the best possible way. Cultivating a culture where shared knowledge is valued and ongoing change is supported, healthcare facilities can increase staff retention rates while simultaneously elevating the patient experience.
Technology and Infrastructure Support
By investing in advanced digital tools and technological infrastructure, healthcare facilities can provide their nurses with the resources they need to search for evidence and create evidence-based treatment plans. Technology plays a critical role in successfully implementing evidence-based practice in nursing.
Explore the Role of Evidence-Based Practice in Nursing at Indiana Wesleyan University
Continuing education for nurses is essential, particularly as the healthcare field continues to evolve to meet the increasingly complex needs of patients. At Indiana Wesleyan University (IWU), we offer a wide range of nursing degree programs for nurses at all stages of their careers. Through our Division of Pre-Licensure Nursing, you can explore programs that allow you to develop the foundation needed to begin your career as a nurse. Our Division of Nursing – Post-Licensure, Master's and Doctoral allows you to learn more about the variety of graduate degree programs that equip you with the skills required for advanced practice registered nursing positions and specialized nursing roles. Within all of our nursing degree programs, you will find that evidence-based practice nursing anchors the curriculum.
Find your program and learn more today!
Sources
https://www.indwes.edu/academics/caps/school-of-integrated-health/division-of-nursing/
https://www.nursingworld.org/content-hub/resources/workplace/evidence-based-practice-in-nursing/
https://www.ncbi.nlm.nih.gov/books/NBK589676/
https://www.nlm.nih.gov/oet/ed/pubmed/pubmed_in_ebp/02-100.html
https://bucketlistrewards.com/blog/key-performance-areas-nurses/
