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EBP Techniques

Question:

How does evidence based practice improve patient outcomes?  How is evidence based practice applied theoretically and clinically?

Healthcare and medical facilities around the world carry out research in order to provide the best possible care to their patients. New research not only adds new knowledge to the existing literatures on health care but also helps to provide state of the art medical facilities for the patients. The objective behind these research works is to help the doctors and the nurses to provide suitable and effective treatment to the patients (Bowling, 2014).

In the recent times, nurses not only provide care using the best techniques, but also adapt other innovative techniques supported by substantial research. One such technique is “Evidence Based Practice” (EBP). The objective of EBP is to implement the current research in providing the best care and treatments to the patients (Stevens, 2013).

The purpose of this position statement is to describe the importance of evidence based nursing practices and how these practices affect patient outcomes. It also describes its application in theoretical and clinical practice. It also provides the complexities or limitations associated with these practices.

EBP is a nursing technique that is gaining popularity at a rapid rate due to its ability to provide better clinical care and overcome patient issues effectively. EBP marks the transition from traditional nursing techniques to more advanced techniques backed by significant research. EBP not only improves the level of patient care but also helps the nurses in making effective decisions during patient care.

The emergence of EBP dates back to the 1990s when there was a development of evidence-based medicine. The main points that describe the reasons behind the emergence of EBPs are: (1) A gap between research and practice, (2) Poor quality of several research works, (3) Overload of Information and (4) Non-evidence based practices.

A significant gap between up to date research and nursing practices led to the development of EBP in nursing . Previously nursing practices were based on knowledge from textbooks read during trainings, knowledge from seniors, from previous experiences and commonly utilized practices (Tabak et al., 2012).

Many research works are based on poor evidence and do not meet the gold standards of control trials. They are not applicable for implementation in nursing practices.

A large number of researches create confusion among practitioners because of their inability to distinguish between reliable and not so reliable research works.

Reasons for Emergence of EBP

Implementations of practices not backed by proper evidences are harmful for patients and are mostly ineffective as well.

According to the Nursing and Midwifery Board of Australia (NMBA), EBP enables the nurses to access and analyze various researches for providing modern, effective and quality care to the patients (Schneider & Whitehead, 2013). EBP provides them with thorough knowledge about the modern practices. It also helps them to carry out nursing interventions that comply with gold standards, regulations and guidelines. It helps them in making quick decisions, which are accurate, and helps them in planning the course of the interventions for the patient. Researches were carried out to determine the patient outcomes of standard nursing practices and evidence based nursing practices. Such research revealed that patients treated by EBP doctors had a reduced mortality rate compared to those treated by doctors following standard practices. The length of the patient’s stay in the hospital subjected to EBP was also reduced compared to those subjected to standard practices. The performance of the EBP doctors also increased compared to the doctors following standard practices. EBP doctors also attended their patients twice as many times compared to the standard practice following doctors (Emparanza, Cabello & Burls, 2015).


Implementation science has paved the way for the development of EBP. Various models, theories and frameworks are present in implementation science that enables better selection of approaches, interventions and their application in research as well as practices in order to merge the gap between them (Nilsen, 2015). The theory-based approaches in evidence/intervention based nursing practices have three basic aims. These aims are categorized under (1) process models that describe the process of translating current research works into practices, (2) determinant frameworks/classic theories/implementation theories that describes or predicts the outcomes associated with EBP and (3) evaluation frameworks helps to evaluate the EBP for determination of its success. Theories are usually based on facts or research, while assumptions are based on common sense or beliefs. Therefore, theories can be easily questioned and can be abandoned if the facts are not right. However, assumptions are not based on facts and as a result, it is difficult to question, thereby leading to the use of practices which do not guarantee any proven results. Clinical application of EBP depends on the skills of the individual (doctor or nurses) and their patient collaborations. However, clinical application of EBP is highly complex because the patients are different from the working models (during testing) described in the literature.  Clinical application of EBP requires the use of the PICO model.

Research-Practice Gap

The PICO model describes the clinical situation based on patient specificity, intervention effectiveness, comparative treatments and the outcomes (Rice, 2013).

It determines the clinical condition of the patient and whether, this condition is same or different to the condition described in the literature.  It also determines whether the characteristics of a particular population described in the literature same as the one where the intervention is to be applied. 

It determines the principle of application of the intervention and the risks or benefits associated with the interventions.

It compares between treatment interventions to understand which treatment shows better outcomes and poses less risk for the patients.

It determines the satisfaction level of the patients, clinical practitioners or nurses.

Evidence based nursing practices is the integration of research, clinical nursing expertise and patient characteristics to carry out prompt decisions and proper interventions (Duphily, 2016). It is backed by relevant informations, which is not the case for traditional nursing practices based on experience and common sense. All nurses have a role to play in the research and subsequent development of practices. The contributors of evidence based nursing practices are qualitative and quantitative research protocols, study designs, case studies, among others. All research works necessitates the requirement to meet international standards and ethical guidelines.

