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These are some of the topics to consider for a nursing evidence-based practice.
- Genetic Testing and Smoking Cessation.
- Adolescents and Substance Abuse Treatment.
- Epley Maneuver in Vertigo.
- Genetics and Depression in Women.
- Omega-3 Fatty Acids and Postpartum Depression.
- Also, treatment of Bell’s Palsy.
- Stop the Stigma: Human Trafficking
- Safe and Efficient Vital Signs- is it Time to Change our Methods?
- Combating Compassion Fatigue Among Emergency Department Nurses.
- Preventing 30 Day Readmission for Patients with Heart Failure.
- Reducing Delirium in the ICU: Implementing a Sleep Protocol.
- Vaccination of the elderly: challenges and potential benefits
- Principles of preventive medicine: primary care for the elderly.
- Migraine diagnosis and treatment methods
- Innovative methods in cardiology.
- Major causes of anxiety disorders in adults
- Vaccination programs: pros and cons
- The role of social workers in primary care
- Responsibility of the pharmacist for public health
- Effective methods of asthma prevention.
- Advantages and disadvantages of home nursing care
- Sleep disorders in women.
- Standard protocol for the treatment of headaches in adults
- Basic guidelines for primary care for disaster victims.
- The role of government agencies in primary care
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In nursing, evidence-based practice entails improving the quality of care by offering quality and holistic care using the latest knowledge and research. Increased research activities on evidence-based nursing have created a difference in the professional practice over the traditional approaches used in nursing. The research practice enables nurses to increase their expertise and skills in clinical practice by gathering relevant information, analyzing the data, and implementing their research outcomes. Old research findings are not suitable or practical in evidence-based nursing practice. Only the latest research outcomes are used.
There are multiple examples of evidence-based practice in nursing, including:
- Angina management
- Alarm fatigue guidelines
- Non-invasive blood pressure measurement in children.
The main emphasis in promoting evidence-based practice is to improve patient care and personalize the service delivery process.
The 5A’s (Steps) of evidence-based practice
Ask
The first step in the practice is defining your clinical question. You must start by having a clinical question that you will be after finding answers. There are various ways through which one can formulate the clinical question. The most common framework for implementing the first step is the PICOT, which stands for:
- P-Patient/Population: Patient characteristics, e.g., Age, condition or gender
- I-Intervention: The proposed evidence-based intervention, such as diagnostic test, therapy, or exposure.
- C-Control/Comparison: This is the alternative to the proposed intervention or contrasting intervention.
- O-Outcome: This refers to the measurable results the research intends to achieve
- T-Time: This refers to the duration for achieving the outcomes.
Patient, intervention, comparison, outcome, and time. A PICOT question must be well structured to increase the chances of getting the best evidence to inform clinical decision-making. There are two main types of questions used in evidence-based practice in nursing: foreground and background.
- Foreground questions: They are very specific, and their answers offer the required evidence to inform a clinical decision. However, clinicians must understand that the foreground question is unsuitable in all situations.,
- Background question: They are very general and depend on basic knowledge generated by the patients or from general clinical resources and textbooks.
When implementing evidence-based nursing practice, different questions can be asked, including meanings, etiology, prognosis, prevention, and therapy. The types of evidence that can be used to respond to the questions can be from qualitative studies, cohort studies, case-control studies, prospective studies, or randomized controlled trials.
Categories of Questions that Use PICOT and Sample Questions
- Intervention/Therapy: Refers to the questions on treating a disease or disability.
Example: In patients with chronic lower back pain, does physical therapy reduce pain and improve long-term functionality compared to opioid medication administration in six months?
- Diagnosis: These questions seek to establish the appropriate diagnostic processes for diseases.
Example: In newborns presenting with jaundice, how reliable is transcutaneous bilirubin measurement compared to serum bilirubin as a diagnostic tool?
- Etiology: These questions seek to address the causes or origins of diseases.
Example: In adults aged 50 years and above diagnosed with hypertension, does the consumption of a low-sodium diet compared to a high-sodium diet increase the risk of developing cardiovascular diseases?
- Prognosis: These questions seek to predict the course of a disease.
Example: In patients diagnosed with stage four pancreatic cancer, what is the long-term survival rate for patients who undergo surgical resection compared to those receiving palliative care?
- Meaning: These questions seek to establish how individuals experience a disease or phenomenon.
Example: Among breast cancer survivor patients aged between 40 to 65 years who have participated in active cancer treatment in the last two years, does participating in mindfulness-based stress reduction (MBSR) program compared to the usual care and support breast cancer survivors receive to enhance their perception of emotional wellbeing, life quality and coping?
Access/acquire
Formulating a clinical question requires the practitioner to search for reliable and credible evidence to answer the questions. Multiple types of evidence can be used in this case, including:
- Background information or expert opinions,
- Case-controlled studies,
- Cohort studies
- Randomized controlled trials
- Critically appraised individual articles, topics, and systematic reviews.
