EBP:Definition & Explanation As I go through my research regarding evidence-based practice and its importance to my profession, I came to encounter different authors who had stated numerous definitions and explanations for the term. One definition that succinctly captures the essence of evidence-based practice (EBP) is that of Ingersoll’s (2000). She defines EBP as, “the conscientious, explicit, and judicious use of a theory-derived, research-based information in making decisions about care delivery to individuals or group of patients and in consideration of individual needs and preferences”.
This means that EBP is a process involving the examination and application of research findings or other reliable evidence that has been integrated with scientific theories. For nurses to participate in this process, they must use their critical thinking skills to review research publications and other sources of information. After the information is evaluated, nurses use their clinical decision-making skills to apply evidence to patient care. As in all nursing care, patient preferences and needs are the basis of care decisions and therefore essential to EBP.
In general, the term “EBP” describes a model of care whereby nurses, using current evidence on research knowledge, make decisions using clinical expertise and patient preferences to guide patient care. The University of Minnesota (2001) has on their web site the following definition of evidence-based care: ”Evidence Based Nursing is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and the health care preferences of their clients”.
Although EBNP may be based on factors other that research findings, such as patient preferences and the expertise of clinicians, the aim of EBNP is to provide the best possible care based on the best available research. Examples: EBP is nothing new to nurses. Florence Nightingale, through her use of meticulous record keeping and data analysis, was able to demonstrate that mortality rates decreased when sanitary methods were improved. By using the data she had gathered, Nightingale was able to develop interventions that, when applied to medical and surgical patients, reduced mortality rates due to unsanitary conditions.
Another example is the way of verifying the placement of a nasogastic tube. The traditional method for verifying the placement of a nasogastric tube was air insufflation. However, according to current nursing research, the accurate method for verifying placement is radiologic examination (Metheny & Titler, 2001). Characteristics As stated earlier, EBP de-emphasizes clinical decision-making based on custom or ritual, integrates the best available research evidence with other sources of data, including clinical expertise and patient preferences.
Furthermore, EBP relies on rigorous integration of research evidence on a topic through integrative reviews, which are rigorous, systematic inquiries with many similarities to original primary studies. EBP typically involves weighing various types of evidence, and often an evidence hierarchy is used to rank studies and other information according to the strength of evidence provided. EBP also possess characteristics such as objectivity and accessibility.
Evidence-based practices eliminate subjective professional judgment when developing appropriate plans of action and it is readily available to the public via public research and studies, making it possible for patrons of the chosen service to assess whether the institution does indeed follow evidence-based practices geared toward bringing about the desired results. Research Utilization The terms research utilization and evidenced-base practice are sometimes used synonymously. Although there is overlap between the two concepts, they are in fact, distinct.
Research utilization (RU), the narrower of the two terms, is the use of the findings from a disciplined study or set of studies in a practical application that is unrelated to the original research. In projects that have had research utilization as a goal, the emphasis is on translating empirically derived knowledge into real-world applications. EBP involves making clinical decisions on the basis of the best possible evidence. Usually, the best evidence comes from rigorous research, but EBP also uses other sources of credible information.
In the words of Burns and Grove (2005), RU was described as “the process of synthesizing, disseminating, and using research-generated knowledge to make an impact on or a change in the existing practices in society”. EBP is viewed as broader in scope than RU. Burns and Grove wrote that “EBP ensures the implementation of quality, cost-effective care to promote positive outcomes for patients, providers, and health care agencies”. EBU compasses not only evidence based on scientific findings but also evidence based on expert clinical opinion and patient and family preferences.
The definitions stated above simply means that RU starts with a research-based innovation that gets evaluated for possible use in practice. EBP starts with a search for the best possible evidence for a clinical problem, with emphasis on research-based evidence. An example of research utilization is that we no longer routinely irrigate urinary drainage systems or clamp and disconnect the tubing when the patient ambulates since research has demonstrated that interrupting the closed system increases the likelihood of a urinary tract infection. Guidelines to EBP
Rosswurm and Larrabee (1999) proposed a model for guiding nurses through a systematic process for the change to evidence-based practice. This model recognized that translation of research into practice requires a solid grounding in change theory, principles of research utilization, and use of standardized nomenclature. The model has the following six phases: •Assess the need for change in practice. •Link the problem with interventions and outcomes. •Synthesize the best evidence. •Design a change in practice. •Implement and evaluate the practice. •Integrate and maintain the practice change.
