Evidence-based practice is at the center of many conversations about professional advancement for clinicians — from the Twitter hashtag #NoJournalNoEBP to debates about whether it’s a fad that only further overwhelms overstaffed nurses.
For a recent op-ed on NursingCenter.com, the editor-in-chief of the American Journal of Nursing, Shawn Kennedy, MA, RN, FAAN, discussed the pros of EBP and how it improves outcomes. (Just look at Florence Health’s namesake, Florence Nightingale, who used evidence-based practice during the Crimean War when she began sanitizing hospitals after noticing a connection between mortality rates and unclean conditions.)
While it seems like applying EBP is straightforward, there are ways it benefits your work that you might not realize. To better understand the nuances of EBP, we chatted with Kennedy about the role of research in healthcare.
Evidence-based practice saves time.
Most importantly, EBP empowers nurses and other clinicians to no longer waste their time on activities that have no known benefit for patients. “I hear nurses say ‘I don’t have time for evidence based practice because I’m so busy,'” Kennedy says. “It actually helps because you’re not spending time doing stuff you don’t need to.”
One of the biggest time-sucks that EBP eliminated is bathing patients and changing their dressings on a daily basis. For decades, nurses spent up to 20 minutes doing so for each of their patients. But research eventually revealed that removing adhesive tape that often can cause skin irritation, and daily baths don’t effect outcomes unless patients have heavily perspired or soiled themselves.
Evidence-based practice has changed and will continue to change your daily routine.
Kennedy outlines a whole series of nursing responsibilities that EBP evolved. One of the first was instilling saline into endotracheal tubes in order to loosen and help remove secretion. It turns out this process didn’t actually affect the secretion, and it just made patients cough and gag.
Similarly, the evidence indicates that the frequency with which you take a patient’s vital signs should be decided on an individual basis. At least once a shift is standard, Kennedy explains, but someone in an unstable position might need it every five minutes. “Best practice is you assess the patient,” she adds. “It’s what does the patient need to make sure you’re providing safe care?”
Before EBP, people just “did things.”
Kennedy has immersed herself in nursing research starting with when the American Journal of Nursing was founded in 1900, and she noticed how much of nursing practice wasn’t supported by any evidence and instead was “what people thought would be helpful.”
Often a new technology would be introduced but relevant research would be lacking. For example, take neonatal monitoring, which has likely led to an increase in the number of C-sections in the U.S. Kennedy posits this is because practitioners have access to more information that might make them “a little nervous. People started implementing the technology without really thinking about whether it’s helping hurting.”
Evidence-based practice isn’t ONLY about the research.
A common misconception about EBP is that it only relies on studies, Kennedy says, cautioning that research populations often don’t reflect every or even most patients.
“It’s not just looking at the evidence and saying, ‘The research article says this,'” she explains. “It’s about what’s in the research, what you know about the patient and the patient’s preferences.”
And while Kennedy encourages nurses to regularly engage with research, she stresses that “one study shouldn’t prompt a huge change in practice. The associations are good fodder for nurses, but if they’re looking to evaluate their practice, they need to look at the studies themselves.”
Many APRNs have been more influential in improving outcomes than physicians.
Because EBP prioritizes the patient’s needs, a major tenet of nursing, it shouldn’t be a surprise that nurses have been at the center of the fight for EBP.
“Physicians were focused on the problem at hand and nurses were left to help the patient implement what they needed to do, so I think they saw more first hand how influential the patient’s life and culture are,” Kennedy explains, adding that nurses have the best sense of what works for patients because they’re the ones putting it in action.
It’s easier than you think to gain access to journals for free or low cost.
Many journals, AJN included, make their research free for the first month its available and then it often becomes free again later on, Kennedy says. In addition, AJN’s CE articles are free for two years. Medscape also offers full, free articles. Just make sure the publisher of the research you’re reading is approved by the International Academy of Nursing Editors, Kennedy adds.
Evidence-Based Practice: Something to Celebrate (Really!), NursingCenter.
Last updated on 10/8/19.