Purpose of Evidence Based Research

Evidence Based Research

 In today’s healthcare environment, practicing nurses are in high demand to utilize current evidence in making clinical decisions relative to patient care (Schaffer, Sandau, & Diedrick 2013). This is best achieved through thoughtful incorporation of the current research in the care of the patient along with nurses’ expertise, patient preferences and values, and local context. Evidenced based practice is defines as a problem-solving approach in making clinical decisions with the healthcare organization and is attributed to improved clinical outcomes, functional outcomes, quality of life outcomes, and economic outcomes (Schaffer et al. 2013).  EBP also focuses on safer nursing practices while enhancing patients’ access to healthcare information regarding the best treatments and it provides more opportunities for highly personalized treatment.

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Research, EBP, and Quality Improvement

The purpose of conducting research is to generate new knowledge or to validate existing knowledge based on a theory. Unlike research, EBP isn’t about developing new knowledge or validating existing knowledge. It’s about translating the evidence and applying it to clinical decision-making (Schaffer et al. 2013). The purpose of EBP is to use the best evidence available to make patient-care decisions. The purpose of QI is to use a systematic, data-guided approach to improve processes or outcomes. While the concept of quality can be subjective, QI in healthcare typically focuses on improving patient outcomes. So, the key is to clearly define the outcome that needs to be improved, identify how the outcome will be measured, and develop a plan for implementing an intervention and collecting data before and after the intervention. Unlike research and EBP, QI typically doesn’t require extensive literature reviews and rigorous critical appraisal. Therefore, nurses may be much more involved in QI projects than EBP or research. Also, QI projects normally are site specific and results aren’t intended to provide generalizable knowledge or best evidence.

APNs Role in Research, EBP, and QI

Nurses can no longer rely solely on their clinical experience to deliver quality care. Nurses should ask and evaluate themselves frequently for best practices and improvement in all practices. Clinical practice is the primary focus of advanced practice nursing (APN) roles. However, with unprecedented needs for health care reform and quality improvement (QI), health care administrators are seeking new ways to utilize all dimensions of APN expertise, especially related to research and evidence‐based practice. International studies reveal research as the most underdeveloped and underutilized aspect of these roles. (Melnyk, Gallagher-Ford, & Long, 2014). I believe this will improve patient care by strengthening the capacity of advanced practice nurses to integrate research and evidence-based practice activities into their day-to-day practice. The question arises as to how we have been practicing nursing without EBP!

Implementation.

Once a topic has been identified there are several steps that can guide one through the research process in an efficient manner (Polit & Beck, 2017). The first step is to ask a question. In this step we must convert the need for information into an answerable question. The second step is to find the information or evidence required to answer the question. Basically, we must track down the best information looking in all different directions to answer this question. Step three involves critically appraising the evidence found. This step is very important because it checks the validity, impact, and usefulness in clinical practice of the question asked. In step four, integrating the critical appraisal with clinical expertise and with the patient’s situation is most important. In this step we include the value and circumstances of the question and situation. Last, but not least evaluation step or step five. Evaluating what was researched, the effectiveness and efficiency in the execution of steps one through four. This step allows us to seek out ways to improve the both for the next time a question is ask.

Topic Search.

Evidenced based practice in nursing was easy to search for in all databases available.  Science Direct is an oddball for most people but I love it. The articles are easy to find, always peer reviewed, and straight from nursing journals. This detail narrows the search on the front in. CINAHL has everything anyone would need and many more articles than most sites. Limiting the key phrases of what one would be looking for is key in these searches.

EBP Models.

A number of EBP models have been developed; many appear very different from each other. Some of these models are more useful in some contexts than others, and each has advantages and disadvantages. The Iowa model of EBP was developed as a model to promote quality care. It has been used in multiple academic and clinical settings (Murphy, Staffileno, & Foreman, 2018). This model blends quality improvement with research utilization in a setting that nurses find understandable. The Iowa model uses “triggers” of EBP, which makes the model unique to the others. The Johnson Hopkins model was developed to ensure that current research findings were incorporated into patient care. This model reflects upon using three domains: nursing practice, education, and research. The core component for decision making must reflect in these three domains (Murphy et al., 2018). The process for choosing a model for a facility is almost the same as following and researching EBP. It is chosen through research and evidence.

Conclusion.

The profession of nursing traditionally has considered direct, hands-on patient care to be its priority. Hands-on care may be becoming secondary, however, to the increasingly cumbersome, time-consuming demands for documentation of nursing care. The study process highlighted the urgent need for a new culture that values EBP. Without this culture shift, direct patient care tasks cannot be best practice. The EBP process must become the standard for “thinking at the bedside.” This involves identifying patient problems when they arise; asking searchable, answerable questions; discovering valid evidence to answer the questions; and working with other members of the healthcare team, including the EBP mentor, to develop, implement and evaluate innovative practices based on the best available evidence (Melnyk et al., 2014).

References

• Melnyk, B. M., Gallagher- Ford, L., Long, L, E., & Fineout Overholt, E. (2014). The establishment of evidenced-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldview on Evidence- Based Nursing, 11, 5-15. https://doi.org/10.1111/wvn.12021
• Murphy, M. P., Staffileno, B. A., & Foreman, M. D. (2018). Research for advanced practice nurses: from evidence to practice. New York, NY: Springer Publishing Company, LLC.
• Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
• Schaffer M.A., Sandau K. E. & Deidrick L. (2013) Evidence- based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing 69 (5), 1197-1209. doi: 10.1111/j.1365-2648.2012.06122.x

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