Application of Evidence Based Practice to Nursing

Evidence Based Practice

 Evidence based practice or EBP is a problem-solving method used to make clinical decisions. Utilizing various resources related to the problem being solved, ensuring the best care is being delivered to the patient. EBP doesn’t take just one scenario and determine that to be the gold standard. Instead EBP takes many scenarios that are related to a problem and identifies techniques that were beneficial and techniques that were not advantageous. This in a way helps reinvent the wheel without completely reconfiguring it. Essentially EBP makes patient centered care more efficient and safer. EBP combines the of best investigative evidence with patient values and ultimately improve patient outcomes (Zimmerman, 2017, p.37).

Nursing Profession

 Nurses make decisions everyday that affect their patient, many of these decisions are made on the premise of evidence-based practice. Nurses have access to thousands of articles and journals on evidence-based practice and utilize those resources when they decide for their patient. Nurses have the unique ability to make critical thinking decisions and alter the care of their patient if they feel it is in the best interest of their patient. For instance, oxygen therapy is typically ordered by the physician however, a nurse can independently administer a nasal cannula without an order from the physician if their patient is experiencing shortness of breath. This is a perfect example of evidence-based practice because the nurse knows the patient needs oxygen immediately based on evidence acquired related to this complication.  Having the knowledge of what will happen if a complication is not addressed immediately has and will continue to save lives every day which makes EBP necessary for the nursing profession.  EBP blends the aspects of science and the art of nursing so the greatest patient results are attained, the information that is obtained is analyzed and used to answer questions necessary for patient centered care (Taylor, Lillis, Lynn & Lemone, 2015, p.34).

History of EBP

 EBP was not always utilized in nursing or in the medical field, it wasn’t until Florence Nightingale discovered how the environment played a role on wound healing. Florence Nightingale is considered to be the pioneer of EBP and rightfully so considering her service in the Crimean War when she cared for wounded soldiers (Mackey & Bassendowski, 2017, p.51). During this time Nightingale explored the various techniques of effective ways to clean skin. Nightingale discovered that the most efficient way to clean skin is to use hot water and soap, opposed to cleaning skin with cold water and soap (Brower & Nemec, 2017, p.14). This was only the beginning for Nightingale she went on make changes in the way we look at how the environment impacts out patients. She realized that our patients needed to have cleanliness, ventilation, temperature, light, well- balanced diet, to meet the needs of the patient involving the environment they are in (Taylor, Lillis, Lynn & LeMone, 2015, p. 29).

Application of EBP to Nursing Care

Many other theorists impacted EBP in unique ways for instance Hildegard Peplau realized in 1952 nurses must make interventions aimed towards their patients’ personality, living situation, and personal preference (Taylor, Lillis, Lynn & Lemone, 2015, p.29). In addition, Betty Newman made a new connection in 1972 regarding the way stress impacts our bodies ability to heal and made efforts to eliminate stressors for her patients, so they could rest and relax ultimately progressing the healing process. The history of EBP has shown us that with trial and error improvements can be made continuously in the way we think about caring for our patients. The founders of nursing set the stage for all nurses to follow, and with a mindful practice of nursing more advancements can be made to EBP.

EBP and Patient Outcomes

Theorist Ida Jean Orlando compiled the nursing process which is a systematic approach to care for the patient (Taylor, Lillis, Lynn & Lemone, 2015, p.29). The guidelines for the nursing process are as follows: assessment, diagnosis, outcome identification and planning, implementing, and evaluation. Nurses are always assessing their patients to correctly identify if their interventions are being therapeutic or non-therapeutic. When interventions are non-therapeutic nurse can utilize EBP for new ideas on how to care for their patient. As mentioned earlier nurses have access to thousands of online articles and journals that can be used when caring for their patients. When a new nurse begins their first shift on the floor this database helps to guide their thinking in the way they will care for their patient. In addition to Orlando’s model nurses can utilize Maslow’s Hierarchy of needs which is another EBP approach to care for our patients. Maslow’s Hierarchy describes the basic needs every person requires and the priority of each need in comparison to another. The Hierarchy explains there are five levels of needs beginning with the most basic: Level 1-Physiologic (oxygen, water, food); Level 2-Safety and Security (safe environment, clutter free, good lighting); Level 3- Love and Belonging (ability to give and receive love); Level 4- Self- Esteem (feeling good about oneself); Level 5- Self- Actualization (reaching ones fullest potential) (Taylor, Lillis, Lynn & Lemone, 2015, p.60-63). Applying the Hierarchy for the patient can help in many ways but, the most important is involving the patient in their care of plan. When patients feel like they have the right to make independent choices regarding their health care plan they tend to adhere to the medication regiments, and follow-up appointment as well as life-style choices that can increase their overall health.

