Research is the mechanism by which best treatments, care protocols, and medicines are determined to yield improved clinical outcomes; evidence-based practice (EBP) is the mechanism by which these proven treatments are brought to patients everywhere. Use of EBP in nursing care has been shown to lead to better patient outcomes and higher nursing job satisfaction. In 2009, the Institute of Medicine (now National Academy of Medicine) declared that, by 2020, 90% of all health care decisions would be based on evidence. Despite the popularity of EBP and the wealth of information about models, processes, and educational strategies, utilization of current evidenced care practices in nursing continues to lag, with some estimates noting implementation taking as long as 7 to 17 years.
A commonly accepted definition for EBP in nursing is given by the International Council of Nurses: “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.” It has also been described as a coalescence of clinical expertise, understanding and implementation of published care practices and consideration of patient preferences. Simply put, EBP in nursing is delivering care with respect for patient preferences, utilizing clinical expertise and knowledge of the literature.
One imperative step in the process of implementing EBP in nursing, is evaluating the literature. Thousands of articles are published each year in scholarly, peer-reviewed, journal publications which describe both research and evidence-based nursing practices that deserve evaluation and consideration for implementation. Providing evidence-based care is a sign of nursing excellence, and as a nursing professional, it is both our privilege and responsibility to evaluate published care practices and consider their implementation to improve patient outcomes. To support nursing in the evaluation of the evidence, the Center for Nursing Excellence is working with nursing leadership and library services to determine the 2 best scholarly journals for each specialty. For example, if your specialty is emergency medicine, the Journal of Emergency Nursing and Journal of Trauma Nursing will likely publish evidence-based care practices that could improve outcomes for patients who come through our Emergency Department.
In order to promote reading of literature and reflecting on current practices, the Annual Performance Appraisal Evidence Guides have been revised to include a qualifier in the Education, EBP and Research, Performance Improvement section. For each step in the ladder, the qualifier has an increased requirement. For example, if you are RNII moving up to an RNIII, the qualifier states:
RN selects (2) articles published within the last 3-5 years related to nursing care in current specialty with a focus on quality improvement, evidence-based practice or research. Write a synopsis of the study and the relevance of the research to your nursing practice. Include the article and the synopsis in your portfolio for evaluation.
This activity is designed to promote reading the literature, reflecting on current practice, and writing about whether the literature supports practice at UAMS, or recommends a change in our practice, leading to an EBP project. Ultimately, it will lead to better patient outcomes and growth as nursing professionals.
Closs, S. J. & Cheater, F. M. (1999). Evidence for nursing practice: A clarification of the issues. Journal of Advanced Nursing, 30(1), 10-17.
International Council of Nurses. (2012). Closing the gap: From evidence to action. Geneva, Switzerland.
Institute of Medicine Roundtable on Evidence-Based Medicine. (2009). Leadership Commitments to Improve Value in Healthcare: Finding Common Ground: Workshop Summary. Washington, DC: National Academies Press.