Evidence Based Recommendations in Primary Care Essay
Evidence based practice is a complex experience that requires synthesizing study findings to establish the best research evidence and correlate ideas to form a body of empirical knowledge (Burns & Grove 2007). There are many definitions but the most commonly used is Sackett et al (1996). Sackett et al (1996) as cited in Pearson, Field, & Jordon, (2007) describes evidence based practice:Evidence Based Recommendations in Primary Care Essay
“the conscientious, explicit and judicious use of current best available evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical experience with the best available external evidence from systematic research”. (Sackett et al 1996 page 5).
The author will discuss the importance of evidence for practice, different types and levels of evidence. The research process, dissemination of evidence, barriers and will conduct a critique of two research articles.
The importance of evidence based practice is to enable nurses to provide high quality care, improve outcomes for patient and families and to run a more efficient health service. Therefore other agencies within the health service will benefit when interventions and care is based on research (Burns & Grove 2007). According to the Nursing and Midwifery Council (NMC) code nurses are accountable to society to provide a high quality of care so therefore it is important that nurses reflect, evaluate the care and keep abreast of new knowledge and evidence that is available (Burns & Grove 2007). Providing a streamlined service, which is cost effective and based on current evidence based practice has shown to reduce cost but also to enhances the quality of care the patient receives (Melnyk et al2010). Working in partnership with the nurse the patient is able to participate in decisions about their care. This is not only beneficial for the patient but also increases the satisfaction of the nurse treating the patient (Craig & Smyth 2007). Furthermore Craig & Smyth (2007) suggests evidence based practice is a problem-solving approach to the delivery of health care. In using a problem solving approach the nurse is able to integrate clinician expertise and patient preferences to provide individualized care suitable for the patient.Evidence Based Recommendations in Primary Care Essay
To acquire knowledge in the past, nurses have relied on decisions based on trail or error, personal experience, tradition and ritual. Parahoo (2006) suggests learning by tradition and ritual are important means of transferring knowledge, for example learning the ward routine. According to Brooker and Waugh (2007) Students learn from effective colleagues who practice safety and on the basis of best evidence. However, a disadvantage of this method of learning may lead to transmission of invalid information and may put the patient and nurse at risk (Brooker & Waugh 2007). According to Burns and Grove (2007) to generate knowledge a variety of research methods are needed. The two different research methods are quantitative and qualitative. According to Burns and Grove (2007) quantitative research is an objective formal systematic process and demonstrates its findings in numerical data. According Munhall (2001) qualitative research is gathering information to describe life experiences through a systematic and subjective approach and does not use figures or statistics to produce findings. In nursing practice the quantitative approach has been considered to provide stronger evidence than qualitative (Pearson, Field, & Jordon, 2007). Pearson, Field, & Jordon (2007) suggest health professionals and servicer users require a variety of information to facilitate change and to include evidence not only of effectiveness but feasibility, appropriateness and meaningfulness to achieve evidence based health care practice.
Evidence based practice promotes the application of research evidence as a basis on which to make health care decisions so it is important to search for the truth and knowledge logically. Robust research which may draw on expertise and experience represent a higher level of evidence because of the discipline involved (Burns &Grove 2007). There are thirteen steps in the quantitative research process and one step gradually builds on another (Burns & Grove2007). The beginning of the research process starts with a problem which usually highlights a gap in knowledge (Melnyk & Fine-Overholt 2005). The next step is the purpose of the research. This is produced from the problem and identifies the aim of the study (Burns & Grove2007). To build a picture up of what is known or not known about the problem a literature review is conducted. This will provide current theoretical and scientific knowledge about the problem and highlight gaps in the knowledge base (Burns & Grove 2007). This is followed by the study framework and research objectives, questions and hypotheses. This continues to the end till all the steps are covered. The final step is the research outcome.Evidence Based Recommendations in Primary Care Essay
Hierarchy of evidence is generated from the quality of information from different evidence. Practitioners are able to use the hierarchy of evidence to inform them on which information is most likely to have the maximum impact on clinical decisions (Leach 2006). Leach (2006) suggests hierarchy of evidence may be used to discover research findings that supersede and invalidate earlier accepted treatments and change them with interventions that are safer, efficient and cost-effective. If findings from a controlled trial are inadequate, choices should be guided by the next best available evidence (Leach 2006).
