The benefits of evidence-based practice in nursing

In nursing, the mission to elevate patient care and assure the highest quality standards is unceasing. At the heart of this pursuit lies evidence-based practice (EBP)—a methodical approach that integrates clinical expertise, research findings, and patient preferences to decide the best course of action in medical care. In this blog you'll learn about the intricacies and impact of evidence-based practice, exploring how it can transform patient outcomes, reduce costs, and fortify nursing practice. Keep reading to examine the foundational elements, advantages, challenges, and the promising horizon that evidence-based practice offers in the field of nursing.

Understanding evidence-based practice

Evidence-based medicine first developed as a methodology in the 1990s in order to assess the veracity of research findings on procedures and products when applied to actual clinical settings. But the push for application of evidence-based practice to the health care industry at large grew out of the need for governments and agencies to find proven, cost-effective medical practices on which to operate institutions and base funding decisions.¹

You can think of evidence-based practice as the final step in a research process. After a theory has been integrated into a research study design, the research project properly structured, and found to result in positive patient outcomes, it can be put into clinical practice to help health care professionals make informed decisions. Evidence-based practice helps bring the latest research findings directly to patients faster and keeps health care progressing and improving.

Evidence-based practice isn't just applied in general medicine and nursing. Today, social science organizations like the Substance Abuse and Mental Health Services Administration (SAMHSA),² National Institute of Corrections (NIC),³ and the National Association of Social Workers (NASW),⁴ all encourage implementing evidence-based practice to their practitioners.

The foundation of evidence-based practice in health care

There are multiple models of evidence-based practice and it can look slightly different depending on the specific discipline, type of treatment, clinical setting, clinicians perspective and more. However, evidenced-based care typically follows the same series of steps.

Step 1: Ask clinical questions

A team of nursing practice researchers at the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice, advise using the PICOT format for clinical inquiries because of its efficiency when searching electronic databases. The PICOT question format is asking a question that takes into account the: population of interest (P), intervention or area of interest (I), comparison intervention or group (C), outcome (O), and time (T).⁵

For example: "In emergency departments (patient population), how does having BSN-educated nurses (intervention) compared with nurses with associate's degrees (comparison) affect the readmission rate (outcome) during a three-month period (time)?"

Step 2: Look for the best evidence

Trying to find research studies that are applicable to a particular issue can be time-consuming but can be simplified by using the PICOT format, which provides more and more specific search terms for a researcher to use. Consider if the question above was instead stated as "Does nursing education affect patient outcomes?" It's a much more broad question that will likely result in pages of research findings that aren't applicable to the emergency department or the level of education that the researcher is concerned with.⁵

Step 3: Critically evaluate the evidence

Evidence-based practice can only be effective if the evidence itself is the result of high-quality research and health care professionals can feel a lot of pressure in their critique process. To confidently evaluate studies without research without laboring for hours, nurses can ask three key questions:⁵

• Are the results of the study valid? Using their research literacy and critical appraisal skills, nurses need to consider the structure and measurements of the study and if they meets criteria for a rigorous, dependable study.
• What are the results and are they important? When looking for new interventions, did the studied intervention work? Can the intervention be applied to the clinical settings the nurse is working in?
• Will the results help me care for my patients? This question can help the researcher narrow in on the applicability of the study. Were the patients in the study similar to the patients the researcher is treating? Do the patient values in the study align with the values of the researcher's patients?

Step 4: Integrate the evidence with existing clinical expertise, patient preferences and values

This step is a defining aspect of evidence-based practice. Research studies alone don't sufficiently justify a change in clinical practice. Nurses, and all health care professionals employing these methods, need to consider their own clinical expertise, practical experience, patients, budget constraints and practice settings to determine whether an intervention is a truly valid option.⁵

Step 5: Evaluate the outcomes

Once a change in practice has been implemented based on research and careful consideration, it's important to note how well the intervention or procedure worked. Were the patient outcomes as expected or did they vary from those in the research findings? Discrepancies can help researchers and clinicians identify issues with implementation or expand upon the findings they used.