No information sources found are reliable and credible for the research process. That is why it is always important to consider the identified sources’ relevance and qualities before using them. Some of the most recommended and reputable databases include the Cochrane Library, CINAHL, PubMed, PsycINFO, Joanna Briggs Institute, NBCI, Science Direct and EBSCO.
The table below provides study types with the highest level of evidence for different categories of PICOT questions.
| Question Type | High Evidence Study Types |
| Diagnosis | Cohort studies |
| Therapy or Intervention | Randomized controlled Trials (RCTs) |
| Prognosis | Longitudinal cohort studies |
| Etiology | Cohort studies and RCTs |
Appraise
Evidence appraisal is very important as it analyses and reviews the validity and quality of the gathered evidence. The third step of evidence-based practice is very important and can involve either critique or appraisal of the evidence to ensure study credibility. The criteria used in evidence appraisal include:
- Size of the study
- Possible bias,
- Similarity of the study population to your patients
- Currency of the study
In critical appraisals, it is crucial to establish:
- Whether the study results are worth looking at. This is based on whether the study design was appropriate for the research question and the validity of the results.
- What the results are: This seeks to establish the size of the result effect and the precision of the result effect.
- Whether the results are relevant to the targeted patient population: In this case, it is crucial to establish whether the results are generalizable in the current clinical practice based on the similarity of patient population, protocols and research setting.
Apply
The 4th stage of the practice entails the application of the research evidence into decision-making, mainly for enhancing patient outcomes and patient care. It also gives answers to the originally formulated clinical questions. The main elements of evidence-based practice that must be considered in the application phase are the patient circumstances and values, clinical expertise, and best research evidence.
Various models could be used to apply research evidence into practice, including:
- The Stetler Model
- Iowa Model
- John Hopkins Model
Assess
The final step in evidence-based practice entails auditing the impact of evidence application to the patient. It mainly entails self-evaluation about the efficiency of the approach. Any approach that proves effective should be applied. However, failure of the evidence application in bringing the desired outcomes should be avoided, and further research should be done for more credible evidence.
Benefits of Evidence-based Nursing
Improved job satisfaction
The evidence-based practice aims at enhancing the nurses’ job satisfaction. In the past, nurses suffered low job satisfaction and high burnout because of understaffing and working for long hours. The condition also impaired the nurses’ ability to offer top-quality care services to patients. However, evidence-based practice has come to solve the burnout challenge among nurses, which highly lowers their morale.
Evidence-based practice in nursing relies on recent research in establishing evidence-based procedures. Hence, health practitioners have effective patient care practices and treatments that best manage their situation. Any agreed-upon intervention is more effective since it is tailored to a patient’s unique needs and not a one-size-fits-all. When nurses determine that the patient responds positively to the administered treatment and procedures, it motivates them.
Enhances clinical proficiency and research
With evidence-based practice, nurses constantly learn new knowledge and skills to transform their nursing practice. For instance, besides handling patients, nurses must also research to understand patient trends. Thus, combining clinical practice and research enables nurses to ace their skills and specialize in their areas of interest.
Prioritization of patient health-related needs
Evidence-based practice in nursing focuses on each patient’s unique needs. There is no generalization of patient situation and use of general interventions. That is why the approach personalizes the care delivery process for the best outcomes.
Enhanced patient care decisions
It is always advantageous when patients can participate in the care delivery process. Their opinions matter in the overall quality of care received. The process gives the nurses ample and productive time while interacting with patients.
The main components of evidence-based practice
Patient values and expectations
Evidence-based practice is a field that appreciates the uniqueness of each patient based on their expectations, preferences, and values. This understanding initiates the need for nurses to have respect for patient autonomy. Therefore, patients can make decisions without coercion or threat concerning their healthcare. The component also supports the promotion of patient education.
In this case, nurses must serve as patient educators to offer them wide-ranging information about their health and allow them to make decisions based on the provided information. In evidence-based practice, nurses must also embrace cultural diversity and sensitivity. This understanding helps healthcare practitioners to respect the varying cultures, attitudes, and beliefs of patients from different backgrounds. It is critical to eliminate discrimination in the healthcare sector, especially against people from certain cultures.
Individual clinical expertise
Among the various aspects of evidence-based practice, individual clinical expertise concerns the amount or level of insights, skills, and knowledge nurses gain from their patient experiences. Evidence-based practice subjects nurses to wide-ranging professional practices such as clinical wisdom, problem-solving, and reflection. Reflection is highly emphasized in evidence-based practice. It enables the nurses to reflect on their clinical practices, strengths, and weaknesses and learn from past encounters.
Evidence-based practice also fosters problem-solving abilities among nurses. There are many challenges and ethical dilemmas that nurses face. Therefore, problem-solving abilities are a very efficient way of training practitioners to solve more complex clinical challenges. In the long run, with evidence-based practice, nurses increase their chances of getting clinical knowledge and wisdom that offers flexibility in any clinical situation.