There are various limitations associated with the use of evidence based nursing practices. EBP helps to replace usual practices with practices backed by considerable research using randomized control trials (RCTs). In RCTs, there are groups of patients who do exceedingly well compared to the others. As a result, there is always the risk of uncertainties in EBP. Another limitation of EBP is based on the RCT interpretations. The interpretations depend on the apparent willingness of the practitioner’s to consider or dismiss the event importance as well as the complexity associated with the patients (Doig et al., 2013).

Researchers have criticized EBP because it excludes the importance of experience, intuition, reasoning and authority in practical decision making. Certain medical or nursing practices either do not have any research backing or have very limited support from research works. In order to garner subsequent evidence for the practices, nurses or practitioners have to carry out a lot of research, which requires excellent medical skills. Moreover, this would result in loss of valuable time and resources (Mohsen, Safaan & Okby, 2016). Thus, in general, the guidelines provided in EBP lacks the ability to represent true complexities associated with medical interventions. It also limits the ability of the practitioner to carry out prompt decisions thereby hindering favorable patient outcomes. Moreover, it also lacks evidence concerned with health addressing of culturally diverse populations (Kirmayer, 2012). However, due to the financial expenses associated with large numbers of RCTs, the reproducibility/validity of the research works are questionable.

PICO Model

According to some researchers, evidence based nursing practices are too narrow as they only rely on technology and research. It cannot discriminate between patients who really need interventions and those who do not; and on the contrary can be treated by proper diets and medications. Some researchers have also criticized EBP, as it could not clarify the assumptions associated with the research frameworks, thereby causing problems in selecting the correct evidences supporting the interventions. 


Moreover, outcome based nursing practices fail to respect the privacy of the patient. Moreover, in order to understand the success of the interventions on human subjects, they depend on a large number of aggregate data involving a large number of patients (Ammouri et al., 2014). It does not consider the fact that certain human beings are more complex than the others, and as a result require a different medical intervention than the one studied. EBP does not give importance to interpretations of the scientific interventions, such as determining the experiences of the patients. Nurses, who follow the EBP guidelines, should also consider and respect the patient preferences associated with the medical interventions.

Conclusion

Evidence based nursing practices tries to merge the gap between current research and nursing practices. As a result, it helps to introduce new interventions in clinical nursing practices. This helps to provide safe and effective treatments for patients, thereby increasing the favorable patient outcomes. It also enables the nurses or practitioners to take prompt decisions based on their skills and knowledge; thereby providing timely treatment to patients. However, there are certain limitations associated with EBP in nursing. These include the lack of sufficient research data supporting certain nursing interventions; thereby limiting the usage of certain modern techniques. Moreover, EBP requires skilled practitioners to carry out the clinical interventions, which necessitates the increase in financial expenses. Keeping in mind the above facts it can be concluded that EBP helps to provide state of the art interventions for patient treatments using modern technologies that meet international standards of quality and human ethics

Reference List

Ammouri, A. A., Raddaha, A. A., Dsouza, P., Geethakrishnan, R., Noronha, J. A., Obeidat, A. A., & Shakman, L. (2014). Evidence-based practice: Knowledge, attitudes, practice and perceived barriers among nurses in Oman. Sultan Qaboos University Medical Journal, 14(4), e537.

Bowling, A. (2014). Research methods in health: investigating health and health services. McGraw-Hill Education (UK).

Doig, G. S., Simpson, F., Sweetman, E. A., Finfer, S. R., Cooper, D. J., Heighes, P. T., & Peake, S. (2013). Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. Jama, 309(20), 2130-2138.

Duphily, N. (2016). Linking evidence to practice: A clinical practice guideline project. NursingPlus Open, 2, 26-34.

Emparanza, J. I., Cabello, J. B., & Burls, A. J. (2015). Does evidence?based practice improve patient outcomes? An analysis of a natural experiment in a Spanish hospital. Journal of evaluation in clinical practice, 21(6), 1059-1065.

Kirmayer, L. J. (2012). Cultural competence and evidence-based practice in mental health: Epistemic communities and the politics of pluralism. Social science & medicine, 75(2), 249-256.

Mohsen, M. M., Safaan, N. A., & Okby, O. M. (2016). Nurses’ perceptions and barriers for adoption of evidence based practice in primary care: Bridging the gap. American Journal of Nursing Research, 4(2), 25-33.

Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science, 10(1), 53.

Rice, M. J. (2013). Evidence-based practice: a model for clinical application. Journal of the American Psychiatric Nurses Association, 19(4), 217-221.

Schneider, Z., & Whitehead, D. (2013). Nursing and midwifery research: methods and appraisal for evidence-based practice. Elsevier Australia.

Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. OJIN: The Online Journal of Issues in Nursing, 18(2), 1-13.

Tabak, R. G., Khoong, E. C., Chambers, D. A., & Brownson, R. C. (2012). Bridging research and practice: models for dissemination and implementation research. American journal of preventive medicine, 43(3), 337-350.

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