Fellow medical colleagues are an excellent source of evidence-based practice information and skills. Physicians, fellow nurses, and any other clinician with extensive experience, or even one who specializes in the area of interest, fall into this category. They can be long-term sources of information as well as mentors (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2017).
Patients can also be trusted sources of information if their preferences and values are influenced by their treatment outcomes.
Researchers who have delved into certain medical practice domains can help a nurse make evidence-based judgments, especially if their expertise is up to date and takes current changes in nursing practice into account. Some of my current nursing practices that aren’t evidence based include:
Administration of albuterol using a nebulizer for treatment of asthmatic children.
Occasional disruption of patients’ sleep to take vital signs which sometimes may not be so relevant in patient management and which may at times interfere with their recovery.
Frequent changes in intravenous dressings.
Those practices that are evidence based include:
Application of clinical guidelines in performing procedures such as drug preparation and administration.
Seeking counsel from other more experienced health care practitioners when dealing with sensitive issues relating to patients eg. Consulting psychiatrists when dealing with patients with mental or emotional problems.
The best time to question one’s current clinical practice is while delivering care to a patient. This is best done alongside other healthcare providers because it helps achieve greater autonomy in nursing practice as well as favorable healthcare and better treatment outcomes for patients.
Evidence based practice can be achieved if information used when making clinical decisions is sourced from:
Clinical practice guidelines
Information from clinical trials
Up to date research articles like journals, reports and periodicals.
Information from recent medical professional development forums such as seminars, workshops and continuous medical education.
Systematic reviews
Patient treatment outcomes can also serve as great evidence when answering clinical questions provided the information is representative of the total population of patients subjected to the same treatment strategies (Bernadette Mazurek Melnyk, 2011). Prior exposure of a patient to a given procedure or treatment criteria can help make a decision whether the same would benefit the patient or determine whether a change is essential.
There are several reasons why evidence based practice is not an integral part of my everyday encounter with patients. I handle my patients without going deep into clinical questioning because:
Lack of teamwork from fellow medical colleagues who could offer additional knowledge and counsel and act as EBP mentors.
Overwhelming workload that prompts me to work as per routines as there is limited time to consult on new developments.
Lack of up to date references in my clinical set up.
Ignorance in some areas of clinical practice.
Diminished investment in staff development strategies like seminars, workshops, fellowships, continuous medical education which could increase and update one’s knowledge base.
For me to attain deep skill in EBP and become a mentor to help others venture into the same a number of options are available for exploration both at an individual as well as organizational level. These include:
Attaining new knowledge and skills in EBP as well as embracing the relevant changes in practice.
Identifying and connecting with EBP mentors, those clinicians with advanced expertise in EBP.
Behavior change; doing away with routines and embracing new ways of clinical practice that are relevant and up to date
Championing for the necessary resources that support evidence based practice such as updated clinical guidelines and references as well as access to computer databases.
Establishing and maintaining a culture of practice based on evidence by creating opportunities that rekindle the passion to continue practicing based on evidence
References
Bernadette Mazurek Melnyk, E. F.-O. (2011). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice. Philadelphia, United States: Lippincott Williams & Wilkins.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2017). Igniting a Spirit of Inquiry: An Essential Foundation for Evidence-Based Practice. AJN, 109(11), 46-52.
