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Evidence-based nursing explained THE EFFECTIVE integration of evidence, including research, into clinical decision making should be central to nursing practice and meeting patients’ needs. Using the best available evidence to deliver high standards of care at all times is a core standard in the code of conduct (Nursing and Midwifery Council 2007). The essentials Evidence-based practice (EBP) and evidencebased nursing (EBN) have a range of meanings; differences often relate to the value placed on the different types of evidence that can inform practice. The most widely cited definition of EBP is rooted in evidence-based medicine (EBM), defined as ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients’ (Sackett et al 1996). This definition emphasises the value of clinical expertise, appraising the best available clinically relevant research and the patient’s individual circumstances and preferences. When considering the most effective treatment, the best evidence will be from a synthesis of well-conducted randomised controlled trials (RCTs). However, despite the hierarchies of evidence developed from EBM, this form of evidence is not always available to answer every clinical question. Although there is no single accepted hierarchy of evidence, typically evidence reflects biomedical research, with systematic reviews and meta analyses of RCTs ranked as the highest form (Figure 1). Figure 1 Example of a hierarchy of evidence Systematic review of multiple welldesigned randomised controlled trials One well-designed randomised controlled trial Trial without randomisation, cohort study, case-control study Non-experimental studies from more than one centre or research group Descriptive studies, expert opinions, committee reports (Adapted from Gray 1997)
12 February 2014 | Volume 26 | Number 1
There are problems aligning EBN with medicine. Nursing and nursing care remains under-researched, and nurse researchers have typically adopted qualitative methodologies as they often focus on the meaning of ill health for the individual and the complexities of everyday nursing practice. An alternative definition of evidence-based health care developed by nurses for nurses may be more helpful. EBN is ‘an ongoing process by which evidence, nursing theory, and the practitioner’s clinical expertise are critically evaluated and considered, in conjunction with patient involvement, to provide the delivery of optimum nursing care for the individual’ (Scott and McSherry 2009). This definition emphasises the need to critically evaluate the practitioner’s judgement and research. Children’s nurses should base their clinical decisions on a range of evidence and their professional judgement to help solve issues that arise when caring for children, and find ways to involve the child, young person and family in decision-making processes. EBN is not a new concept but, with increased financial pressures and even greater scrutiny of the way care is delivered, it will remain a driver in contemporary health care. There are advantages and challenges to embracing EBN. It is a continual cycle of critically evaluating established and new evidence, including research, and nursing practices. The challenges of implementing EBN are wide ranging and require children’s nurses to engage with, support and deliver it. While continuing personal and professional development can help nurses acquire the skills to appraise evidence and evaluate practice, management and leadership expertise are central to developing a comprehensive nursing evidence base, and embed EBN in the workplace. Key messages ■■ EBN should draw on the professional’s clinical experience, knowledge and the best available evidence. ■■ Clinical practices become outdated if new evidence is not sought, appraised and integrated in practice.
Geek speak Case-control study Often used in epidemiological research to identify factors that may contribute to developing a disease by comparing individuals who have the disease (cases) with those who do not (controls). For example, a study to investigate if vaccination is associated with increased risk of autism. Cohort study Large groups of individuals or cohorts are followed over time. The study describes those who develop a specific disease and those who do not, analysis is carried out and possible links (cause and effect) to developing the disease are explored. This research differs from case-control studies because all participants are disease free at the outset. For example, a prospective cohort study to identify early life risk factors for obesity in older children. Randomised controlled trial (RCT) A prospective cohort study, but the intervention is assigned by the researcher. The important features are that the study is experimental, participants are assigned randomly to one of two groups: those receiving and those not receiving treatment. For example, an RCT of the effects of a nurse-led home visiting programme on infant health.
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Research essentials
References Gray MJA (1997) Evidence-Based Health Care: How to Make Health Policy and Management Decisions. Churchill Livingstone, London. Nursing and Midwifery Council (2008) The Code. Standards of Conduct, Performance and Ethics for Nurses and Midwives. NMC, London. Sackett DL et al (1996) Evidence based medicine; what it is and what it isn’t. British Medical Journal. 312, 7023, 71-72. Scott K, McSherry R (2009) Evidence-based nursing: clarifying the concepts for nurses in practice. Journal of Clinical Nursing. 18, 8, 1085-1095.
