The influence and challenges of evidence based practice in nursing

The influence and challenges of evidence based practice in nursing

Evidence based nursing

According to the Encyclopedia of Nursing Research, "evidence-based practice (EBP) refers to nursing practice that utilizes research findings as the foundation for nurses' decisions, activities, and interactions with clients" (2006, p. 183). [Melnyk, 2004]

Evidence based nursing has been defined as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett et al., 1996, p. 71). The practice of evidence based nursing requires the clinician to integrate “individual clinical expertise with the best available external clinical evidence from systematic research” (Sackett et al., 1996, p. 71).

Steps Involved in Evidence based nursing

Sackett et al., argued that there were no particular methodological constraints on the research studies that could inform evidence based nursing. Although randomised trials and meta-analyses are regarded as the gold standard of medical research, other types of investigation such as cross-sectional and patient follow-up studies could be equally useful, and relevant evidence might sometimes be found in the basic sciences such as genetics or immunology. Similarly, the American Association of Colleges of Nursing (AACN), in its “position statement on nursing research”, emphasises that nursing research provides the scientific basis for the practice of nursing, and that research methods based on multiple philosophical and theoretical paradigms are appropriate to study phenomena relevant to nursing (American Association of Colleges of Nursing, 1998). Nursing research can be classified into clinical research, health systems and outcomes research and nursing education research (American Association of Colleges of Nursing, 1998). Across these three categories research results and methods from a wide range of disciplines, such as biology, physiology, pharmacology, psychology, sociology, management studies and economics, can be used to inform nursing research.

Nursing is an essentially practical discipline. The debates in this field focus on how to bring the best available research evidence to bear on the day-to-day patient care problems faced by nurses. How does one give nurses greater access to research evidence, then how does one ensure that the evidence is correctly used in nursing practice, and what barriers are to be overcome in bringing this about? There is a consensus that EBP, although not an entirely unproblematic concept, is desirable. Nursing deals with multifactorial health problems upon which light can be shed by many fields of research, and research methods must be pluralistic. Although at first sight nursing might seem to be a quite different field of investigation to management, at closer viewing the parallels are striking-notably, that management is an essentially practical discipline that deals with multifactorial problems, draws inspiration from many fields, and is methodologically pluralistic.

Implications And Challenges

EBP in nursing is currently high on the political and professional agendas (Gagan and Hewitt-Taylor, 2004). For example, the British National Institute for Health and Clinical Excellence (NICE)-a National Health Service agency created to produce guidance on public health, health technologies and clinical practice-explicitly espouses an evidence based approach (Kelly et ...