MEDICAL MYTHS AND TRUTHS

Two sentinel publications by the Institute of Medicine—To Err Is Human and Crossing the Quality Chasm (IOM, 2000; IOM, 2001)—drew attention to quality issues in U.S. health care (see Chapter 10). A major theme of both reports was that although the technology of health care had advanced at lightning speed, the delivery system had not advanced, causing potentially lethal situations in health care. One of the most common situations seen was the increased rate of hospital-acquired infections, and one of the proposed solutions to the improvement of care was the use of evidence-based decision making in health care.

Evidence-based practice requires a shift from the traditional paradigm of clinical practice grounded in pathophysiology and clinical experience to one of the integration of best practice and scientific evidence. This paradigm shift allows for the continuous improvement of practice and a creation of environments that stimulate innovation.

As a new nurse, there will be many times that you ask yourself, “Why do we do it this way?” Or “There must be a better way to do this.” For answers to these questions, you must look to the evidence. What does the evidence tell you? What is the best practice, or what is the best way to do this? Some of our standard practices are “sacred cows,” meaning they represent “the way it has always been done.” For instance, does every patient admitted to your unit need their temperature taken at 7 am? Perhaps not, but that is just the “way that we do it” or perhaps that was the “best practice” when the policy was implemented. But what does the evidence (scientific data) tell us today? As nurses, it is important that you remain current within your practice area, because the evidence is always changing and growing. Estabrooks (1998) and Pravikoff et al. (2005) found that knowledge sources most frequently used by nurses were school experiences and colleague experience. Assuming that this is the case, a nurse with 15 years of experience may be using “evidence” that is 15 years out of date, and this experienced nurse who is mentoring new nurses may be fostering practice in the new nurse that is 15 years out of date. A colleague of this author once said that “health care was a long history of tradition unimpeded by progress”—the move to evidence-based practice is changing this.

DECISION-MAKING MODEL

Evidence-based practice is a decision-making model based on the “conscientious, explicit and judicious use of current best practice in making decisions about the care of individual or groups of patients” (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). “This practice requires the integration of individual clinical expertise with the best available external clinical evidence from systematic research, available resources, and our patient’s unique values and circumstances” (Sackett et al., 1996). This definition requires nurses to carefully and thoroughly integrate evidence into their practice. But how do they do this?

This new paradigm of evidence-based practice requires the development of a clinical inquiry approach. Nurses must ask themselves the following questions and not blindly accept standard practice (Salmon, 2007):

RESEARCH UTILIZATION

Evidence-based practice differs from research utilization. Research utilization is the process of using research-generated knowledge to make an impact on or a change in existing practices (Burns and Grove, 2007). Evidence-based practice requires synthesizing research study findings to determine best research evidence. Research evidence is a synthesis of high-quality, relevant studies to form a body of empirical knowledge for the selected area of practice. The best research evidence is then integrated with clinical expertise and patient values and needs to deliver quality, cost-effective care (Sackett et al., 2000).

POPULATION, INTERVENTION, COMPARISON INTERVENTION, OUTCOME (PICO)

A framework for formulating evidence-based questions is PICO (Population, Intervention, Comparison Intervention, Outcome). Box 4-1 describes the focus of the PICO question.

In health care organizations, there may be many triggers that initiate the need for change. They can be data driven, resulting from performance review data, risk management data, benchmarking data, and financial data. Or they can be knowledge driven, resulting from new research findings, change in regulatory guidelines and standards, or questions from practitioners.

As a nurse manager, your role will be in the promotion and implementation of evidence-based practice in your organization. The Iowa Model of Evidence-Based Practice provides direction for the development of evidence-based practice in a clinical facility (Figure 4-1).

This model of evidence-based practice can be used as a guide for implementing a research-based protocol. The steps in this model are to:

SUMMARY

As a new nurse entering the profession, it is imperative that you maintain currency within your profession. Here are some strategies for using research evidence in your own practice:

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