Strategies for implementing evidence-based practice effectively

Nursing, at its core, is an occupation grounded in the dedication to patient welfare and the application of expertise vital to their care. As methodologies evolve and the connection between clinical research and patient outcomes grows ever-clearer, the prominence of evidence-based practice in nursing continues to expand. This practice forms the cornerstone of clinical care excellence, combining rigorous research with the expertise that nurses bring to the bedside, each reinforcing the other to raise the caliber of patient care.

Implementation of evidence-based techniques requires more than an understanding of studies and outcomes—it demands intention and the cultivation of a workplace culture conducive to change. From solo practitioners to expansive healthcare systems, the successful application of evidence-based practice hinges on strategic planning and steadfast commitment. In the shifting landscape of health care, evidence-based practice stands out not only as a best practice but as a necessary pivot point, leading to the kind of innovation and improved outcomes that professionals in nursing strive for.

In this blog, we'll dig into pragmatic approaches and key strategies that can smooth the path for nurses and their leadership teams to fully embrace and integrate evidence-based methodologies, ensuring that the care delivered reflects the latest and most robust clinical scholarship.

What are the core components of evidence-based practice?

Evidence-based practice is predicated upon three fundamental elements, each contributing to the comprehensive approach required to provide high-quality care grounded in empirical evidence. The core components of evidence-based practice are:¹

1. Best available evidence
At the heart of evidence-based practice is the utilization of the most current and relevant research findings. Peer-reviewed studies, systematic reviews, clinical guidelines, and well-designed trials to guide decisions about patient care are all examples of potentially useful and valid research evidence.

2. Clinical expertise
Even though evidence-based practice is concerned with using current research findings, clinicians must interpret that evidence through the lens of their own clinical experience and understanding of their patient's needs. In other words, nurses need to use critical thinking to determine when evidence should or should not be incorporated into treatment and how it can be adapted to fit individual circumstances.

3. Patient preferences and values
In evidence-based practice, patients are partners in the care process, not merely recipients. Evidence-based practice respects and integrates patient values, choices and beliefs, ensuring that clinical decisions align with patient preferences and consent. This shared decision-making ensures care that resonates personally with each patient.

Relevant evidence, clinical expertise, and patient preferences serve as the outline for effective evidence-based healthcare. In the upcoming section, we’ll explore methods and insights for actualizing these components into daily nursing practice.

How to Implement Evidence-Based Practice Effectively

The theoretical argument to use evidence-based practice and its benefits are pretty clear. However, the challenge lies in its application. Meticulously bridging the gap between scholarly evidence and hands-on patient care can be complex and require a lot of resources, but is critical to advancing nursing–and all types of medical practice. Part of the challenge is that implementation of evidence-based practice effectively isn't a one-and-done aspect of professional development, but rather an iterative cycle that involves continual discovery, integration, and evaluation.

To begin, here are the basic steps to implement evidence-based medicine:

1. Ask a clinical question

In medicine there's more than one type of clinical question. Background questions ask very broad, overarching things like "What is the best way to set a broken bone?" or "What is a side effect of morphine?" Foreground questions ask specific questions that lead to action.²

Evidence-based practice hinges on asking foreground clinical questions. Nursing research teams, such as one at the Center for the Advancement of Evidence-Based Practice at Arizona State University's College of Nursing and Health Innovation, champion the PICOT framework for its systematic nature that sharpens the search in electronic databases. Crafting a query using the PICOT structure involves several components: pinpointing the specific patient or population group in question (P), identifying the procedure or treatment of interest (I), selecting an alternative or comparing a group to contrast with the intervention (C), defining the desired outcome or goal of the intervention (O), and considering the timeframe over which the outcome will be measured (T). This format also helps researchers slow down and put together question with a clear goal.^2,3

2. Find the best evidence

In evidence-based practice there are several hierarchical levels by which information is to be ranked and determined to be reliable research. Understanding and applying the levels of evidence helps practitioners to critically evaluate research and make informed decisions that optimize patient outcomes. It also aids in prioritizing research when there is conflicting evidence or when evidence is limited.⁴

Starting at the top of the pyramid with the "best" evidence here are the levels:⁴

Level I: Systematic Reviews and Meta-Analyses
Systematic reviews and meta-analyses synthesize results from multiple studies on a specific clinical question, using rigorous methodology to identify, select, and critically appraise relevant research.

