Each representative of the medical profession certainly at least once in life thought about the essence of healing art. The traditional answer to this question is something like this: “healing art consists of the knowledge needed to understand the causes and pathophysiological mechanisms of diseases, from clinical experience, intuition and a set of qualities that together constitute the so-called “clinical thinking”.
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Cultivated in the traditional medical education concept “clinical thinking” does not have clear meaning and holistic vision of healing and is based on analogies. At the turn of 80-90-ies the new fild of knowledge was formed in medicine – clinical epidemiology. The most popular became the works of the group of Canadian scientists – D. Sackett, B. Haynes, G. Guyatt and P. Tugwell from the McMaster University, Ontario. They were the first who tried to study the medical skill in terms of rigorous scientific principles. These scientific principles have a great impact on the style of medical practice and ideology of doctors.
Clinical epidemiology is developing the scientific basis of medical practice – a set of rules for clinical decision-making. The central tenet of clinical epidemiology is that: every clinical decision should be based strictly on proven scientific facts. This postulate is called “evidence-based medicine”.
Evidence-based medicine is an approach to medical practice in which decisions on the use of preventive, diagnostic and therapeutic measures are taken based on the available evidence of their efficacy and safety, and such evidence undergoes search, comparison, compilation, and wide dissemination to be used in the interest of patients (Evidence Based Medicine Working Group, 1993).
Evidence-Based Medicine is a conscientious, explicit and judicious use of current best evidence for making decisions about care of individual patients. The practice of evidence-based medicine involves the union of individual expertise with the best available external evidence obtained from systematic research. By individual clinical expertise experts mean the professionalism and clinical thinking, acquired through the accumulation of clinical experience in clinical practice. Increasing professionalism is manifested in many ways, but most pronounced it is in the more efficient and effective diagnosis, the more thoughtful identification and compassionate attitude to the difficulties of patients, their rights and preferences in making clinical decisions regarding the provision of medical care. Under the best available external proof, specialists mean clinically relevant research. External clinical justified evidence not only invalidates the previous diagnostic tests and treatments, but also replaces them with new, more powerful, precise, effective and safe. (Sackett, DL et al. (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312 (7023), 13 January, 71-72).
Principles of evidence-based medicine include the testing of the efficacy and safety methods of diagnosis, prevention and treatment in clinical trials. The practice of evidence-based medicine is the use of data from clinical trials in daily clinical work of a doctor or a nurse.
In most countries there were recognized some of the rules for conducting clinical studies outlined in the standard GCP (Good Clinical Practice) as well as the rules of production of drugs (standard GMP) and perform laboratory tests (standard GLP).
The International System of evidence-based medicine evolves exponentially: since its establishment in the early 90’s to the present time the number of centers, books, publications and forums on the problem is huge. The U.S. Agency of Health Policy and Research subsidized in 1997 12 such centers established at leading universities and research institutions of different states, a growing number of centers on individual issues (child health, primary care, general practice, mental health, etc.). The common thing for all directions is the use of the principle of evidence at any level of decision-making – from the state program till the appointment of individual therapy.
Nowadays evidence-based practice is widely implemented in professional nursing practice. The idea of evidence-based practice for nursing was developed from the evidence based medicine movement.
Currently, nursing is an integral part of the health system. It is a multifaceted health discipline that has a social health importance, as it is meant to maintain and protect public health. Nursing is a science and art, aimed at solving existing problems related to human health in a changing environment.
Thus, evidence-based nursing is the kind of evidence based medicine. It involves identifying the necessary research and implementation of them into practice care in order to improve the quality of patient care. The aim of EBN is to provide high quality and most cost-effective care ever possible. EBN is a process based on the collection, interpretation and integration of important research results. Some experts define the EBN narrowly, considering only the use of randomized clinical trials, while others also include the use of case reports and expert opinions. In order to apply the practice in the right way, a nurse must understand the concept of research and know how to properly evaluate the study. These skills are taught in modern institutions of nursing education, as well as at training.
Nurses serve instrumental roles in ensuring and providing evidence-based practice. They must continually ask the questions, “What is the evidence for this intervention?” Or “How do we provide best practice?” And “Are these the highest achievable outcomes for the patient, family, and nurse?” Nurses are also well positioned to work with other members of the healthcare team to identify clinical problems and use existing evidence to improve practice. Numerous opportunities exist for nurses to question current nursing practices and use evidence to make care more effective.
