In today's healthcare environments, evidence-based practice is the recommended method to healthcare delivery. Nurses that use evidence-based practice not only increase their skills and competence in healthcare delivery, but they also improve patients' outcomes, costs, and morbidity. The purpose of this study is to examine the significance of evidence-based practice in the healthcare system and to argue why it is critical for nurses and physicians to grasp research methodology in order to successfully integrate EBP in their normal practice. A case study of the UK community health nursing has been highlighted to illustrate how such understanding and utilization of the approach has improved diagnosis and treatment of cellulitis in the region. The study concludes by affirming the position that, owing to the importance of EBP in the current healthcare practice, nurses must understand the methodologies of research to implement the EBP in their routine assignments correctly.
Key Words: Evidence-based practice, internal evidence, external evidence
EBP- Global Health Essay Position
Introduction
It is now widely acknowledged all over the world that evidence-based practice is the core of high-quality healthcare delivery and the avenue to ensuring the best outcomes for patients care. A lot of studies have been conducted in this area in the recent past. A majority of these research assert the importance of evidence-based research approaches to nursing practices in improving the quality of care, realizing improved patients health, reduction in costs of healthcare and reduction in patients morbidity compared to the traditional approaches (Williams,2004; McGinty & Anderson, 2008). As Williams (2004) mentions, when clinicians (nurses) know how they can find, critically appraise as well as utilize the best evidence in their clinical practice scenarios, the patients become more confident in their services and in their expertise. As a result, improved quality of the outcome is often registered.
The emergence of 'evidence-based medicine' (as it was called) in the nursing profession is traced to the early 1980's, when the term was introduced in medicine for the first time. The evidence-based practice was used as an approach to practice in medicine that relied entirely on the scientific evidence to determine the most suitable practice approaches for the specific patients' scenarios. Later the term evolved to be referred as to evidence-based practice, and was extended to all professions within the field of medicine. Following the expansion and applications, all clinicians, rather than the physicians alone began to recognize the importance of evidence-based practice in their medical care provisions. Various definitions have been given to describe this practice. One of the earliest and most remarkable definitions is provided by Sackett, et al. (1996). They defined evidence-based practice as a conscientious, judicious, and explicit, utilization of the available current evidence in the practice scenario to make decisions concerning the care for individual patients. Melnyk & Fineout-Overholt (2011) summarized the components of evidence-based practice and its role in decision making in figure 1 below.
Figure 1: The Components of EBP (Source: Melnyk & Fineout-Overholt 2011, p. 4)
Based on the figure, there are two levels of evidence that can be used to inform clinical practice: external evidence and internal evidence. Understanding the premises of evidence-based practice in nursing research requires that we understand what is meant by the term 'evidence' as used in science. According to Melnyk & Fineout-Overholt (2011), external evidence in scientific research is generated through rigorous research through cohort studies or randomized-controlled trials. The findings of this evidence are to be generalized to the entire related settings to inform decision making and practice. When implementing the evidence from these researches, however, it is essential to determine whether or not clinicians and nurses can, on their own, achieve similar results in their individual clinical settings. Due to this transferability aspect, it is essential that the measurements of key outcomes are considered when implementing the changes in practice as informed by evidence. Comparably, the internal evidence is generated in all care scenarios and includes all instances of outcomes management, quality improvement projects and are aimed at improving the overall quality of clinical care and settings (Melnyk & Fineout-Overholt, 2011).
Part A: Importance of EBP for Nurses
Nurses play an instrumental role in the healthcare sector to improve the quality and conditions of the patients in clinical settings. Due to this important role, nurses must continue to ask one key question: what is the evidence to be used to improve the outcome of this intervention? Besides, the nurses should strive at all times to provide the best quality care to the patients. As Beyea & Slattery (2006) observes, the nurses are positioned sufficiently to identify the emergent and existing clinical problems and thus use the existing evidence to improve the outcomes of their interventions during practice. Besides, Beyea & Slattery (2006) observes that nurses have numerous opportunities in which they can question the rigor of the current nursing practices and use this evidence to provide high-quality care for their patients.