According to Scottish Intercollegiate Guidelines Network (SIGN 2009) the revised grading system is planned to place greater weight on the quality of the evidence supporting each recommendation, and to highlight that the body of evidence should be considered as a whole, and not rely on a single study to support each recommendation. The grading system currently in use with the SIGN guidelines starts with 1++ and ends in 4. For the evidence to be rated at 1++ it must include a high quality meta-analyses, systematic reviews of random controlled trails (RCT) or RCT with a low risk of bias. Level 4 is based on expert opinion (SIGN 2009).Evidence Based Recommendations in Primary Care Essay
There are many barriers to implementing evidence based practice. One of the common barriers is staff information and skill deficit. Health professionals lack of knowledge in regarding results of clinical research or current recommendations may not have the sufficient technical training skill or expertise to implement change (Pearson, Field, & Jordon 2007). Nurses have also highlighted lack of time as a barrier in applying research to practice. As the number of patients increases nurses face the challenge of providing safe, high-quality care within a short time frame. Nurse educators and researchers have developed a “toolkit” to ease the implementation of evidence based practice into nursing (Smith, Donez & Maghiaro 2007).Evidence Based Recommendations in Primary Care Essay
According to Gerrish and Lacey (2006) dissemination is a process of informing people about the results of a particular research. There are many ways to present results, video, seminars and the most accepted is through professional journals. However with the internet being more asses sable the researcher is able to post details on the website hosted by NHS trust or university. One disadvantage in using the internet is that it provides no guarantee of quality (Gerrish & Lacey 2006). SIGN guidelines are circulated free of charge throughout Nation Health Service (NHS) Scotland. For this to happen they must be made widely available as soon as possible to facilitate implementation. Furthermore guidelines on their own have proved ineffective and more likely if they are disseminated by active educational intervention and implemented by patient-specific reminders relating directly to professional activity (SIGN 2009).
EBP is now considered essential to the delivery of quality nursing care and has been utilized in everything from hand hygiene to dress code. It connects clinical decision-making to the best current evidence, clinical expertise and patient preference. The purpose of EBP is to reduce variations in practice and standardize healthcare.
As healthcare continues to shift from volume-based to value-based, EBP is becoming even more critical. Baccalaureate-trained nurses are expected to know more than ever about problem-solving and best practices to support patient safety and healthy outcomes.
“Nurses arguably spend more time with the patient than anyone else in healthcare,” said Chief Nursing Officer Christina Dempsey for the patient satisfaction consulting firm Press Ganey. “As such, they are not only the gatekeepers, they are the ‘thin white line between patient safety and both the patient experience and sub optimal outcomes — much like police officers are the thin blue line between anarchy and order.”
The Institute of Medicine (IOM) set a goal of 90 percent of all healthcare practice to be evidence-based by 2020. As the United States moves toward the goal, nurses are at the forefront of implementing this evidence-based practice in healthcare. Key to this effort are registered nurses (RNs) who earn Bachelor of Science in Nursing (BSN) degrees and work in direct patient care.Evidence Based Recommendations in Primary Care Essay
Origins of Evidence-Based Practice
Historians have linked the earliest use of evidence-based practice to Florence Nightingale and her treatment of sick and injured soldiers during the Crimean War in the 1850s. Among her important insights were connecting poor sanitary conditions and the death rate of wounded soldiers.
In the 1970s, British researcher Archie Cochrane published Effectiveness and Efficiency: Random Reflections on Health Services, which criticized the lack of credible evidence behind many commonly accepted healthcare interventions. Cochrane became widely known as the father of EBP. In the 1990s, Dr. Gordon Guyatt, an internal medicine specialist, coined the term evidence-based medicine.
