Nursing, and healthcare in general, has gone through tremendous changes in the past two decades. One of the greatest transformations regarding patient care has been the shift to evidence-based nursing care. Sometimes called evidenced-based practice, this model uses the latest research and historical evidence to implement improved care. This has already become a widely-used method, and it is also likely to remain an instrumental component of nursing care due to its ability to provide more favorable patient outcomes.
The Evolution of Evidence-Based Care
Evidence-based care–often attributed to Florence Nightingale–came into focus following a 1999 report by the Institute of Medicine (IOM), now called the National Academy of Medicine (NAM). The report found that as many as 98,000 people were dying each year due to preventable medical errors, costing the nation’s hospitals upwards of $29 billion per year. In response, the IOM issued a follow-up report titled Crossing the Quality Chasm: A New Health System for the 21st Century in 2001, which outlined 10 principles, including evidence-based practice. These principles were to serve as a guideline for transforming healthcare and reducing unnecessary medical errors.
The IOM recommends that providers use evidence-based care to make decisions, in which “patients should receive care based on the best available scientific knowledge [and] care should not vary illogically from clinician to clinician or from place to place.” Essentially, the goal was to standardize patient care across the nation using the most up-to-date research possible.
At the time, healthcare providers were slow to incorporate research from clinical trials into daily practice, taking an average of 17 years from the conclusion of a trial. The IOM called on the Department of Health and Human Services (HHS) to establish a program that would allow easier access to scientific findings and data for healthcare providers and patients. The Agency for Healthcare Research and Quality (AHRQ), part of the HHS, formed the National Quality Measures Clearinghouse (NQMC) and the National Guideline Clearinghouse (NGC) in response.
Each searchable database offers slightly different information. The NQMC provides interested parties with “specific evidence-based health care quality measures and measure sets” and the NGC offers “objective, detailed information on clinical practice guidelines.” Both databases help to disseminate this information so it can be employed in a more timely fashion.
A Valuable Approach
The establishment of easily accessible databases was just part of the transition to evidence-based nursing care. The 2010 IOM report also identified the importance of proper training for nurses and healthcare providers. This additional training recommendation also includes the call for 80 percent of RNs to have a BSN by 2020. After the report was released, college curricula shifted to focus on teaching the core elements of evidence-based practice.
The American Association of Colleges of Nursing (AACN) updated their core baccalaureate requirements for licensed nurses to reflect the changes as well. The guidelines list nine essential requisites, including the study of evidence-based practice. Specifically, universities with nursing baccalaureate programs were advised to teach students that “professional nursing practice is grounded in the translation of current evidence into one’s practice.”
In addition, the introduction and expanded use of electronic health records (EHRs) has simplified the use of evidence-based practice. As accessibility to clinical trial data has increased, nurses are able to incorporate the findings into practice much sooner. This improved quality of care often leads to better patient outcomes, fewer medical errors and greater patient satisfaction.
Evidence-Based Care in Practice
In daily practice, nurses follow a number of protocols that originally evolved from evidence-based practice. Through years of clinical usage and supported by empirical studies, these protocols have been proven to result in more favorable patient outcomes and have now become the widely-accepted standards of care. Examples may include the administration of vaccinations per the CDC’s vaccination schedule or the use of post-surgical ambulation to avoid complications such as pneumonia and deep vein thrombosis.
Nurses utilize evidence-based care in a number of settings, including but not limited to hospitals, physician offices, nursing homes, hospice, and rehabilitation and substance abuse facilities. The practice of conducting such care is the result of following a five-step process according to the AACN:
- Develop a researchable question.
- Search for the best evidence available and assess the strength of that evidence.
- Complete a critical analysis and synthesis of the evidence.
- Develop recommendations for practice.
- Evaluate the outcome of evidence-based practice changes.
Nurses can use the five-step process to evaluate issues affecting both nurses and patients. For example, nurses can implement it to reduce work-related injuries among nursing staff, prevent patient falls or reduce hospital-acquired infections. While these are just a few examples, researchers and clinicians can evaluate any identifiable issue or concern under the theory of evidence-based practice.
A Growing Trend
By all indications, evidence-based nursing care is here to stay, in large part due to the correlating increase in positive clinical outcomes. Thanks to technological advances, gathering and disseminating data has become much easier, allowing nurses and other healthcare providers to integrate it into patient care quickly. Online RN to BSN programs are incorporating evidence-based care coursework to ensure nursing graduates have the skills to offer their patients the best care possible.
Learn more about the UNM online RN to BSN program.
About – National Guideline Clearinghouse. (2015, June 18). Retrieved from http://www.guideline.gov/about/index.aspx
About – National Quality Measures Clearinghouse. (2015, June 18). Retrieved from http://www.qualitymeasures.ahrq.gov/about/index.aspx
Crossing the Quality Chasm: A New Health System for the 21st Century. (2001, March). Retrieved, from http://nationalacademies.org/hmd/reports/2001/crossing-the-quality-chasm-a-new-health-system-for-the-21st-century.aspx
Drenkard, K. N. (2013). Evidence-Based Practice. Retrieved from http://www.aacn.nche.edu/qsen/workshop-details/new-orleans/KD-EBP.pdf
Stevens, K. R. (2013, May 31). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. Retrieved from http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html
The Essentials of Baccalaureate Education for Professional Nursing Practice. (2008, October 20). Retrieved from http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf
To Err is Human: Building a Safer Health System. (1999, November). Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
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