The primary concern of evidence-based practice in nursing scenario is to assist the nurses in providing high-quality care to patients and improving the patients' outcomes. These practices are guided by research rather than traditions, myths, through advice from colleagues and other outdated practice information. The nursing care scenario changes from time to time depending on the practice environment. This infers that the disease conditions and ways of handling them continue to change as well forcing the nursing practice to change compulsorily. Due to these, the information about these changes in the clinical and nursing practice environments must be available for the nurses to refer to before embarking on care provision. Due to the changes in the care environment, Mensik (2011) observes that the information learned in class, read in textbooks, reviewed during the nursing orientations as well as the myths and traditions of practice often become obsolete. This leads to demand for new information which captures the changes in the new practice environments.
A study by Mensik (2011) highlighted that the majority of nurses provide care based on their experience, information learned in school, etc. but rarely use the updated information from journals, research reports as well as from the hospitals' libraries. Coupled with Mensik (2011) observations that the average age of nurses in the healthcare setting is about 40 years, it is evident that the knowledge harbored by nurses regarding their work scenario and settings is obsolete or near obsolete. As a result, the quality of practice which is based on such obsolete knowledge cannot translate to the required level of quality regarding the patients' care. It is in this scenario that the evidence-based practices set in to provide critical and more informed strategies. The goal of this change is to ensure that the quality of care delivered to the patients is up to date and reflects the current practice scenario as well as the patients' conditions.
Houser (2008) study summarized the importance of EBP in nursing and within the healthcare scenario by pointing out six key benefits of the approach. These benefits include improving the patients' outcomes, contributing to the science of nursing, keeping nursing practice relevant to the current environment, and increasing the nurses' confidence in decision-making. Also, Houser (2008) noted that by using EBP, the nurses ensure that they comply sufficiently with the current policies and procedures based on the latest research findings. This assurance helps to support the JCAHO readiness index. Lastly, Houser (2008) study also observes that by integrating the EBP into the current nursing practice, the quality of care would be improved significantly and consequently, result in the improvement of the patients care quality.
Why nurses need to understand research methods to implement EBP correctly
The mistakes made in the healthcare scenario, however, small may result in fatalities thus must be avoided at all costs. Due to this, research and evidence-based practice are complementary to each other in a bid to deliver quality healthcare to the patients. Nurses are education to use their knowledge to guide research and decision-making in healthcare settings. Burns, Dudjak, & Greenhouse (2009) define nursing research as a systematic process of scientific inquiry that utilizes rigorous guidelines to produce trustworthy and unbiased responses to the questions raised during practice. Research helps to generate knowledge, or create new knowledge based on the changes in the practice environment. Through the researches, the healthcare professionals, including nurses understand newly generated knowledge and how they can be applied to benefit the patients (achieve the best evidence for intervention).
Evidence-based practice itself is regarded as a research area which is aided by the patients' values and the judgments from the clinicians with an aim to provide high quality and safer care. According to Burns, Dudjak, & Greenhouse (2009), evidence-based practice scenarios is where the knowledge generated through research is translated into real practice and utilized sufficiently at the bedside to generate better outcomes. As a result, knowledge of research methods would enable the effective infusion of the nurses' abilities to gather, interpret and apply evidence to nursing scenario effectively to deliver high quality and achieve improved intervention outcomes.
Nursing practice is often regulated by state acts which define the limits to which nurses can practice and exercise their duties and responsibilities. These scenarios also tend to delineate the differences in knowledge possession and acquisition by the nurses as well as their utilization in nursing practice. The general perception about nurses and their work is that they should work under the directives of the physicians. The American Nurses Association (ANA) maintains the universal definition of nursing by stating that nursing is the optimization, protection, promotion of the health and abilities, preventions of illnesses and injuries, alleviation of the people's sufferings by carrying out diagnoses, and the treatment of human responses as well as advocate for the care of families, individuals, the communities and populations to achieve an all-rounded care outcome (American Nurses Association, 2010).