A final unofficial step, advised by the nurse researchers the ASU, is to disseminate the results of actually implementing evidence-based practice. As the researchers note, evidence-based practice can be extremely effective but health care professionals often fail to share their experiences leading to needless duplication of effort, or perpetuation of clinical practices that are not based on evidence.⁵

What are the benefits of evidence-based practice?

Evidence-based practice requires investments of time, personnel, and training. But is it worth it? The evidence says: yes.

Improved patient outcomes

In a scoping review of the outcomes of implementation of evidence-based practice, researchers found that, among various implemented evidence-based practices, findings indicate that they improve patient outcomes and return on investment (ROI) for health care systems. Specifically 94% of studied implementations showed a positive ROI, and none showed a negative ROI. Additionally, 89% resulted in improved patient outcomes, 10% showed no change, and less than 1% worsened outcomes (typically length-of-stay).⁶

Reduced health care costs

With evidence-based practice, health care systems can reduce costs by focusing on proven interventions and eliminating unnecessary or outdated procedures. This not only streamlines the allocation of resources but also enhances the overall efficiency of patient care without compromising the quality and comprehensiveness of the services provided.

Consistent Quality of Care

By systematically applying the latest and most relevant clinical research, nurses are able to offer treatments that have been vetted through rigorous scientific evaluation. This not only reduces practice variations but also assures patients receive the best possible care, tailored to the latest advancements in medical science. Evidence-based practice serves as a safeguard, ensuring every patient benefits from the same high-caliber care protocols that are continually refined and updated.

Empowerment of nurses and professional development

Evidence-based practice empowers nurses to take the lead in clinical decision-making processes, advocating for care that reflects both research insight and their own clinical expertise. This engagement can increase job satisfaction and encourage continuing education, as nurses stay abreast of evolving best practices. By merging empowerment with ongoing education, evidence-based practice acts as a catalyst for nurses to become lifelong learners and leaders in health care innovation, further elevating their roles and the quality of care they provide.

Key limitations in implementing evidence-based practice

Despite the numerous benefits of evidence-based care, nurses will likely encounter an array of challenges when attempting to implement this type of practice and decision-making.

Resources: As with most things in nursing, a key challenge is having enough time and money to conduct evidence-based practice at a satisfactory level. Many health care organizations are already struggling to keep their departments fully staffed with nurses and therefore aren't likely to have the ability to let nurses spend extra time on the research necessary for evidence-based practices. Additionally, budget constraints can prevent nurses from implementing research findings even when well-supported.

Level of experience necessary: Evidence-based practice is inherently limited in its philosophical scope because it prioritizes knowledge derived from clinical research, in other words, outside information, which may not always be applicable to individual cases facing a provider. Without substantial experience within a clinical setting, nurses could find integrating non-evidentiary knowledge, such as clinical judgment and patient preferences difficult.

Availability of evidence: The quality and quantity of evidence to support evidence-based guidelines can vary significantly based on the topic, population, setting, and intervention. Sometimes, the evidence may be outdated, biased, or conflicting, which can limit its applicability to specific cases.

The future of evidence-based practice in nursing

The path forward for evidence-based nursing practice holds promise and potential, guided by technological innovation and a steadfast commitment to research. Today, information is more accessible than ever and with new technologies the nursing profession is on the cusp of a revolution that prioritizes data-driven decisions for numerous benefits to patients, nurses, and health systems. Nurses equipped with the critical thinking, knowledge translation, and problem-solving approach to practice characterized by evidence-based nursing, will be poised to lead the charge in curating cutting-edge care strategies, informed by global best practices and multi-disciplinary collaboration.

Improve patient care using evidence-based methods

As the health care landscape continues to advance, the integration of Evidence-Based Practice (EBP) within nursing is more crucial than ever. It stands as a beacon of progress, assuring consistent quality of care, and empowering nurses to contribute to improved health care policies. While challenges in implementation persist, the potential benefits for patient outcomes and professional development are undeniable. Oklahoma City University embraces the future of nursing by empowering students with the knowledge and tools needed to champion evidence-based decision making. 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 specializations in Leadership or Education, admissions, curriculum, or to get assistance with completing your application, schedule a call with an admissions outreach advisor.