Implementing Evidence-Based Nursing Practice

Teri Britt Pipe; Kay E. Wellik; Vicki L. Buchda; Carol M. Hansen; Dana R. Martyn

Disclosures

Urol Nurs. 2005;25(5):365-370. 

In This Article

Evidence-Based Nursing Practice

Nursing has a strong tradition of focusing on various ways of knowing to provide excellent care. Carper (1978) identified four fundamental patterns of knowing in nursing: empiric, ethics, personal, and aesthetic patterns. More recently, Fawcett, Watson, Neuman, Walker, and Fitzpatrick (2001) updated and applied Carper's theory. Empirical knowing relates to factual descriptions, explanations, and predictions. Ethics refers to moral obligations, values, and desired ends. Personal knowing pertains to the genuine transpersonal relation between each nurse and each patient. Aesthetic knowing shows the nurse's perception of what is significant in the patient's behavior and also addresses the artful performance of nursing skills and ways of being. All these ways of acquiring, processing, reflecting, and evaluating nursing knowledge are important in developing a comprehensive clinical perspective. Evidence-based practice explores the empiric way of knowing, focusing on Methods of critically appraising and applying available data and research to understand and inform clinical decision-making better. Although it clearly is not the only way of knowing, evidence-based practice provides a way to frame and address questions about how to provide the best patient care. For the Purpose of this article, the following definition of evidence-based practice has been selected: "the integration of best research evidence with clinical expertise, and patient values" (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000, p. 1). This definition highlights the importance of combining the best available evidence with clinical judgment, and emphasizes a pivotal role for patient-centered care.

Nurses face a real challenge when translating best evidence into clinical practice. For example, the relevant research-based databases are not comprehensive in many areas. Also, there is an ongoing explosion in the amount and type of information available. Time constraints are inherent in clinical practice, and they are exacerbated by increasing demands for nursing care. A need also exists for accurate and systematic ways to make inferences from the research as applied to particular patient populations (Craig & Smyth, 2002).

Bridging the gap from research to clinical practice can be accomplished by multiple means. One of the most common is incorporating evidence-based research into an organization's policies and procedures (Craig & Smyth, 2002). However, several operational issues arise. First, numerous small studies have been published in the nursing literature, and evaluating studies for scientific merit can be a large task. In some cases, published guidelines can help reflect national standards and minimize this task. Second, although policies can be changed to reflect current guidelines (developed from the evidence), the critical issue becomes the actual change in nursing practice to reflect evidence-based research. For example, the traditional method for verifying the placement of a nasogastric tube was air insufflation. However, according to current nursing research, the accurate method for verifying placement is radiologic examination (Metheny & Titler, 2001).

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