Patient-Centered Care and Evidence-Based Practice. Patient-centered care is an important part of 21st century nursing care, as is evidence-based practice. In this lesson, we’ll explore both of these nursing core competencies in our framework for professional nursing.
Patient-centered care (also known as person-centered care; sometimes expanded to be called patient- and family-centered care) is an important concept in nursing today. Nurses using this type of care provide “knowledge, resources, and support” (Hood, 2018, p. 384) to patients and families to enable them to be participating members of the care team.
Joanne Disch, PhD, RN, FAAN, is chair of Chamberlain University’s Board of Trustees. Disch, along with colleagues Jane Barnsteiner and Mary K. Walton, wrote a book entitled Person and Family Centered Care. Dr. Disch was interviewed by Jennifer Bouchard of the Chamberlain blog team about this important nursing core competency. According to Dr. Disch, “patients want to play a role in their healthcare and become partners with clinicians. The fundamental core of nursing is to work with the patient, not for the patient” (Bouchard, 2014, para. 5).
Patients and families need to partner with nurses to help meet their continuing healthcare needs and improve outcomes. Patient and family education is part of patient- and family- centered care, but it is not the only part. When nurses use this important nursing core competency, patients and families are not passive recipients of care but are instead active participants in the process.
“The Nurse of the Future will provide holistic care that recognizes and individual’s preferences, values, and needs and respects the patient or designee as a full partner in providing compassionate, coordinated, age and culturally appropriate, safe and effective care” (Massachusetts Department of Higher Education Nursing Initiative, 2016, p. 10).
Evidence-Based Practice in Nursing
Florence Nightingale knew the value of science and research as she developed her theoretical foundation of nursing practice. Nursing research gained momentum in the second half of the 20th century as nursing theorists worked to develop models of practice based on fact and science rather than on tradition and opinion. Use of research is one of the criteria that helps to distinguish nursing as a profession.
Nurses often turn to each other for answers to complex care issues, rather than investigating the professional literature for a research-based answer. They may not have the skills necessary to find answers in the professional nursing research literature. The role of the BSN-prepared nurse includes being able to
- formulate a research question;
- search the professional nursing journal literature (in databases such as CINAHL);
- read and critically appraise research articles;
- interpret the meaning for colleagues; and
- implement the results into nursing practice.
The results of research supply evidence on which nursing practice is based (i.e., evidence-based practice, or EBP). Typically, research in a new area begins with individual, isolated studies. It takes several studies to produce a large enough body of evidence to significantly change nursing practice. Systematic reviews or meta-analyses examine the results of multiple studies to determine common themes that lead to the best practices that guide nursing today.
The quality of evidence may be ranked in a pyramid.
Identification of evidence and best practices results in the development of clinical guidelines to provide the best care to patients. The U.S. government has a growing repository of clinical guidelines (mostly medical, but nursing ones are being added) at the National Guideline Clearinghouse at http://www.guideline.gov/ (Links to an external site.)
Making decisions based on intuition and habit is being replaced with evidence based on research. EBP is never static. Interventions that were accepted practice 5 years ago may be replaced tomorrow by new research results. The professional nurse must become skilled at searching the professional literature for new evidence.
The role of the BSN-prepared nurse as scientist is to utilize evidence. You may participate in research, but typically the BSN nurse is not the lead researcher.
- How have you participated in nursing research?
- How do you want to participate in the future?
Using the PICO(T) Format
The well-written clinical question is the key to searching for evidence. If you ask the right question, with the right elements or key terms, this will aid your search for high quality, relevant research findings among the millions of studies that are stored in databases. If you ask a poorly constructed question, you are unlikely to effectively and efficiently find usable evidence.
The PICO(T) system helps us formulate a searchable clinical question. It organizes our thinking about the issues we or our patients face, and it focuses our attention on possible interventions to address these issues as well as desired outcomes that we hope will occur as the result of these interventions. PICO(T) is an acronym that represents the following.
P = Patient Problem (or Population)
I = Intervention
C = Comparison
O = Outcome
T = Timeframe (optional)
Click on each letter to view the PICO procedure for answering clinical questions.
P I C O
Let’s look at an example of a clinical question about an issue that nurses may ask about their patients’ care.
Question: In postoperative patients, does coughing and deep breathing every 4 hours guided by an RN compared to coughing and deep breathing every 4 hours PLUS the use of incentive spirometry hourly decrease the incidence of pneumonia?
This clinical question contains most of the elements we need to conduct a successful search. The PICO(T) elements are identified below.
P: Postoperative patients
I: Cough and deep breathe every 4 hours guided by RN
C: Cough and deep breathe every 4 hours PLUS use of incentive spirometry every hour
O: Number of cases of postoperative pneumonia that develop
T: The T is “silent,” which means it is not time-sensitive and, therefore, not identified in this question. This is the case for many clinical questions.
Questions and PICO(T)
Read the clinical question below, and identify the PICO(T) elements it contains.
In patients discharged from the hospital with a Foley in place, does group teaching (by RN) regarding bag emptying and urine measurement OR individual teaching on the same topic with return demonstration result in increased reports of patient comfort with these procedures?
- What is the P, or patient population?
- What is the I, or intervention?
- What is the C, or comparison?
- What is the O, or outcome?
What nursing research issues can you think of related to your area of practice?
Search versus Research
After formulating a PICO(T) question, a search of the professional nursing literature is the next step. CINAHL is an excellent database where nursing evidence and nursing literature are found, but there are others, too, that may be found in the Chamberlain Library. A general Internet search (such as a Google search) will not deliver scholarly nursing journal articles. Look for tutorials in the library to improve your search skills. Your skills in library navigation will be used in all future courses.
There is no need to perform an actual research study (experiment to compare interventions or a qualitative study) in order to benefit from evidence. Current evidence and best practices can be gleaned from reading published nursing research studies conducted by others that can be applied to your practice. These studies are found in scholarly professional nursing journal articles found in CINAHL.
Critical Appraisal of the Evidence
After locating articles containing evidence, the nurse “must appraise each research study by assessing its strengths and weaknesses” (Hood, 2018, p. 252). In nursing process terminology, critical appraisal of an article (or study) is the evaluation phase. “A thoughtful critique is based on critical thinking skills used to address the steps of the research process” (Kearney-Nunnery, 2016, p. 87).
How might nurses appraise/critique a research study/article?
This week, we have examined two competencies essential to expert clinical nursing care: patient-centered care and evidence-based practice. You have explored the method to find and appraise scholarly literature. You are on your way!
Test Your Knowledge on Patient-Centered Care and Evidence-Based Practice
Now let’s take a few minutes to check our learning from this week.