Practice Based on Tradition and Research
Nursing care is based on tradition but also on research. Many tradition based nursing practices have been identified as harmful (e.g. lengthy bedrest) or unnecessary (e.g. daily bed baths). Yet, nursing care based on research findings can also be harmful if these findings are applied to the wrong patient population or in an inappropriate setting or too early because clinical trials are not completed. Certainty of what knowledge to use in practice does vary from traditions through to pooled clinical research results that provide evidence of good patient outcomes.
The Spectrum of Certainty
The nurse clinician must also determine if utilization of the research results (however convincing in the article) are appropriate to the patient, family, community or organization. Further, the clinician must also have a plan for teaching their client(s) to use the most scientific and up-to-date research results.
Evidence Based Practice (EBP) is defined as using nursing research. EBP is built on pooled studies such as meta-analysis.
This is Graphic Quiz - Evidence Based Practice
Type in the box below an example of your evidence based practice. Define why this improves on tradition.
Review these following only if you want to - this is not an assignment.
If you are interested, link to the National Guideline Clearinghouse (NGC) web site. The NGC site, located at www.guideline.gov, is a database of evidence-based clinical practice guidelines and related materials for health care professionals.
The complete cholesterol guidelines, the Executive Summary, and an At-A-Glance version are on the Web at http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm. This web site also contains an interactive 10-year risk calculator. A copy of the guidelines can be ordered by phone from the NHLBI Health Information Center at (301) 592-8573.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adults Treatment Panel III) Executive Summary. Available at: http://www.nhlbi.nih.gov. Accessed May 29, 2001.
American Academy of Neurology issued new dementia guidelines (concentrating on Alzheimer's disease) detailing early detection options. The document is available online at http://www.aan.com.
Acute chronic obstructive pulmonary disease is addressed in new guidelines from the American College of Physicians-American Society of Internal Medicine (1). The document is online at http://acponline.org/scipolicy/guidelines/?idx. Adult diabetes is detailed in Coordinated Performance Measurement for the Management of Adult Diabetes.
Collaboration on a clinical guideline among physicians (the American Medical Association [AMA], American Diabetes Association, and others), and health plans (the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance). The document is available at http://www.ama-assn.org/ama/pub/category/3798.html.
References
Klein, S., Kinney, J., et al. Report of Conference on the Current Role of Nutrition Support. JPEN 1997; 123-56.
Wolfe, B., Mathiesen, K. Clinical practice guidelines in nutrition support: can they be based on randomized clinical trials? JPEN 1997; 21:1-6.
American College of Physicians. Parenteral nutrition in patients receiving cancer chemotherapy: a meta-analysis. Ann Intern MEd 1989; 110:734-6.
Guyatt, G., Sackett, D., Taylor, D., et al. Determining optimal therapy - randomized trials in individual patients. N Engl J Med 1986; 314:889-92.