For example, a recently published evidence-based project describes the potential benefits of discontinuing the routine practice of listening to the bowel sounds of patients who have undergone elective abdominal surgery. The authors reviewed the literature and conducted an assessment of current practice, and they subsequently developed and evaluated a new practice guideline. These authors reported that clinical parameters such as the return of flatus and first postoperative bowel movement were more helpful than bowel sounds in determining the return of gastrointestinal mobility after abdominal surgery. The authors found that this evidence-based project resulted in saving nursing time without having negative patient outcomes (Madsen et al., 2005).
To understand what Evidence-based practice in nursing is better while defining the process it describes. In every day activity of clinical nursing, EBP provides nurses with a tool with the help of which they can provide the best and safest health care ever possible. The new emphasis of the EBP nursing comes from the problems that have emerged in recent years regarding the safety of the health system.
As it is written on the Yale University Nursing Library website and the website of University of Minnesota, the first step in EPP is to formulate right, necessary questions. Such questions consist of background questions such as “what causes some particular disease?” Such kind of questions has a practical application – the need to solve an exact clinical problem. The clinical questions should include foreground questions also. These pertain to how the disease or condition in question is usually treated.
Finding the Answers
As soon the right questions have been formulated, the nurse can then look for possible solutions to the problem by making some necessary research. The aim of the research is to find sources that tall about the possible treatments and outcomes of the disease. Nurses in clinics often use databases such as CINAHL and MEDLINE for performing their searches.
The next step is to evaluate the evidence as soon as it is found. Not all clinical treatments are the same, and not all sources that pretend to provide evidence of a possible clinical treatment are the same. Implementing the evidence-based practice in nursing process there is a need to understand that there not only various levels of possible treatment, but also various levels of quality in terms of research sources. The research quality is based on the quality of the research design and its applicability to the exact clinical case.
Having evaluated the evidence, the nurse can start its application in her practice. One of the main questions that appear at this stage is how the evidence can be applied in order to meet nurse’s specific need or situation. Concerns of nurses include the validity of the diagnosis, how possible therapeutic techniques can affect the patient, whether there is any adverse risk to the patient and the prognosis of the treatment. As soon as the decision is made about the provision of a certain treatment, application of the treatment is usually made.
Re-evaluation of the result
As soon as the treatment has been made, the clinical nurse should reevaluate if the implemented evidence was adequate and useful for the particular patient and situation. Clinical nurse should assess whether or not the intervention was successful. Nurses ought to know whether their findings might contribute new knowledge to the nursing field. They also should know how they will apply these findings throughout their future nursing practice. (Http://www.ehow.com/about_6728914_define-evidence_based-practice-nursing.html)
“Evidence based clinical practice is an approach to decision making in which the clinician uses the best available evidence, in consultation with the patient, to decide upon the option which suits that patient best”. (Muir Gray JA. (1997) Evidence-based healthcare: how to make health policy and management decisions. London: Churchill Livingstone).
So evidence-based practice helps nurses to provide high-quality patient care based on research and knowledge rather than because “this is the way we have always done it,” or based on traditions, myths, hunches, advice of colleagues, or outdated textbooks.
For example, when clinical questions arise, should one look to a nursing textbook for the answers? Remember that books are not published every year, and new information may not be included in the edition you have. Also, when using textbooks, consider whether you have the most current edition.
There are also issues to consider when asking colleagues for advice-specifically, be mindful that their responses may be based on their personal experiences, their observations, what they learned in school, what was reviewed during nursing orientation, or myths and traditions learned in clinical practice.
A recent study provided evidence that most nurses provide care in accordance with what they learned in nursing school and rarely used journal articles, research reports, and hospital libraries for reference (Pravikoff, Tanner, & Pierce, 2005). That finding, combined with the fact that the average nurse is more than 40 years of age, makes it apparent that many nurses’ knowledge is probably outdated. Practice based on such knowledge does not translate into quality patient care or health outcomes. Evidence-based practice provides a critical strategy to ensure that care is up to date and that it reflects the latest research evidence.
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So, EBP important to nursing practice because it results in better patient outcomes; it contributes to the science of nursing; it keeps practice current and relevant; it increases confidence in decision-making; policies and procedures are current and include the latest research; integration of EBP into nursing practice is essential for high-quality patient care. Thus, evidence-based practice is very important for modern professional nursing practice.
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