PHN 652 How has evidence-based practice evolved?
PHN 652 How has evidence-based practice evolved?
Nurses use the evidence-based approach to care delivery aiming to improve patient outcomes. Evidence-based care approach focuses on patient safety and beneficence. In the early 2000s, there was a high rate of inappropriate variations in nursing practice (Volovici et al., 2019). Therefore, evidence-based practice was introduced into the nursing curriculum to improve the standardization of nursing practice. Nurses access clinical guidelines from the Guidelines International Network. Nursing institutions educate nurses on how to appraise and apply relevant, timely, and up-to-date scientific evidence in nursing practice. In the early 2000s, the published guidelines had shortcomings of poor quality data, poor reporting, and poor treatment methodology (Volovici al., 2019). As such, the Institute of Medicine reviewed the guidelines to ensure a proper foundation. Therefore, healthcare facilities and healthcare professionals adhere to the IOM standards of nursing practice.
The advantages of the evolution of evidence-based practice include enhanced relevance of nursing practice, nurses’ expertise, nurses’ confidence, and decision-making skills. Nurses also provide patient-tailored care with confidence in their decisions. Evidence supports timely and up-to-date clinical services relevant to nursing practice. In addition, nurses acquire an appraisal and decision-making skills which enhance their expertise in the medical field (Correa-de-Araujo, 2016). However, the evolution of evidence-based practice has a few limitations which include additional workload and risk for bias (Correa-de-Araujo, 2016). Nurses need to develop appraisal skills and spend more time searching for clinical evidence. As such, more time and effort are spent on establishing evidence-based interventions. Nurses with limited appraisal skills can confirm irrelevant evidence based on personal experience and judgment. Biased evidence-based practice can result in patient harm and poor patient outcomes in communities. Therefore, nurses should adhere to the IOM directions and attend training programs to improve evidence-based practice.
Correa-de-Araujo, R. (2016). Evidence-based practice in the United States: Challenges, progress, and future directions. Health Care for women international, 37(1), 2-22. doi: 10.1080/07399332.2015.1102269.
Volovici, V., Steyerberg, E. W., Cnossen, M. C., Haitsma, I. K., Dirven, C. M., Maas, A. I., & Lingsma, H. F. (2019). Evolution of evidence and guideline recommendations for the medical management of severe traumatic brain injury. Journal of neurotrauma, 36(22), 3183-3189. https://doi.org/10.1089/neu.2019.6474
According to Dillard (2017), evidence-based practice has a long history which started from ancient Egypt to ancient Greece and Rome, the Bible, Ibn Sina, James Lind, and many more in between that shows examples of the early practitioners utilizing strong evidence-based for research. Learning about the foundation of evidence-based practice and its contribution to our healthcare is important to develop a sensitive evidence-based practice for the diverse clients. Florence Nightingale is known for the first evaluating and making decisions through observation outcomes (Brower, 2017). One of her work is the used of soap and hot water to cleanse the skin which is the most effective way. Recently, evidence-based practice became reflection of different types of research to include systematic review, and randomized-control trial (Dillard, 2017). The advantage of evolution of evidence-based practice for public health nurses is the discoveries of new treatments or interventions to improve disease control and promote the health of the population. The challenges of public health nurses for the evolution of evidence-based practice is the limited access and resources to information.
Brower, E.J. (2017). Origins of evidence-based practice and what it means for nurses. International
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Dillard, D.M. (2017). The history of evidence-based practice. International Journal of Childbirth
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In the mid to late 1970s Stanhope & Lancaster (2020) narrate that there was a growing consensus among nursing leaders that scientiﬁc knowledge should be used as a basis for nursing practice. Stanhope & Lancaster (2020) state that the term Evidence-based practice (EBP) was first applied in medicine to begin the development of new ways of guiding professional decision making by using the best available evidence. To my knowledge as a practicing nurse, EBP arose during Florence Nightingale evidence-based delivery of care during the Crimean war.
EBP approaches are based solely on science, and they usually treat patients the way health care providers would want to be treated.
