A Shift in Perspective

Evidence-based practice ... the "new" kid on the block.

A Shift in Perspective

Have you ever tried to change the ingredients in your mother’s chicken pot pie recipe and lived to hear the repercussions of such a malevolent crime? The answer is probably yes. But following what appears to be an act of treason from the perspective of your mother, you simply take it to the chin and pray that you never have the audacity to change any of your mother’s cooking again. You will proceed to eat the same pot pie that you have been accustomed since the age of 7 and your life will go on relatively unchanged for better or for worse. This, however, can not be spoken of in the same context of your nursing practice, and especially so when it comes to the concept of change.

Nursing Practice and Change

To attempt to change your mother's special pot pie recipe and fail miserably is the equivalent to a slap on the wrist. But to take the same approach to your practice is not only a tragedy, but an act of negligence that has the potential to do more harm than good. You see, almost every action that you perform as a nurse, and every thought you have towards an inquiry along the continuum of your critical thinking has been answered or proven in some way. Whether it be the type of fluid solution, antiseptic, medication to treat blood pressure, or the type of dressing to use for a wound, somewhere, somehow, it has been proven to either be effective or ineffective, shown to perform a certain mechanism that was previously unknown, and/or claimed to be the “gold standard” with 95% certainty. There are only two certainties with respect to the ways of knowing in nursing and in science, that is, objective truth and subjective truth. We simply do not play “pin the tail on the donkey” when it comes to answering a research question. The scientific method is employed, a hypothesis is created, an experiment is performed, and results are tabulated. This idea of “method” can be traced back to the Platonic era, in which truth was established using geometry and deductive reasoning [4].

Florence Nightingale and Change

Skipping ahead to the 19th century, we see the emergence of what is referred to today as “evidence-based medicine” and the beginning of a new era and approach to the practice of medicine and nursing. To speak about the concept of evidence-based medicine without first paying homage to the individual who began the conversation would be inappropriate [1].

Florence Nightingale, the face of nursing, and her contributions to the Crimean War in the mid-1800s, precipitated a change in perspective that we see today in the practice of nursing. If it wasn’t for Nightingale's astute eye, and perhaps outlook on her role in the grander scheme, it could be concluded that the number of casualties caused by the war would be far greater and topics such as asepsis and infection prevention would not be where they are today [1].

Fast forward to present day, and we literally have information at our fingertips. From RNAO Best Practice Guidelines to medical periodicals, peer-reviewed journals, etc. It would be ungrateful for us as a collective to do “what has always been done” and simply ignore a proven truth. While there are barriers that exist with respect to the implementation of evidence base(s) into practice, which include, but are not limited to nursing characteristics, organizational culture, and clinical context, there are ways to promote change [2].

Evidence-based practice is the new kid on the block. Underneath lies improved patient outcomes, a stepping stone for future research, improved cost savings, and equally as important, provides accountability and transparency within the decision making process [3].

Change is Constant

And with that said, the only constant here is change. Change in the way things are done. Just because something is ALWAYS done a certain way, it does not mean that it’s the right way to go about it. Owe it to yourself, and most importantly, your patient, to be up to date on the happenings around you. You will be better for it and so will the practice of nursing. We owe it to Nightingale.

References

References:
[1]Canadian Nurses Association. (2019). Evidence -Based Practice. https://www.cna-aiic.ca/en/nursing-practice/evidence-based-practice
[2]Canadian Nurses Association. (2019). Strategies to Promote. https://www.cna-aiic.ca/en/nursing-practice/evidence-based-practice
[3]anadian Nurses Association. (2019). Evidence Based Practice. https://www.cna-aiic.ca/en/nursing-practice/tools-for-practice/primary-care-toolkit/evidence-based-practice
[4]Stanford Encyclopedia of Philosophy. (2015). Scientific Method. https://plato.stanford.edu/entries/scientific-method/
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MBar1

About MBar1, RN

MBar1 is a Registered Nurse (RN) and specializes in Med/Surg.

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Specializes in Dialysis.

EBP isn't new, we were discussing that when I was in my ASN in the late 90s, then in my BSN program in early 2000s, then in my MSN program in 2015.

I love having the evidence to back up what we do in practice. Unfortunately, I've been around long enough to realize that nursing, and medicine, is not a one size fits all proposition. Many companies, insurers, and providers, focus on exactly what the data says and will only provide for that, when sometimes that answer does not work for every patient. Just my 2 cents...

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Specializes in Med/Surg.
3 hours ago, Hoosier_RN said:

EBP isn't new, we were discussing that when I was in my ASN in the late 90s, then in my BSN program in early 2000s, then in my MSN program in 2015.

I love having the evidence to back up what we do in practice. Unfortunately, I've been around long enough to realize that nursing, and medicine, is not a one size fits all proposition. Many companies, insurers, and providers, focus on exactly what the data says and will only provide for that, when sometimes that answer does not work for every patient. Just my 2 cents...

The practice of medicine lies on a continuum. An event that takes place within practice, and that changes an approach previously viewed as "best" means that the axiom by which previous thought and process was perceived has now ventured down a new path-one that is novel and continuously transfiguring based on the purpose it serves. So EBP is new, not relative to date of inception, but to the utility of the proposition that practice can be, and perhaps should be subjugated by the scientific method.

So the sentiment goes: EBP is another stop along the voyage to an effective and well equipped profession that services the public and the health of the population. Think about it; maybe one day healthcare, either the entirety or a sub component of it (perhaps palliation & end of life) could be based upon Greek dogmatic ideology-that could perhaps help navigate the grey areas of palliative care in relation to suffering, reality of life, and purpose. Who knows? But until then, the novelty of practice will continue to be predicated on the most relevant school of thought, from which, preceding approaches once reigned supreme,and were inevitably outgrown by a necessity for CHANGE.

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Specializes in Gastrointestinal Nursing.

Yes, one thing is for sure. . . change is constant. Medicine's evolution over the years has built on previous knowledge and has expanded on it. EPB is used in everything now, from charting to dispensing medications. It improves the quality of patient care, which is what we all want!

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