Best external evidence
Evidence-based practice relies on tangible evidence that can be used to improve healthcare experiences and outcomes. Its success depends on the support of clinical research involving the nurses. The practice focuses on current research. Hence, nurses must use recent or current information or materials to get the latest news affecting patients. Therefore, nurses must be aware of the platforms, such as the latest publications and reputable and trusted databases, to gather up-to-date news to help their professional practice.
The involvement of scientific procedures in the research process requires the nurses to be systematic in all the research processes. There is also a high emphasis on using valid and reliable statistical methods and analysis techniques free from bias. Not any external evidence is suitable or reliable. The accepted evidence is only the one that is practical in a given clinical context. Find more insights through getting our evidence-based practice writing services.
Research types applicable in evidence-based practice
Expert opinions
These are the professional advice offered by experts in the medical field. The opinions are based on the clinical experience of the experts, their knowledge of the best practices, and their literature knowledge. Evidence-based practice benefits from expert opinions and is used mainly when no convincing or strong empirical proof exists in a particular medical field. Reliance on the research proofs or evidence is crucial in supporting the expert opinions. There are steps and procedures used to use expert opinions in evidence-based practice.
First, there must be an identified team of experts with proven expertise. The experts must also have proof of achievements in their areas of specialization. The experts then undergo a consultation to measure the level and quality of their advice or guidance on specific clinical questions. It is always critical to balance the proofs given by the experts with other available evidence, such as from clinical guidelines and research findings. The third step of the process is critical appraisal. It aims at appraising expert opinions in evaluating their credibility and strength in supporting the evidence based on the addressed clinical questions.
Evidence from observational or case studies
Case-control studies in the medical field entail scientific studies that use patients versus normal people to make certain conclusions. The studies are commonly adopted to understand the operation or characteristics of rate conditions. Besides, evidence-based practice entails the clinicians observing and recording data throughout their research practices. The studies have proven efficiencies in assessing patient behaviors and responses to medications or medical procedures and investigating the history of certain health conditions.
Randomized control trials
The trials are dominantly adopted in the medical context concerning facilitating evidence-based practice. It entails two groups of people, one used as the specimen and the other as the control experiment. The main aim of randomized control trials is to determine the success or reliability of an intervention. Generally, randomized control trials are a form of experimental study that entails random selection of the participants, which must be a control or placebo group and the treatment group.
The comparative nature of the study helps lower the chances of getting wrong outcomes because of the risk of bias. Randomized control trials are used in nursing mainly to support quality improvement, informed decision-making, and evidence-based guidelines and promote clinical efficacy.
The Levels of Evidence-Based Practice
Four primary grades or levels in evidence-based practice enable medical practitioners to evaluate the validity, credibility, and strength of the gathered evidence. The primary levels involved are;
Level A
It is a level that features high-quality evidence using meta-analyses and systematic reviews of well-planned and designed randomized control trials. High levels of evidence must be offered to ensure the credibility of the research process. High-quality evidence is possible because reliable approaches and sizable sample sizes are adopted to minimize bias.
Systematic reviews offer comprehensive overviews of existing studies based on the established clinical question. It is a comprehensive process that entails performing a systematic literature search, quality appraisal of the studies, and use of meta-analysis to synthesize the outcomes. However, randomized controlled trials are important in evaluating the effectiveness of a certain treatment or intervention.
Level B
In evidence-based nursing practice, level B is characterized by moderate quality evidence. The randomized control trials must be performed in an organized way and designed effectively. However, the process needs to be more comprehensive as it is in level A. Generally, there is no randomization at this level. However, the study or research process entails the adoption of quality control trials.
Level C
This level gets evidence from case studies, cohort studies, case-control studies, observational studies, and non-randomized studies. The level has limited or low-quality evidence because of the increased bias during the process. Level C of evidence-based practice is effective when there is less information on a health condition, so there must be support from expert opinions.
Level D
Of the different evidence-based practice levels, level D offers the lowest evidence to aid the clinical process. However, it is most effective in complex scenarios since it relies on evidence from the other levels.
Relevance of evidence-based practice for nurses
Evidence-based practice is an approach nurses use to transform the care delivery process to ensure enhanced health outcomes. It entails the nurse knowing the patient’s underlying problem and establishing solutions to the identified health-related challenge. Evidence-based practice helps nurses to establish a positive impact and transformation on the communities, patients, and the world.
It is also an important technique used for standardizing care and reducing the likelihood of medical errors. Before the inception of evidence-based practice, nurses had less responsibility in shaping the nursing practice. However, evidence-based practice enables nurses to actively shape the nursing practice while collaborating closely with our healthcare practitioners.
Besides, evidence-based practice has created a meeting point between the real-world experience of the nurses and medical research. That is why there is increased transformation witnessed in the healthcare sector. The main difference between evidence-based practice and non-evidence-based practice is the idea of medical research.
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