Evidence Based Practice
Learning evidence-based practice and applied nursing research allows me to integrate the most useful research evidence with clinical expertise and patient values. The course taught me to estimate data for medical usage considering its relevancy and believability. EBP is based on systematic and rigorous appraisals of data used. Relevancy and believability of data is checked by assessment measures and the effectiveness of interventions.
There are three key directions to use to define whether the gathered data fits to these criteria:
What is the evidence?;
Are the pieces of evidence to be trusted? (methodology and execution flaws, etc);
Are the results helpful for practicing with other patients? (Are they transferable?) (Benet & Benet, 2000, p.8).
EBP practices a hierarchy of evidence which allows for critical data evaluation. Systematic review, a meta-analysis, or an established evidence-based clinical practice guideline based on a systematic review is considered as the first-choice sources.. Randomized controlled trials (RCTs) , other types of quantitative and qualitative studies, and expert opinions and analyses are taken onto consideration only after the first choice sources (Benet & Benet, 2000, p.8).EBP practice is integrated with research and quality improvement. The main difference between research and quality improvement lies in its goals. Research is conducted for generating new knowledge or validating existing one. It must be conducted with usage of disciplined and rigorous methods.
Quality improvement, on the other hand, is meant to improve patient outcomes (Varkey, Reller, Resar, 2007, p.1). It does not require extensive literature reviews and critical appraisal. A typical example of quality improvement project is improving a process to remove urinary catheters within a certain time frame or improving the process for patient education for a specific chronic disease.
EBP and applied nursing use evidences gathered from both primary and secondary research. Primary research is represented by case reports, case series, case-controls, cohort and randomized trials (Northwestern University, n.d.). Primary resources credibility and validity needs to be estimated by the researcher himself. Secondary research involves meta-analyses, guidelines, decision and economic analyses, evidence-based textbooks, systematic reviews, etc. Secondary sources include outside evaluation, analyses or synthesis of the data. In clinical practice both of these research types are used. Secondary research allows formulating a general hypothesis, but continuation of study can require tracking the primary source (Northwestern University, n.d.).
Secondary resources allow researcher to estimate credibility of the information, because they contain and external comments on research results. This way the practical improvements are based on valid and credible knowledge, thus, they are efficient.
Evaluation of evidences hierarchy, research and quality improvement allow to use EBP for improving a quality of nursing care.)
Bennet, S., Bennet, J., W. (2000) .The process of evidence-based practice in occupational therapy: informing clinical decisions. Australian Occupational Therapy Journal. 47. 171-280.
Varkey, P., Reller, K., & Resar, R., K. (2007) . Basics of Quality Improvement in Health Care. Mayo Clin Proc. 82(6), pp.735-739.