Level II: Randomized Controlled Trials (RCTs)
RCTs are experimental studies that randomly assign participants to an intervention or control group to measure the effectiveness of interventions. They are considered the gold standard for evaluating the efficacy of treatments due to the minimization of bias.

Level III: Controlled Trials without Randomization
These are studies in which participants are assigned to intervention or comparison groups, but the assignment is not random. While still valuable, these studies are seen as less rigorous than RCTs due to the potential for allocation bias.

Level IV: Cohort Studies and Case-Control Studies
Cohort studies observe a group of individuals with common characteristics (like a treatment or risk factor) over time and measure their outcomes against a non-exposed group. Case-control studies, on the other hand, compare individuals with a specific condition to those without the condition, looking retrospectively for exposure to risk factors or interventions.

Level V: Case Reports, Case Series, and Qualitative Studies
Descriptive studies such as case reports or case series detail individual or group cases, providing insights into specific phenomena. Qualitative studies explore phenomena in depth and context through methodologies like interviews or focus groups.

Level VI: Expert Opinion and Consensus Statements
This level includes opinions from experts in the field, based on their clinical experiences, knowledge from the literature, and consensus panels. These sources are valuable for areas in which there is limited research but are considered the weakest form of evidence due to their subjective nature.

3. Critically appraise the evidence

In their article "Critical appraisal skills are essential to informed decision-making," Mhaskar, Emmanuel, et al. detail the questions required for analyzing research evidence:⁵

1. Are the results valid? Did the study address a clearly focused issue? Was the assignment of participants to treatments randomized? Were all the participants who entered the study properly accounted for at its conclusion? Description of dropouts and withdrawals: How do dropouts threaten validity?

   • Much like your own clinical question, a well-designed study should follow the PICOT format where the outcomes being measured are clearly stated with a rationale as to why these outcomes were selected for the study.
2. How precise are the results? Were the methods of analysis appropriate, clearly described and justified? What are the key findings? If the results are unbiased, they need further examination in terms of precision. Better precision comes from larger studies compared with smaller studies.
3. Are the results applicable to my patient? What are the patient populations, disease and treatments under investigation? What are the benefits and risks associated with the treatment? Do the benefits outweigh the harms? Other important considerations are whether you have the necessary skills or resources to deliver the intervention.

4. Integrate the evidence

This step is where clinical expertise and patient values come in. Considering the research evidence that's been evaluated, researchers should incorporate their own clinical practice experiences and patient preferences into their final decision for how to proceed. You'll need to include evaluation of the strategic case, the business case, get informed written consent from the patient and ensure patient safety, plus take into account potential risks for the health care system and ensure that your implementation process doesn't disrupt the rest of the healthcare practice. This part is obviously easier said than done. As the research team at ASU states, "There is no magic formula for how to weigh each of these elements; implementation of EBP is highly influenced by institutional and clinical variables."³

For example, over years spent in the nursing profession, you may have seen a certain specialized treatment work well on patients like yours. However, the institution at which you work may not have the budget or the right staff for that type of treatment.

5. Evaluate clinical outcomes

In the fifth step of evidence-based practice, evaluating clinical outcomes is imperative to determine the actual impact of interventions on patient health and wellbeing. This phase involves systematic observation and measurement of specific indicators after implementing an evidence-informed intervention. For instance, if a new protocol for pain management in postoperative patients is adopted, the evaluation would assess metrics such as pain scores, medication use, recovery times, and patient satisfaction. This step not only measures efficacy but also sheds light on potential areas for refinement of the clinical question or plan of action. The continual analysis of patient outcomes ensures the interventions remain both effective and relevant, leading to sustained improvements in patient care.³

6. Disseminate results

The final phase in the evidence-based practice cycle is crucial. Disseminating results is about sharing knowledge and experiences to promote widespread adoption of successful practices. This step involves communicating the outcomes and insights from evidence-based interventions to stakeholders, such as fellow healthcare professionals, through various channels like conferences, journals, professional networks, and workshops. For example, if an EBP project successfully reduces incidence of hospital-acquired infections, dissemination might include a detailed case study publication or a presentation at a nursing symposium. By effectively broadcasting these research findings, practitioners contribute to collective quality improvement in healthcare, fostering a culture of evidence-based medicine across the medical community.³

