• Choose a category
• All
• Classic-Fiction

By Root 1636 0

and practice and nurses must justify their rationales for practice. Where historically, nursing and specifically clinical procedures were based on rituals rather than research (Ford and Walsh 1994, Walsh and Ford 1989), evidence-based practice (EBP) now forms an integral part of practice, education, management, strategy and policy. Best Research for Best Health (DH 2006b) outlines a health research strategy to ensure practice is underpinned by world-class research. Building research evidence that ranges from prevention of ill health, promotion of health, disease management, patient care, delivery of healthcare and its organization to public health and social care is essential in striving to improving health (DH 2006b). Critical appraisal of research and evidence is also essential for healthcare staff to understand and appropriately carry out evidence-based practice.

Nursing care must be appropriate, timely and based on the best available evidence. NHS staff now have open access to these resources to facilitate EBP, which increases the likelihood of the care that is delivered to patients being based upon evidence of what works (Rycroft-Malone et al. 2004a). Defining and exploring the concept of EBP should help to further clarify the expectations that nurses now have to meet.

What is evidence-based practice?

This has been described by Sackett, a pioneer in introducing EBP in UK healthcare, as:

… the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

(Sackett et al. 1996, p.72)

Despite the emphasis on research in EBP, it is important to note that where research evidence is lacking, other forms of evidence can be equally informative when making decisions about practice. Evidence-based practice goes much wider than research-based practice and encompasses clinical expertise as well as other forms of knowing, such as those outlined in Carper’s seminal work (1978) on nursing. These include:

empirical evidence

aesthetic evidence

ethical evidence

personal evidence.

This issue is evident throughout this manual where clinical expertise and guidelines inform the actions and rationale of the procedures. Indeed, these other types of evidence are highly important as long as we can still apply scrutiny to their use. Porter 2010 describes a wider empirical base upon which nurses make decisions and argues for nurses to take into account and be transparent about other forms of knowledge such as ethical, personal and aesthetic knowing, echoing Carper 1978. By doing this, and through acknowledging limitations to these less empirical forms of knowledge, nurses can justify their use of them to some extent. Furthermore, in response to Paley’s 2006 critique of EBP as a failure to holistically assess a situation, nursing needs to guard against cherry-picking, ensure EBP is not brandished ubiquitously and indiscriminately and know when judicious use of, for example, experiential knowledge (as a form of personal knowing) might be more appropriate.

Greenhalgh (2002), another EBP pioneer, describes later developments in the evidence-based medicine (EBM) and EBP movement and how intuitional and clinical knowledge was allowed its place.

Medicine and nursing have undoubtedly been shaped in recent years by the move toward EBP and the pressure to revisit and review practice regularly. Traynor (2009) discussed how nursing, as well as lower status groups in medicine, embraced the shift to EBP as an exercise in the 1990s and suggested that this may be in part due to nurses’ status as a profession and the subsequent desire to acquire technical knowledge. Regardless of what the impetus has been for nursing to adopt EBP as integral to its practice, the use of evidence is now widespread, expected and accepted practice.

Evidence-based nursing (EBN) and EBP are differentiated by Scott and McSherry (2009) in that