Evidence-based practice protects against litigation.
Evidence-based practice (EBP) is a problem-solving approach that encompasses research, clinical expertise, and patient values and circumstances. Nurses should use information from these three components to make informed decisions that are in the best interest of their patients. Integrating EBP with your practice will improve patient care and reduce your risk for legal action.
The gold standard
Evidence-based practice is accepted as the gold standard for professional nursing practice because it improves patient outcomes. For example, the 2003 Institute of Medicine (IOM) report Health Professionals Education: A Bridge to Quality states EBP is a core competency for healthcare professionals, and IOM's 2010 landmark report The Future of Nursing: Leading Change, Advancing Health confirms EBP as a basic competency.
Additional support comes from general and specialty nursing associations. The American Nurses Association's Standards of Practice include the competency, "The registered nurse utilizes evidence-based interventions and treatments specific to the diagnosis and problem." Other competencies also mention the importance of evidence. Standards from specialty nursing organizations include EBP as well. For example, the American Association of Critical-Care Nurses' standard of professional practice related to research has this as its measurement criteria: "The nurse continually questions and evaluates practice and uses best available evidence or research findings to develop appropriate plans of care."
All this adds up to a consensus that EBP is a vital part of the profession. In a court case, an attorney will stress this fact while attempting to prove that you failed to engage in EBP. That's why your practice must be based on evidence, even though doing so can be challenging.
Barriers to EBP
A 2012 study published in the Journal of Nursing Administration found that only 34.5 percent of nurses agreed or strongly agreed that their colleagues consistently use EBP in managing patients. If EBP is so effective in improving outcomes, why don't more nurses practice it? The study found that although nurses believe in EBP, they encounter multiple barriers, with the top two being lack of time and lack of support from the organization where they work, including resistance from colleagues and managers.
The same study found that most nurses want to learn more about EBP but find education resources lacking. They also lack mentors to guide them.
Overcoming the time barrier
Fortunately, many resources are available to break the time barrier, particularly when it comes to collecting and evaluating the evidence. These resources include:
* Cochrane Database of Systematic Reviews (www cochrane.org), which provides analysis of available literature related to a topic (some information is available for free)
* Journals such as Worldviews on EvidenceBasedNursing and Nursing Research, as well as journals in your specialty practice area (requires a subscription)
* National Guideline Clearinghouse (www.guideline. gov), which provides summaries of clinical practice guidelines and has a tool that allows you to compare multiple guidelines (free access)
* Resources from specialty associations. For example, AACN Practice Alerts provides nursing actions related to a specific issue, such as assessing pain in the critically ill adult. The actions are backed by evidence found in the literature (free access).
* Joanna Briggs Institute (joannabriggs.org), which provides evidence reviews (some information available for free)
* U.S. Preventive Services Task Force (uspreventiveservicestaskforce.org), which provides evidence-based recommendations for preventive care (free access)
* Tools for appraising the evidence. Several scales are available to help you evaluate the evidence you find. You can link to these scales at http:// nursingworld.org/Research-Toolkit/Appraising-theEvidence.
An often overlooked but highly valuable resource is the medical librarian. A medical librarian at your facility, local university, or health center can guide you through the process of conducting a literature search so it's more efficient.
Overcoming resistance can be challenging. You can start by serving as a role model for others. Take the lead in suggesting practices that could benefit from a re-examination. For instance, is the acuity tool you currently use really the best one to ensure that assignments benefit patients?
Suggest your nurse practice council embrace EBP as a tool to improve patient care. Managers might choose to tap into clinical nurse specialists to serve as resources to staff who want to engage in EBP projects and build such projects into job descriptions and evaluations. Another option is to partner with a faculty member at a local university.
Overcoming a lack of knowledge
You don't need a large budget to gain knowledge about EBP. You can access free self-study programs online. For example, staff at Duke University Medical Center Library and the Health Sciences Library at the University of North Carolina at Chapel Hill developed an "Introduction to Evidence-Based Practice" tutorial, available online at http://guides.mclibrary.duke.edu/ content.php?pid=431451&sid=3529491.
For tips on interpreting the information you find, access the "How to read a paper" section of the BMJ website, which contains an article on how to read and interpret different types of research studies and includes two articles related to statistics (www.bmj. com/aboutbmj/resources-readers/publications/how-read-paper).
If your organization provides educational reimbursement, consider attending a workshop on EBP. Retain documentation of the courses you complete so you can show evidence of your efforts should you be involved in a lawsuit. The evidence will also be helpful for career advancement.
Staying on top of developments in your field helps ensure you are aware of the latest research. You can use technology to make the process easier. For example, services such as Feedly (www.feedly.com) let you customize feeds of news stories related to your interest areas. You can easily scan the headlines and short descriptions to determine if you want to learn more. Other options you might want to try:
* Sign up to receive electronic tables of content from journals you are interested in. You can scan the table of contents to determine what's of interest to you.
* Subscribe to electronic newsletters such as those provided by Medscape or SmartBrief.
* Listen to podcasts as you exercise or drive to work.
* Download an app such as Mendeley (www. mendeley.com) that lets you capture articles as PDFs and organize them according to keywords and other parameters.
Taking just these few steps can ensure that you are current in your evidence-based knowledge.
Steps of evidence-based practice
Here are the basic steps of EBP:
* Cultivate a spirit of inquiry.
* Ask the clinical question in PICOT (Patient population, Intervention or Issue of interest, Comparison intervention or group, Outcome, and Time frame) format.
* Search for and collect the most relevant best evidence. This includes searching for system-atic reviews and meta-analyses.
* Critically appraise the evidence for its validity, reliability, and applicability.
* Integrate the best evidence with your clinical expertise and patient preferences and values in making a practice decision or change.
* Evaluate outcomes of the practice decision or change based on evidence.
* Disseminate the outcomes of the EBP decision or change. Source: Melnyk BM, Fienout-Overholdt E. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice, 2nd ed. Philadelphia: Lippincott, Williams & Wilkins; 2010.
Basing your practice on evidence will benefit your patients by ensuring optimal outcomes. It will also benefit you by providing support for your decisions should you find yourself in the uncomfortable position of being named in a legal action.
American Association of Critical-Care Nurses. Standards for acute and critical care nursing practice. http://www.aacn.org/wd/practice/content/standards.for.acute.and.ccnursing. practice.pcms?menu.
American Nurses Association. Nursing: Scope and Standards of Practice, 2nd ed. American Nurses Association: Silver Spring, Md. 2010.
Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. October 5, 2010. http://www.iom.edu/Reports/2010/The-future-of-nursing-leading-change advancing-health.aspx.
Institute of Medicine. Health Professions Education: A Bridge to Quality. April 18, 2003.
http://www.iom.edu/reports/2003/health-professions-education-a-bridge-to-quality.aspx. Melynik BM, Fienout-Overholdt E, Gallagher-Ford L, Kaplan L. The state of evidencebased practice in US nurses: critical implications for nurse leaders and educators. J Nurs Admin. 2012; 42(9):410-417.
Melnyk BM, Fienout-Overholdt E. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice, 2nd ed. Philadelphia: Lippincott, Williams & Wilkins; 2010. Saver C. Keeping practice knowledge current. Part 1. Nurse Pract. 2012; 37(12):1-5.
This risk management information was provided by Nurses Service Organization (NSO), the nation's largest provider of nurses' professional liability insurance coverage for over 650,000 nurses since 1976. The individual professional liability insurance policy is administered through NSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to email@example.com or call 1-800-247-1500. www.nso.com.
Jennifer Flynn, BA
Manager, Healthcare Risk Management
Nurses Service Organization (NSO)
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