Implementing Evidence Based Practice

Evidence based practice (EBP) is a frequently used term in everyday health-care jargon. EBP is based on research, evidence on best practices, and the consideration of individual patient’s needs and preferences (Bick, 2011). EBP started in medicine as evidence-based medicine (EBM). Professor Archibald Cochrane (1909–1988) was considered a pioneer in this area and can be considered the father of EBM in our era (Collaboration, 2020).

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There are many definitions of EBP, one of the most widely cited is by Sackett (1996) and refers to evidence-based medicine, but can also applied to health care in general, ‘Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means ‘integrating the best available research evidence with clinical expertise and the patient's unique values and circumstances’ (Straus, Glasziou et al., 2011).

High quality, current and valid research is essential to provide women with up-to-date evidence-based practice (Rowland and Jones, 2013). The Nursing and Midwifery Council (NMC, 2018) Code states you must deliver care ‘based on the best evidence and best practice and ensure any information or advice given is evidence-based’ (Baston and Hall, 2017). World Health Organization (WHO) says that ‘Health systems can benefit directly from EBP through overall improvement in the quality of care; this means better patient outcomes and increased patient safety’ (Jylhä et al., 2017).

• Within midwifery evidence-based guidelines could appear as a solution to multiple problems: providing a set of practical steps that embody safe and effective care
• reducing the risk to women and babies
• setting defensible standards for nursing practice
• providing direction for newly qualified or recently employed staff and students

Evidence alone is not enough, clinical judgement and patient preference are as important in order to provide the best EBP for both women and their babies (Aveyard and Sharp, 2009).

Implementing EBP is a process that involves locating and applying research findings to clinical practice. This process follows a series of steps commonly known as the five steps of evidence-based practice in which we; ask - formulate a clinical question, acquire - search for the best evidence to answer your question, appraise - critically review the evidence for validity and applicability, apply - implement findings with your patient and assess - evaluate the result. When having assessed the effects, new questions can arise, requiring us to restart the five-step process (CIAP, 2018).

Student midwives should be able to ask questions in order to acquire the evidence to continue and apply the knowledge gained.

As students, we are taught to provide high-quality care. This high-quality care is supported by evidence, which took many years to become guidelines of care through translation from research to clinical practice. Gaining knowledge of EBP and learning strategies for implementation are critical skills for student midwives. As students, we hold a promise of continuous learning, and it is essential to build evidence-based knowledge over time (Salinas, 2017). EBP and research are not the same, EBP focusses on the use or application of knowledge that is often produced by research. Research is concerned with the production of knowledge that is as objective and accurate as possible (Rees, 2012). As students we need to be able to apply all five steps which provide a clear step by step approach, in order to provide safe, effective care to both mothers and babies and provide the best clinical decisions.

When it comes to sources of information and evidence there is ample. While all evidence is classed as information, not all information is classed as evidence. In the healthcare, evidence is considered as high-quality information gained from research-based investigations, which makes it more predictable and reliable. Evidence is often used as a basis for change in healthcare. Every source of information is useful but in the same breath has limitations.

The research method regarded as the most likely to ensure good quality evidence is randomized controlled trials (RCT). RTCs use research methods aimed at reducing bias and are considered the most reliable form of primary research in the field of health interventions. The power of the RCT lies in its objectivity and its freedom from bias and is regarded and the ‘gold standard for comparing alternative forms of care’ ((Enkin et al., 2000) (Marshall et al., 2014). However when relevant research studies have not yet been done on a subject, information can be based on the best available evidence, the experience and expertise of health and care professionals or the personal experiences of patients or service users (Titler, 2008). Disadvantages of EBP include the lack of evidence, the oversight of common sense, and the length of time and difficulty of finding valid credible evidence ("Evidence-Based Practice: Advantages & Disadvantages.", 2017).

Gaining knowledge of EBP and learning strategies for implementation are critical skills for student midwives and other health care professionals, no matter the setting. EBP is important to the professional development, responsibility, and capabilities of student midwives, and it has become an important subject in midwifery and has integrated into daily practice.

• Aveyard, H. and Sharp, P. (2009) A beginner's guide to evidence based practice in health and social care professions. Maidenhead: Open University Press :.
• Baston, H. a. and Hall, J. a. (2017) Midwifery essentials. Volume 1, Basics. Second edition. / Helen Baston, BA (Hons), MMedSci, PhD, PGDipEd, ADM, RN, RM, Jenny Hall, EdD, MSc, RN, RM, ADM, PGDip (HE), SFHEA. edn.: Elsevier.
• Bick, D. (2011) 'Evidence based midwifery practice: Take care to ‘mind the gap’', Midwifery Journal, 27, pp. 569-570.
• CIAP, C. I. A. P. (2018) Introduction to Evidence-Based Practice (Accessed: 27 February 2020).
• Collaboration, T. C. (2020) About Us. Available at: https://www.cochrane.org/ (Accessed: 2 March 2020).
• "Evidence-Based Practice: Advantages & Disadvantages." (2017): Study.com. Available at: https://study.com/academy/lesson/evidence-based-practice-advantages-disadvantages.html (Accessed: 3 March 2020).
• Jylhä, V., Oikarainen, A., Perälä, M.-L. and Holopaine, A. (2017) Facilitating evidence-based practice   in nursing and midwifery in   the WHO European Region  (Accessed: 27 February 2020).
• Marshall, J. E. e., Raynor, M. D. e., Fraser, D. w. o. f. and Myles, M. F. T. f. m. (2014) Myles textbook for midwives. Sixteenth edition / edited by Jayne E. Marshall, Maureen D. Raynor ; foreword by Emeritus Professor Diane M Fraser. edn.: Churchill Livingstone.
• The code: Professional standards of practice and behaviour for nurses, midwives and nursing associates .
• Rees, C. (2012) An introduction to research for midwives. 3rd ed. edn.: Churchill Livingstone.
• Rowland and Jones (2013) 'Research midwives: Importance and practicalities', British Journal of Midwifery, 21(1).
• Salinas, A. (2017) Why evidence-based practice matters to students. Available at: https://www.nurse.com/blog/2017/02/22/why-evidence-based-practice-matters-to-students-alexanders-student-blog/ (Accessed: 2 March 2020).
• Titler (2008) Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville: Agency for Healthcare Research and Quality.