EBP and Policies

EBP guides the way many policies and procedures are conducted in the health care field and in the way healthcare professionals care for their patients. EBP has helped to decrease hospital acquired illnesses and infections by placing wall hand-sanitizer stations inside and outside patients’ rooms.  EBP found the connection with how germs are spread hand to surface and implemented handwashing techniques to kill the germs and limit the spread of infection. Tuberculosis precautions are also EBP, TB is an airborne sickness which is why there is a policy in place that a TB patient must be in a negative air pressure room, so the airborne bacteria doesn’t float around the hospital. In addition to the specialized room, the patient will also have to take medication for at least six months, this is an EBP related to medication administration and the effectiveness of the medication on the bacteria. In addition to the precautions and treatment for TB, a very important policy that was implemented was to use sterile technique to the application of a Foley catheter. After, many patients in various medical care settings received a Foley catheter a urinary tract infection appeared several days after the catheter had been removed. EBP showed that when a Foley catheter is not placed using sterile technique this allows for bacteria to enter the urethra and thus allows for the infection to take place. Policies were then implemented for all Foley catheters to be placed using sterile technique. These are just a few examples of how EBP has influenced facility policies. The advancements in medicine will continue to produce new policies in the healthcare field and many medical professionals will find themselves in a position to change with the times sort to speak.

EBP and Healthcare Professionals

Many healthcare professionals have already found themselves in a position to change with the times. When new policies are implemented the health care professionals are held responsible if the policy is not followed. This is crucial when discussing patient centered care, when research has been conducted and a revelation in medicine has been confirmed. It is mostly likely going to alter the way patients are cared for in the best way possible.  With all the technology and the ability to link up various research efforts to find cures for Cancer, AID’s, Parkinson’s, and so forth this allows healthcare professionals to take caring for their patient to the next level.

EBP Related Quality Improvement and Patient Safety

Quality improvement in health care is aimed toward ensuring quality care for every patient regardless of financial status, race, ethnicity, education level and so forth. Quality improvement is directly related to EBP in the way that nurses and medical staff care for the patient. As mentioned earlier there have been multiple policies that have been implemented based on EBP so that falls right in to quality improvements territory. In fact, Quality and Safety Education for Nurses (QSEN) set forth the “goal to prepare nurses with the knowledge, skills and attitudes necessary to continuously improve the quality and safety of their health care system” (Taylor, Lillis, Lynn & Lemone, 2015, p.330). This bridges the gap between EBP, quality improvement and patient safety. When quality improvement makes a discovery, this begins a research project in a sense to see how the information is related, that turns into EBP when we have a focused assessment and evaluation of benefits and disadvantages. The research that was conducted is then put in place as EBP with patient safety at the fore front of the entire process. 

EBP Benefits to Nursing

EBP can help new nurses made difficult decisions, influence facility policies, and maintain patient safety. Following the guidelines put in place by the Institute of Medicine and continuing to further personal education can help to prevent life threatening errors or procedures. Nurses have a immediate responsibility to pay attention to new EBP because this could be the difference between a good out come for their patient and a complicated outcome for their patient. In addition, following EBP can help prevent injury to the nurse, for example needle sticks can be prevented by following the policies that are put in place per facility. This simple act of knowing the policy and having the education on what needles to use for procedures can prevent this injury. Patients are in a safer environment when policies and procedures are being followed especially the policies that were put in place based on evidence-based practice.

Reference(s)

• Brower, E. J., & Nemec, R. (2017). Origins of evidence based practice and what it means for nurses. International Journal of Childbirth Education, 32(2), 14-17
• Mackey, A., & Bassendowski, S. (2017). The history of evidence based practice in nursing education and practice. Journal of Professional Nursing, 33(1), 51-55. https://doi.org/10.1016./  j.profnurs.2016.05.009
• Taylor, C., Lillis, C., Lynn, P., & LeMone, P. (2015). The Art and Science of Person-Centered Nursing Care: Fundamentals of nursing (8th ed.). Philadelphia, PA: Wolters Kluwer.
• Zimmerman, K. (2017). Essentials of evidence based practice. International Journal of Childbirth Education, 32(2), 37-42