An advantage of the evolution of EBP is that it’s involved in policies for most institutions and so acting as advocate for patients. Involving EBP in presentations, meetings and nursing units helps public health nurses promote their research as well as understanding of their everyday work.
The mishap of EBPs would be lack of specific evidence of support material for the public health problems that may arise in the communities.
According to Stanhope & Lancaster (2020) community-focused nursing agencies may lack the resources needed for its implementation in the clinical setting, such as time, funding, computer resources, and knowledge. Nurses may be reluctant to accept ﬁndings and feel threatened when long-established practices are questioned. Cost can be a barrier if the clinical decision or change will require more funds than the agency has available, while compliance can be a obstacle if the client will not follow the recommended intervention (Stanhope & Lancaster, 2020).
In a study by Kaseka & Mbakaya (2022) conducted in all four central hospitals in Malawi on tertiary level institutions that provide specialist care describes that Registered Nurse Midwives knowledge, attitude and use of EBP had the highest mean score followed by knowledge of skills and then practice.
Kaseka, P. U., & Mbakaya, B. C. (2022). Knowledge, attitude and use of evidence-based practice (EBP) among registered nurse-midwives practicing in central hospitals in Malawi: a cross-sectional survey. BMC Nursing, 21(1), 1–13. https://doi-org.lopes.idm.oclc.org/10.1186/s12912-022-00916-z
Stanhope, M. & Lancaster, J. (2020). Public Health Nursing Population-Centered Health Care in the Community. Elsvier
According to Mackey & Bassendowski, (2017) ”The concept evidence-based practice is defined, and the similarities and differences to evidence-based medicine” Evidence Based practice has evolved throughout the decades and continues to do so. Not only is evidence-based practice is foundational to undergraduate and graduate nursing education , it also paves the for the nursing discipline to minimize the theory to practice gap (Mackey & Bassendowski ,2017). Public health nursing involves working with communities and populations as parallel partners, while focusing on primary prevention and health promotion within in their communities . With that, pros and cons are inevitable , just like anything else. Some advantages include ; improvements in communities health and safety, educating the communities on all programs including women and children benefits, being able to provide resources and access to health care. Some major disadvantages are ; budget strain in both government and nonprofit sectors , limited resources and increased stress due to a higher risk of physical injury or physiological stress while working with the at risk populations (Li, Cao, & Zhu, 2019). Nonetheless, the roles of public health nurses have developed as advocates, collaborators, educators, partners, policy-makers, and researchers.
Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review. Medicine, 98(39), e17209. https://doi.org/10.1097/MD.0000000000017209
Mackey, A., & Bassendowski, S. (2017). The History of Evidence-Based Practice in Nursing Education and Practice. Journal of professional nursing : official journal of the American Association of Colleges of Nursing, 33(1), 51–55.
The clinical Information Access Portal (n.d.) acknowledged that it was highlighted in the early 70’s by Dr. Archie Cochrane that most treatment related decisions were not based on a systematic review of clinical evidence, but on intuition and pathophysiologic rationale. By doctors identifying that there is a gap between research and clinical practice, many doctors started to convince practitioners of the benefits of using an evidence-based approach for treatments and interventions (The clinical Information Access Portal, n.d.). To shift the emphasis in clinical decision making from intuition and pathophysiologic rationale to scientific and research, Guyatt et al introduced the term “Evidence-based medicine” in 1992 (The Evidence Based Practice (EBP) Optometry Project, 2013). Four years later, Sachett et al identified that evidence-based clinical decision making is a combination of not only research evidence but also clinical expertise that also takes into account the patient’s preferences” (The EBP Optometry Project, 2013).
The advantages of the evolution of EBP have allowed public health nurses along with communities to have a structure that will help health professionals make informed decisions about their clinical work, provides potential cost effectiveness of interventions to clients, and aids counselors in making treatment decisions using empirical evidence and statistical approaches (Yates, 2013). On the other hand, it is also reported by Yates (2013) that the disadvantages of using EBP are identified when the practice places less emphasis on a health professionals’ judgements and expertise and more emphasis on cookie cutter approaches to treatment and on the belief that health professionals who use EBP will have superior results compared to counselors who do not.
