Evidence-Based Practice...your thoughts

CompleteUnknown · Apr 25, 2012

What do you think of this move toward Evidence-Based Practice in nursing? Has your place of worked pushed you to integrate EBP into your patient care? It is a hot topic and my school is really advocating for EBP, stating if you do not perform EBP, you are guilty of performing malpractice.Do you agree with this?

The more I think about this, the more I think it's unfortunate your school is suggesting that there is a 'move' towards EBP - as if the concept is something new. It seems to be suggesting that it's only very recently that nurses have been interested in knowing that there's a reason for what they're doing, and considering whether or not what they do is beneficial and of proven benefit.

As you can see from the responses so far, it's not something new, it's always been there. I think your instructor's statement 'if you do not perform EBP, you are guilty of malpractice' is meant to make you think and question what you see and do, but it's a very provocative way of approaching the topic. I see more and more students who seem to almost expect to find outdated or poor practice (some even go looking for it) and are surprised if they find 'best practice' - this can only lead to conflict between students and working nurses.

NicuGal, MSN, RN · Apr 25, 2012

Everything we practice is evidence based if you think about it. It really is the best practice and if your protocols are written to EBP then if you don't follow them, yes, you are liable.

mindlor · Apr 25, 2012

A really good example is backflushing the secondary tubing into an empty piggyback bag then reusing the secondary tubing set again for tthe next piggyback as long as the primary fluid is compatible, of course.

Evidence says its all good and will reduce BSI. reduce cost, etc....

Many of the senior nurses on my floor however refuse to reuse secondary tubing no matter what....

mindlor · Apr 25, 2012

yet another example is scrubbing the hub......new evidence says that one should scrub for 10-15 secs and let dry an equal time before hooking up.

The old-schoolers give it a one microsecond once over and hook up so fast all they are doing is spreading the bacteria around......

So.........

Even more is dressing changes........many of the dressing changes that I was taught to do using sterile technique are done in my hospital using clean technique. The claim is that doing them sterile did not significantly effect client outcome......

The list goes on and on

mrmedical, ASN, BSN · Apr 26, 2012

I agree that it is probably the new "buzz" as previous posters had said. I don't have any qualms with it other that it seems a little pretentious. I just hope that it doesn't devovle nursing or medicine in to some brain dead step-by-step check list or "this-or-that" type of care administration and kill off good interventions or creative solutions to problems because they're not EBP(TM) approved yet.

llg, PhD, RN · Apr 26, 2012

EBP is something we SHOULD have been doing all along. However, we have NOT actually been doing it consistently or well.

If you get beyond the introductory level of EBP, you'll see that it involves a much more rigorous consderation of the the evidence -- both research evidence and non-research evidence -- than has been typically done in the past. Think about it ... a large percentage of the nursing population doesn't even take a research class in school. They don't have the knowledge to understand / evaluate many of the research articles out there. Lots of nurses only "skim over" the statistics and other technical elements within a research article because they either don't understand it or don't value it.

In reality, many (most) decisions have been made (and policies written) without a rigorous literature review. At best, there is a cursory look at a few recent articles chosen because they are readily available. In other words, they don't really evaluate the quality of the articles of the articles they read -- they either accept them or not based on whether it seems reasonable to them. ("Yeah, that sounds like a good idea. Let's try that.")

Having a formal EBP process in place is forcing people to do a better job of living up to the standards we always said we believed in. EBP is not perfect. It has its limits. But for most clinical settings, it's a big step forward.

Vespertinas · Apr 26, 2012

We had an EBP unit-based council. It was in full swing during our magnet evaluation 2 years ago....

Really though, I was into it.

Esme12, ASN, BSN, RN · Apr 26, 2012

A really good example is backflushing the secondary tubing into an empty piggyback bag then reusing the secondary tubing set again for tthe next piggyback as long as the primary fluid is compatible, of course.
Evidence says its all good and will reduce BSI. reduce cost, etc....
Many of the senior nurses on my floor however refuse to reuse secondary tubing no matter what....

I have back flushed IVPB for years.......maybe it is the just the nurses that you work with that are reluctant to embrace change

skylark, BSN, RN · Dec 29, 2013

I know this is an old thread, but I wanted to pick up some thoughts on here.

Evidence based practice in wound care . . .

all the evidence supports ending WTD gauze as it simply does not tick any boxes in terms of the requirement of a dressing.

temperature control

antimicrobial barrier

stabilize pH

long wear time to reduce trauma of adhesive dressing removal

appropriate use of nurse's time

hold exudate away from skin

etc

So why is it still out there?

I'm in a new job where we are expected to do WTD, evidence says no, what do I do??

rnmi2004 · Dec 30, 2013

I agree with other posters -- it's nothing new. However, in my relatively short time as a nurse, I've seen some practices come and go that turned out to be based on shaky evidence.

Remember beta-blockers for all perioperative patients?

How about uber-tight glycemic control?

There & gone within a few months. Remember, the studies claiming to show evidence of benefit may later turn out to be flawed or not beneficial to a larger patient population.

TiffyRN, BSN, PhD · Dec 30, 2013

I remember the cardiologists checking patient's ears for a fold as an indicator of heart disease. Turns out it's merely a correlation due the the tendency of obese patients to have earlobe folds and obesity is a risk factor for CAD, not earlobe folds. I remember all the cardiac patients getting vitamin C & E supplements until they figured out these (at the high doses recommended) were detrimental to the cardiac patients. Also all post-op CABG patients getting Vioxx or Celebrex (for post-op pain control) until you know, they found out these drugs actually increase risk of death for cardiac patients.

But still, I support well-documented use of research to guide practices. In the above cases, conclusions were drawn from other studies that made the practitioners come to conclusions but the actual practices had not been tested until later.

Also GrnTea; you mentioned a book called "Ritualistic practices in Nursing" and I tried to google it. I got "Nursing and ritualistic practice" by Walker. Is this the book? I'm interested in reading the book you described.

Thanks!

nurseprnRN, BSN, RN · Dec 30, 2013

Yep, that's it, and there's a follow-up book that goes with it. Both of them ruined me for life :) since after reading them I always wanted to know why we did (whatever).