The definition by ANA provided above highlights that the responsibility of the nurses is not limited only to carrying out tasks and responsibilities as ordered by the physicians. Rather, nurses are also required to carry out diagnoses and provide relevant and good quality treatment to all human responses. The nursing knowledge is created and disseminated by the understanding of what goes on in the care environment. This knowledge is primarily obtained through research. However, Mensik (2011) notes four other areas of creating and disseminating this knowledge. They include empirics, ethics, personal knowledge and experiences, and aesthetics. The empirics component is concerned with generation of knowledge through formal research. Mensik (2011) refers to this component of knowing in nursing as, 'the science of nursing.'
To generate adequate knowledge through research; therefore, nurses are required to conduct formal research such as randomized-controlled trials, cohort studies commonly used in nursing research. Consequently, to be able to conduct such researches in a sound and appropriate manner, it is important that the nurses have the relevant knowledge and understanding of the research methods as used in nursing science. This will help not only to understand the basis upon which the studies are conducted but also how the evidence generated should be applied to practice scenarios, where, when and under what conditions the evidence should be used as opposed to others. In this regard, therefore, knowledge of scientific research methods by nurses is essential for understanding and implementing EBP in healthcare scenario in the right way to achieve the necessarily quality and safety objectives.
How nurses are using EBP around the world
Case study: How nurses are using EBP approach to diagnose and manage Cellulitis in UK
Cellulitis is a highly spreading bacterial infection which affects the dermal and subcutaneous tissues. Cellulitis is caused by the bacteria called streptococci (especially two species of the bacteria - Streptococcus pyogenes and Staphylococcus aureus. In 2011, the number of people admitted to hospitals with cellulitis across the United Kingdom had increased by 77% in seven years. This led to an increase in funding for prevention and treatment of the disease from £172,000 in 2004 to £254,000 in 2011 (Nazarko, 2014). The community nurses play a key role in caring for the people who are affected by cellulitis in the United Kingdom and for those who express symptoms which reflect the disease. They carry out roles such as prevention, as well as referring the people suspected of having the disease for advanced diagnosis. Characteristically, cellulitis display similar symptomatic expressions as other conditions making diagnostic errors very common. Confusion of the disease with other conditions such as eczema, acute venous problems, and edema with blisters, etc. are commonly expressed.
In the United Kingdom, cellulitis is treated with penicillin (especially penicillin V administered orally and benzylpenicillin) (Nazarko, 2014). The treatment is majorly recommended and supported by evidence-based resources as well as practice guidelines which are modeled based on the evidence-based texts. The rationale for this use is based on the facts that penicillin is used to treat any streptococcal infections. Also, flucloxacillin is suitable for treating any staphylococcal infections. Despite this knowledge, Nazarko (2014) observes that some clinicians are sometimes unaware of the fact that flucloxacillin can also be effective for treating streptococci. Being responsible for community outreach and thus in charge of the initial identification of the disease, the community nurses need to keep to updated with the latest information of cellulitis to avoid misdiagnosis and thus incompatible treatment. Particularly, the community nurses need to investigate the literature to understand the emerging diseases which have similar symptomatic expressions as cellulitis to avoid misdiagnosis in the field. Use of evidence-based practice by community nurses and the clinicians in the United Kingdom to manage and treat cellulitis has borne fruits and is expected to achieve additional milestones.
Conclusion
Evidence-based nursing is a widely researched area in the present nursing literature due to the realization of its importance in disease management and treatment as well as improving quality of decisions made in clinical settings for improved quality of healthcare outcomes. The healthcare setting, like other sectors of the society, keeps changing from time to time. Also, the disease-causing microbes continue to adjust to resist drugs and display different symptomatic expressions. Nurses and clinicians need to keep themselves updated with the most recent information regarding the disease expressions and changes in treatment procedures to grant the best quality care services to the patients. To be able to utilize evidence-based practice effectively and improve quality of care outcomes, the nurses need to understand the research methodologies. Such understanding is essential to create, understand, interpret and implement the evidence generated to improve the overall quality and outcome of care. A case scenario has been provided in which the community nurses in the UK are using evidence-based nursing approaches to managing cellulitis in the region. This study therefore, confirms the position that nurses must understand the research methodologies used in research publications to implement EBP in their work scenarios effectively.
References
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