Joanna Smith, senior lecturer in children’s nursing, University of Huddersfield, and Julia Cappleman, senior lecturer in children’s nursing, University of Salford, on behalf of the RCN’s Research in Child Health network’s core community NURSING CHILDREN AND YOUNG PEOPLE
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Evidence-based nursing explained THE EFFECTIVE integration of evidence, including research, into clinical decision making should be central to nursing practice and meeting patients’ needs. Using the best available evidence to deliver high standards of care at all times is a core standard in the code of conduct (Nursing and Midwifery Council 2007). The essentials Evidence-based practice (EBP) and evidencebased nursing (EBN) have a range of meanings; differences often relate to the value placed on the different types of evidence that can inform practice. The most widely cited definition of EBP is rooted in evidence-based medicine (EBM), defined as ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients’ (Sackett et al 1996). This definition emphasises the value of clinical expertise, appraising the best available clinically relevant research and the patient’s individual circumstances and preferences. When considering the most effective treatment, the best evidence will be from a synthesis of well-conducted randomised controlled trials (RCTs). However, despite the hierarchies of evidence developed from EBM, this form of evidence is not always available to answer every clinical question. Although there is no single accepted hierarchy of evidence, typically evidence reflects biomedical research, with systematic reviews and meta analyses of RCTs ranked as the highest form (Figure 1). Figure 1 Example of a hierarchy of evidence Systematic review of multiple welldesigned randomised controlled trials One well-designed randomised controlled trial Trial without randomisation, cohort study, case-control study Non-experimental studies from more than one centre or research group Descriptive studies, expert opinions, committee reports (Adapted from Gray 1997)
12 February 2014 | Volume 26 | Number 1
There are problems aligning EBN with medicine. Nursing and nursing care remains under-researched, and nurse researchers have typically adopted qualitative methodologies as they often focus on the meaning of ill health for the individual and the complexities of everyday nursing practice. An alternative definition of evidence-based health care developed by nurses for nurses may be more helpful. EBN is ‘an ongoing process by which evidence, nursing theory, and the practitioner’s clinical expertise are critically evaluated and considered, in conjunction with patient involvement, to provide the delivery of optimum nursing care for the individual’ (Scott and McSherry 2009). This definition emphasises the need to critically evaluate the practitioner’s judgement and research. Children’s nurses should base their clinical decisions on a range of evidence and their professional judgement to help solve issues that arise when caring for children, and find ways to involve the child, young person and family in decision-making processes. EBN is not a new concept but, with increased financial pressures and even greater scrutiny of the way care is delivered, it will remain a driver in contemporary health care. There are advantages and challenges to embracing EBN. It is a continual cycle of critically evaluating established and new evidence, including research, and nursing practices. The challenges of implementing EBN are wide ranging and require children’s nurses to engage with, support and deliver it. While continuing personal and professional development can help nurses acquire the skills to appraise evidence and evaluate practice, management and leadership expertise are central to developing a comprehensive nursing evidence base, and embed EBN in the workplace. Key messages ■■ EBN should draw on the professional’s clinical experience, knowledge and the best available evidence. ■■ Clinical practices become outdated if new evidence is not sought, appraised and integrated in practice.
Geek speak Case-control study Often used in epidemiological research to identify factors that may contribute to developing a disease by comparing individuals who have the disease (cases) with those who do not (controls). For example, a study to investigate if vaccination is associated with increased risk of autism. Cohort study Large groups of individuals or cohorts are followed over time. The study describes those who develop a specific disease and those who do not, analysis is carried out and possible links (cause and effect) to developing the disease are explored. This research differs from case-control studies because all participants are disease free at the outset. For example, a prospective cohort study to identify early life risk factors for obesity in older children. Randomised controlled trial (RCT) A prospective cohort study, but the intervention is assigned by the researcher. The important features are that the study is experimental, participants are assigned randomly to one of two groups: those receiving and those not receiving treatment. For example, an RCT of the effects of a nurse-led home visiting programme on infant health.
iStock
Research essentials
References Gray MJA (1997) Evidence-Based Health Care: How to Make Health Policy and Management Decisions. Churchill Livingstone, London. Nursing and Midwifery Council (2008) The Code. Standards of Conduct, Performance and Ethics for Nurses and Midwives. NMC, London. Sackett DL et al (1996) Evidence based medicine; what it is and what it isn’t. British Medical Journal. 312, 7023, 71-72. Scott K, McSherry R (2009) Evidence-based nursing: clarifying the concepts for nurses in practice. Journal of Clinical Nursing. 18, 8, 1085-1095.
Joanna Smith, senior lecturer in children’s nursing, University of Huddersfield, and Julia Cappleman, senior lecturer in children’s nursing, University of Salford, on behalf of the RCN’s Research in Child Health network’s core community NURSING CHILDREN AND YOUNG PEOPLE
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 14, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