Models of EBP
In the past two decades, researchers have created dozens of EBP theoretical models and frameworks to help educators and clinicians advance the science behind EBP and facilitate changes. In general, all of the models follow the same basic structure:
- Identify the problem
- Review and analyze research that addresses the problem
- Evaluate the need for change and potential barriers
- Consult with stakeholders who will support the practice change
- Implement the change
- Evaluate outcomes
Because no single model meets the needs of all healthcare settings, several are commonly used in nurse-led research for quality improvements to healthcare. The most commonly used models are adaptable to a variety of environments:Evidence Based Recommendations in Primary Care Essay
Evidence-Based Practice 101
The foundations of evidence-based practice in medicine can be traced to the work of British epidemiologist Archie Cochran e in the 1960s and 1970s. Cochran’s promotion of the use of scientific studies to direct practice led to the Cochran Database of Systematic Reviews. The movement gained ground in the 1980s and 1990s, due in part to the advent of readily available computer databases that made accessing health care research easier. Crystal Bennett, DNSc, RN, identifies five basic steps in the practice of evidence-based medicine: formulation of a clinical question; gathering the best evidence to address the question; critical evaluation of the best evidence; merging evidence with the clinician’s own experience, the patient’s condition, available resources and the patient’s preferences and values to come to a clinical decision; and evaluation of the result of implementing the evidence in order to determine practice change.
Benefits for Patients
Providing the best possible patient care is the hallmark of nursing practice. Evidence-based practice allows nurses to direct patient care according to scientific research, including randomized controlled trials, patient care studies and compiled patient data, relying on nursing interventions that have proven successful in the past with similar patient populations. “Patients and families receive more consistent nursing interventions and achieve better clinical outcomes. Patients fall less often and suffer from fewer pressure ulcers,” writes Debra Wood, RN, for Nurse Zone.
Benefits for Health Care
The health care industry’s embrace of evidence-based practice as health care costs continue to rise is not coincidental. Evidence-based practice across the health care spectrum often results in better patient outcomes — meaning fewer demands on health care resources — and lowered health care costs. Wood cites as an example the traditional nursing practice of instilling normal saline before suctioning a mechanically ventilated patient. “Now, nurses know that the saline offers no benefit and just wastes time and supplies,” Wood writes.Evidence Based Recommendations in Primary Care Essay
Benefits for Nurses
The benefits of evidence-based practice for patients and healthcare do not, fortunately, come at a cost for nurses. Rather than referring to outdated academic texts or facility traditions to make decisions about patient care, evidence-based practice allows nurses to contribute research to the science of nursing and apply the most recent research and practices while discarding unproven methods. It also provides something just as important — a sense of authority in practice. “Nurses who embrace evidence-based practice feel empowered and enjoy a greater satisfaction with their care giving role,” Wood writes.
Throughout the years, nursing has evolved — both in the way nurses provide patient care and the way they are educated. Over the past few decades though, evidence-based practice has emerged as the gold standard of care and greatly influenced Bachelor of Science in Nursing (BSN) coursework.
What Is Evidence-Based Practice?
Evidence-based practice (EBP) is a patient-centered approach founded on independent scientific research, clinical expertise and patient experiences. Nurses and other healthcare providers who utilize this approach must consider the most recent healthcare research when determining the course of care and treatment.
The field of nursing earned recognition as an applied science in the 1960s, and research efforts intensified. The accumulation of research may have led to increasing knowledge levels; however, healthcare leaders began to express concern at the widening gap between the ideal healthcare environment and what patients were actually experiencing. Moreover, they were worried that the growing amount of scientific background and research was not being transferred and applied consistently to clinical patient care, thereby failing to meet the goal of improved and consistent outcomes.Evidence Based Recommendations in Primary Care Essay
In response, the Institute of Medicine (IOM) — which changed its name to the National Academy of Medicine (NAM) in 2015 — issued Crossing the Quality Chasm: A New Health System for the 21st Century in 2001. This report noted prior research that indicated the current system was causing preventable harm. It also reiterated the need for uniformity across the healthcare system to ensure that all patients were receiving the highest quality of care no matter where they sought treatment. To reach that goal, it was theorized that incremental changes would not be enough — a complete overhaul would be necessary. One of the recommendations was to implement EBP.