It is first important to realize that the term practice is not solely linked to patient care. Rather, the term refers to all areas in which nurses may be found within the diverse settings of healthcare. Nursing practice includes (but is not limited to) education, executive, informatics, healthcare policy, safety, and so on. This means that evidence-based “practice” is applied to all areas of nursing practice.
Consider the following classic diagram that presents the elements composing EBP.
Evidence Based Practice
Citation: Adapted from Melnyk, B. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3 rd ed.). Philadelphia, PA: Wolters Kluwer.
Notice that EBP is the only area where the three elements overlap—to demonstrate EBP, the practitioner must use all of the elements at the same time. EBP represents an integration of research evidence, expertise, and patient values. Using this model will foster decision-making that produces holistic, person-centered care.
However, the above model focuses on patient care and many of us practice areas other than clinical areas with direct patient care responsibilities. So can the EBP model work for other practice areas? Remember, “practice area” refers to more than a clinical setting!
How Is EBP Linked to the Spirit of Inquiry and Research?
EBP is more than facts! Within nursing and healthcare there is an accepted spirit of inquiry. The nurse in advanced practice is continuously seeking new information, but the quality of the information must be determined and then used. When working within healthcare, information is always tempered in its application by considering the person (or persons) that the information is applied to. Equally important is to flavor the decision-making with the expertise of the advanced practice nurse.
The spirit of inquiry frequently focuses on clinical outcomes, the driving focus is often quality improvement (QI), where the intent is to improve outcomes. An interesting aspect is the relationship between QI and EBP. A project that initially focuses on QI may identify a concern that, in the spirit of inquiry, the participants may develop a PICO question resulting in new information that is used as part of EBP. A PICO question is said to be an answerable EBP question. PICO stands for: Patient, Population or Problem, Intervention, Comparison and Outcome. A PICO question frames the problem and supports the retrieval of evidence by identifying key search terms (Dang & Dearholt, 2018). The key is translation of information, results, and facts into the practice setting so that nursing practice is improved resulting in improved patient outcomes.
However, barriers to evidence-based practice need to be removed. A few of the barriers include, but are not limited to:
- lack of knowledge or experience with EBP and its steps
- lack of knowledge or confidence in reviewing research articles
- resistance to change within the culture of the organization
- peer pressure to continue with practices because “this is the way we have always done it.”
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