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Evidence Based Nursing Introduction

What is Evidence Based Nursing?

Definitions of evidence based nursing have varied in scholarly literature.  Scott & McSherry's extensive literature review looked at commonalities between EBN definitions and synthesized them to come up with the following definition: 

"An ongoing process by which evidence, nursing theory and the practitioners’ clinical expertise are critically evaluated and considered, in conjunction with patient involvement, to provide delivery of optimum nursing care for the individual."

Why Evidence Based Nursing?

Evidence-based nursing is one approach that may enable nurses to manage the explosion of new literature and technology and ultimately may result in improved patient outcomes.

Nursing students spend a great deal of preclinical preparation time designing care plans, reviewing pathophysiology, and memorizing pharmacologic interactions. Although these activities are useful, they cannot be the only methods of preparing students for nursing practice.

Sole reliance on textbooks and expert faculty knowledge does not promote the critical thinking skills that nurses must have to survive in the current fast paced clinical settings. Students must learn to develop independent, evidence-based methods of clinical decision making. Both medical and nursing professionals have explored this change in healthcare practice, research and knowledge development, a paradigm shift called "evidence based practice".

Evidence based practice (EBP) "involves an ability to access, summarize, and apply information from the literature to day-to-day clinical problems". Evidence based practice "requires an emphasis on systematic observation and experience and a reliance on the research literature to substantiate nursing decisions." Evidence based practice allows practitioners to meet a daily need for valid information about clinical situations.

Evidence based practice allows nurses to enrich their clinical training and experience with up to date research. With the large amount of research and information that exists in nursing, learning the skills of evidence based practice allows nurses to search for, assess, and apply the literature to their clinical situations.

Quotations from: Kessenich CR, "Teaching nursing students evidence-based nursing." Nurse Educator, Nov/Dec 1997, 22(6): 25-29.

Further Reading: 
Royal J, Blythe J. "Promoting research utilisation in nursing: the role of the individual, organisation, and environment." Evidence-Based Nursing July 1, 1998; 1(3): 71-72.

How is EBN different from Evidence Based Medicine?

Evidence based medicine is defined as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."

Quotation from: Sackett, David L, et al. "Evidence Based Medicine: What It Is and What It Isn't." BMJ 1996; 312: 71-72.

Both EBM and EBN fall under the umbrella of evidence based practice.  However, nurses' approach to evidence based practice may differ from the standard biomedical model. Typically, nurses are committed to providing holistic care; treating and working with patients rather than working on them. Effectiveness of treatment is only one part of the clinical decision-making process: in deciding on therapeutic interventions, acceptability to the patient and cost-effectiveness are considered.

McSherry, Robert, (ed.) Evidence-informed nursing : a guide for clinical nurses. London ; New York : Routledge, 2002. pg.7

Isn't EBP Just "Cookbook" Medicine?

Some clinicians have expressed apprehension about the use of evidence-based practice, concerned that EBP is just "cookbook" medicine. However, Evidence Based Practice does more than just identify research, it integrates the best possible evidence with individualized patient care. Clinicians using evidence based practice do not simply "follow a recipe", but use their own clinical experience and apply the evidence to the specific clinical situation. The DiCenso article addresses other questions that clinicians may have regarding EBP.

In recent years, the opposite phenomenon has been observed, and some nurses sing the praises of evidence based nursing without really understanding what the term entails.  Read the article by Jennings and Loan for more details.

Further Reading:
DiCenso A, Cullum N, Ciliska D. "Implementing evidence-based nursing: some misconceptions" [editorial]. Evidence-Based Nursing 1998 Apr;1:38-40.

Jennings B.A., & Loan L.A.  "Misconceptions Among Nurses About Evidence-Based Practice." Journal of Nursing Scholarship 2001; 33(2); 121-7.

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