Helpful strategies to implementing evidence-based practice in nursing

Transitioning to a model of evidence-based practice can require substantial shifts in routine, mindset, and collaboration across a team of healthcare professionals or entire health care organization and can even require a systematic review of operations. To facilitate this transition, strategic approaches can build a sustainable foundation for evidence-based research nursing. Here are some fundamental strategies:

Create a supportive environment

Provide administrative support for research activities, allowing time for nurses to find educational opportunities related to evidence-based practice, and recognizing efforts and accomplishments when it's properly implemented in clinical practice. Cultivating a culture that values inquiry and continuous improvement encourages all staff to engage with and contribute to evidence-based practice initiatives.

Develop proper education and training

When nurses are equipped with the skills to interpret and apply research findings, evidence-based practice thrives. Through comprehensive training programs including workshops, degree programs, seminars, and continued education courses, nurses can develop their skills in critical appraisal, statistics, and the evidence-based practice process. Educational institutions, like Oklahoma City University, play a crucial role by embedding these competencies in their nursing curricula.

Seek out interdisciplinary collaboration

Healthcare is a team effort, and successful evidence-based practice projects often require diverse expertise. Collaborating with healthcare professionals from all disciplines like physicians, pharmacists, therapists, and others can provide a well-rounded perspective on patient care and enhance the design and implementation of evidence-based practice interventions. It also helps to create an atmosphere of shared responsibility for improving patient outcomes.

Embrace technology

Technological resources are indispensable for accessing the latest research and data. Implementing user-friendly databases, mobile applications, and other digital tools plus paying for subscriptions and access to such tools can streamline the process of finding and applying research evidence. Additionally, health technology can aid in monitoring outcomes and providing feedback, which is essential for the continuous evaluation of evidence-based practice effectiveness.

Through a combination of these strategies, evidence-based practice can become a standard of care in an organization, amplifying both the quality of patient care and the professional development of nurses. ‍

How can nurses ensure successful EBP implementation?

Transitioning to evidence-based practice can be transformative, enhancing patient care and outcomes. While a lot of it depends on the culture of an organization, individual nurses can do certain things to ensure they implement evidence based practice successfully:

• Communicate readily: Encouraging dialogue between staff about research findings, best practices, and patient experiences helps demystify evidence-based practice and its relevance to daily nursing tasks.
• Invest in training and ongoing education: Continuous education is critical for staying up-to-date with the latest evidence and clinical decision-making methodologies. Regular workshops, seminars, and accessing e-learning platforms are excellent ways to bolster nurses' skills and confidence in applying EBP. Pursuing advanced degrees, such as those offered by Oklahoma City University's online nursing programs, can also greatly enhance understanding and confidence in the practice of evidence-based practice.
• Cultivate a culture of lifelong learning: Creating a culture that prioritizes learning and professional growth is essential. Actively promoting research participation, rewarding innovative ideas, and supporting advanced studies are ways to instill a love for ongoing learning. This continuous learning environment inspires nurses to stay curious, question the status quo, and embrace new evidence that can improve patient outcomes.

By focusing on these elements, nurses can lead and navigate the evidence-based practice landscape with skill and confidence, embodying the highest standards of care envisioned by the nursing profession.

Transform your nursing career with OCU’s online MSN program

The shift towards evidence-based practice is not just a trend but a conscious shift in methodology for clinical excellence. Nurses, as catalysts for change, play a pivotal role in embedding evidence-based thinking into clinical practice and the fabric of patient care. By fostering a spirit of curiosity, prioritizing education, embracing collaboration, and leveraging technology, the nursing community sets the stage for a future where evidence guides practice and patient outcomes are continually enhanced.

At Oklahoma City University, students are prepared to meet this challenge head-on armed with the knowledge, skills, and confidence to implement evidence-based practice with competence and care. Explore the online Master of Science in Nursing from OCU to discover how you can be at the forefront of delivering excellent patient care using evidence-based methods. For more information on OCU's MSN, including the RN-MSN, specializations in Leadership or Education, and Community-Based Public Health, admissions, curriculum, or to get assistance with admissions requirements and completing your application, schedule a call with an admissions outreach advisor.