Clinical Information Access Portal (n.d.). History of Evidence-based Practice. https://www.ciap.health.nsw.gov.au/training/ebp-learning-modules/module1
The Evidence Based Practice Optometry Project (2013). A Brief History of Evidence-base Practice.
Yates, C. (2013). Evidence-Based Practice. Counseling Outcome Research and Evaluation, 4(1), 41-54. https://www-tandfonline-com.lopes.idm.oclc.org
Evidence-based medicine aims to improve healthcare and reduce cost through the use of sound clinical evidence in evaluating treatments, procedures and outcomes. Florence Nightingale was applying the concepts of evidence-based reform to the medical profession more than a century before. She used statistics to reveal the nature of infection in hospitals and on the battlefield. Nightingale marshaled data and evidence to establish guidelines for health care reform. Tracing the origins of evidence-based medicine back to Nightingale underscores how critical this movement is to improving the quality and effectiveness of patient care today (Aravind & Chung, 2010).
There are many advantages of EBP in public health nursing and in the communities. Nurses can provide personal care and treatment, work with families and communities, and play a central role in public health and controlling disease and infection. These roles have been recognized by the World Health Organization (Li et al., 2019). Community nurses combine the skills of nursing, public health, and some phases of social assistance, and they function as a part of the entire public health program. WHO has suggested that health improving in communities is dependent upon nursing services underpinned by evidence-based practice. Systematic implementation of EBP can enhance healthcare safety and improve patient outcomes (Li et al., 2019). Nurses who practice based on scientific evidence have been able to make better decisions in service delivery.
There are barriers to EBP. Several studies have found that both human and organizational factors are associated with barriers to the use of EBP including lack of time to read literature, heavy workload, lack of ability to work with computers, lack of staff experienced in EBP, and lack of resources. Though nurses generally report positive attitudes and beliefs towards EBPstudies show that nurses were not familiar enough with its principals and they use EBP to a limited extent (Khammarnia et al., 2015).
Aravind, M., & Chung, K. C. (2010, January). Evidence-based medicine and hospital reform: Tracing origins back to Florence Nightingale. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386633/
Khammarnia, M., Haj Mohammadi, M., Amani, Z., Rezaeian, S., & Setoodehzadeh, F. (2015). Barriers to implementation of evidence based practice in zahedan teaching hospitals, iran, 2014. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381851/#sec4title
Li, S., Cao, M., & Zhu, X. (2019, September). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775415/
Evidence-based practice (EBP) is a problem-solving approach to the delivery of healthcare that integrates the best evidence from research with a clinician’s expertise, including internal evidence from patient data, and a patient’s/family’s preferences and values, (Secretary’s Advisory Committee, 2010). It is crucial that registered nurses be proactive in their quest for research knowledge, so the gap between theory and practice continues to close. Research on the sustainability of evidence-based interventions has been growing rapidly since the time of Florence Nightingale. The evolution of EBP is the reason for the provision of the highest healthcare quality and patient outcomes. In addition, the advantage of, EBP is reduced healthcare costs and geographic variation in the delivery of care and the distribution of resources to the community or public, (Secretary’s Advisory Committee, 2010). In the evolution of evidence-based practice, in public health the resources and energy away from public health’s traditional and unique prevention-oriented, population-focused perspective to include a primary care focus.
Public health nurses are more empowered using EBP to address public health issues such as the prevention of infectious diseases through vaccination, education, providing resources and information for healthy and safe prenatal and postpartum care, education, and preventive care. Public health evidence can take many forms. Provides online access to selected evidence-based public health practices resources, knowledge domains of public health, and public health journals and databases. The disadvantage of this evidence-based evolution for public health nurses and communities can be insufficient evidence and intervention with no real value, lack of time, funding for preventive measures, and technology, (Stanhope & Lancaster, 2020).
Secretary’s Advisory Committee. (2010). Evidence-Based Clinical and Public Health Generating and Applying the Evidence. https://www.healthypeople.gov/sites/default/files/EvidenceBasedClinicalPH2010.pdf
Stanhope, M & Lancaster, J. (2020) Public Health Nursing Population-Centered Health Care in the Community. Elsevier