Are Nurses Practicing Evidence-based Nursing Care?
The culture has been changing over the last few decades to emphasize the importance of evidence-based care giving for nurses. Many Registered Nurses are well educated and well experienced and are expected to take continuing education throughout their profession. However, do nurses understand and practice evidenced-based care? A brief review of the history and current state shows some interesting highs and lows along this important pathway.
One of the most famous nurses in history was Florence Nightingale (1820-1910). Upon returning from the Crimean war, she pushed for improved hygiene and sanitary conditions as well as record keeping to increase the understanding of outcomes. She also made strides in improving the knowledge surrounding mortality rates in subpopulations, and demonstrated that trained nursing staff influenced outcomes over untrained staff.1
Despite this strong foundation, nursing has somewhat strayed from evidence-based practice. Possibly the most notorious example was the practice of Therapeutic Touch (TT) started in the 1970s. Therapeutic Touch involves the transfer of human energy from one person to another through close physical proximity and creates a healing effect. Although the debate about TT is beyond the scope of this paper, it was originally well published and endorsed by nursing leaders of the time.2 However, one of the youngest persons to have published in a medical journal, Emily Rosa, performed a basic scientific study on Therapeutic Touch which found there was no detectable human energy field. Despite this finding, another article challenges her conclusions based on inappropriate design and analysis. 3,4 This is how evidence-based practice develops. A single robust study, regardless of its findings should still be repeated multiple times to confirm the results before it is considered evidenced based and ready to formally influence practice.
Nurses need to continue to advocate for evidence-based care. Anecdotal practices may be effective, and should be formally subjected to rigorous research. To be on par with other healthcare professionals (i.e., physicians, pharmacists etc) nurses will need to learn to discuss evidence and understand that their actual day to day practice is guided by established processes that optimize patient care. A strong tool available for nurses to better understand the strength of evidence is the Johns Hopkins Nursing Evidence Based Practice protocol. The American Nurses Association has provided links to the appraisal tool, however there is a full text that provides greater detail.5 The appraisal tool is a good start for a nurse interested in evaluating evidence. However, additional expert input will be needed to actually be able to rate published research.
The healthcare environment is changing, and the focus on evidence-based practice is being emphasized. In a 2011 report to Congress, the US Department of Health and Human Services calls for the development of a National Quality Strategy that will specifically use evidence-based results to improve “medicine, public health, and health care delivery”.6 Nurses can have a positive influence on setting a national standard as this endeavor is implemented.
Professional nursing requires understanding of best practices as defined by replicated and strong evidence published in peer-reviewed journals. This article begins to define the responsibility and shows a tool to critically analyze evidence. There is a common pitfall to believe anything in print, however, keep a healthy skepticism, be objective, and always strive for the best outcomes for patients.
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1. McDonald L. Florence Nightingale and the early origins of evidence-based nursing. Evid Based Nurs 2001;4:68-69 =
3. Public Broadcasting Service. Ask the Scientist.
4. Cox T. A nurses-statistician reanalyzes data from the Rosa therapeutic touch study. Altern Ther Health Med 2003;9(1):58-64.
5. American Nurses Association, Nursing World. Johns Hopkins Nursing Evidence-Based Practice.
6. Department of Health and Human Services. Report to Congress, National Strategy for Quality in Healthcare Improvement. March 2011.
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