EBP and Nursing Research

[Tait, MSN, RN]

In my current MSN advanced research class we are discussing Evidence Based Practice (EBP) and nursing research. As an ADN student I remember nursing research being discussed as a sort of "oh that is what the BSN's do" topic. I remember thinking about how there must be this magical room out there somewhere where BSN's were busy researching things.

When I started working at a Magnet hospital (one of those Magnet hospitals that actually uses the idea not just for promotion) I noticed EBP being used a lot. Every policy we put forth to the floor was always labeled as EBP.

Before I go any further into describing my recent experiences with nursing research and EBP I would like to know how other people view these topics. Does EBP mean anything to you? Do you know the difference between nursing research and EBP?

I would love to hear others experiences with EBP and nursing research from the ADN, diploma, BSN, and MSN educated folks out there. I have to say this class has really opened my eyes to exactly how these practices integrate into patient care and wonder if perhaps education on these topics is lacking in ADN training or if I just spaced out that day.

Tait

PS. If anyone screams "homework" on this post I will start posting very ugly pictures of wounds with titles like "Pretty kitties" or "Giggling babies!" I will also assume you didn't actually read but the first few lines of my post.

[Altra, BSN, RN]

I think that EBP is a throwaway term that makes us look silly to other academic disciplines.

Yes, really.

How do you evaluate the quality of research in any field? By examining the statistical methods used, and the quality (breadth, depth) of the data investigated.

But too often in nursing, we throw around the EBP term as if we're beating our chests saying, "this conclusion is based on actual research, not just pulled out of thin air!"

[canesdukegirl, BSN, RN]

Let me make sure that I am understanding you because you and I both slept through that during school!

EBP means that data has been collected and the data has proven to increase positive outcomes for patients. This data is then implemented into our nursing practice, yes?

Off the top of my (foggy) head, I can think of a few things:

IS use in post op patients to increase tidal volume.

Scrub time pre-op

Actual scrub detergents used

Adequate padding to protect nerves during intra op procedures

Am I totally off base? I am not sure what you are looking for...

[Tait, MSN, RN]

Let me make sure that I am understanding you because you and I both slept through that during school!

EBP means that data has been collected and the data has proven to increase positive outcomes for patients. This data is then implemented into our nursing practice, yes?

Off the top of my (foggy) head, I can think of a few things:

IS use in post op patients to increase tidal volume.

Scrub time pre-op

Actual scrub detergents used

Adequate padding to protect nerves during intra op procedures

Am I totally off base? I am not sure what you are looking for...

No you got it Canes. Basically a problem is isolated and supported by nursing research which then is converted into a practice that can be implemented like the ones you listed! You get an A!

[Altra, BSN, RN]

No you got it Canes. Basically a problem is isolated and supported by nursing research which then is converted into a practice that can be implemented like the ones you listed! You get an A!

That is basically the same line I got in 2 different classes related to research in my BSN curriculum, AND with the deletion of the word "nursing" ... the same definition given in a research/statistical methods class for my business degree.

And that is my problem with this (IMHO) silly "evidence based practice" term.

[Tait, MSN, RN]

That is basically the same line I got in 2 different classes related to research in my BSN curriculum, AND with the deletion of the word "nursing" ... the same definition given in a research/statistical methods class for my business degree.

And that is my problem with this (IMHO) silly "evidence based practice" term.

I am finding your post difficult to understand. Are you offended by the term or the idea of supporting practice with evidence? Is there another term you think would better suffice? Do you feel it is silly for nursing to assign itself a term for this practice?

[Altra, BSN, RN]

No, I'm not offended by the principle of using evidence to guide practice, thanks.

I find the terminology silly. Quality practices/decision-making in any field are of course based on evidence/conclusions validated by quality research.

Again, maybe I'm making a poor attempt at humor, but when I hear that phrase my temptation is to reply, "ooohh ... evidence-based practice as opposed to ... pulling something out of thin air/your backside/idiom of your choice?"

[Altra, BSN, RN]

Do you feel it is silly for nursing to assign itself a term for this practice?

Yes, I feel it is silly for nursing to assign itself a term for this practice.

[canesdukegirl, BSN, RN]

So Altra, just so I am clear on your thought process-you think that it is silly to term "evidence based practice" because it is a redundant phrase? Like a practice wouldn't be implemented if it wasn't researched first?

One of the surgeons that I work with HATES the term "past medical history". He thinks that it is redundant. "History" is in effect "past" and he can't stand to hear the phrase.

[Altra, BSN, RN]

I think it's a bit more than the redundancy, canes ... just another symptom of a larger nursing identity crisis/self-esteem issue. But that's a whole other thread.

Love the PMH example! :)

[HouTx, BSN, MSN, EdD]

In my part of the world, the term 'EBP' is used by all clinical disciplines, not just nursing. Here's how we operationalize it. Each of our policies and procedures must include relevant references which indicate the reason we are proscribing a certain intervention or action. Regular review of each P&P now includes updated review of EBP - anything new since the last review. My organization subscribes to online services that provided an automated review of clinical research, so it isn't very time consuming.

Our standardized order sets are all EBP-based. This has been the most difficult transition - maybe nurses are more flexible and willing to change than docs??

As an educator, I incorporate EBP into my own practice. It comes as a real shock to most nurse educators when they discover that some of the most widely accepted educational practices and theories (e.g. Knowles) have absolutely no (research based) evidence behind them -they are just blindly accepted because it is what we were taught.

I say Hooray for EBP!!!! Anyone else old enough to remember when we were taught to do Foley care with betadine ointment?? ... YIKES

[llg, PhD, RN]

Nursing did not originate the use of the "evidence-based practice." Other disciplines have emphasized these principles for years. In health care, Dr. Archibald Cochrane was the leader who brought the terminology into vogue as he advocated for "Evidence-Based Medicine."

So ... the belief that EBP is some fad developing out of an identity crisis in nursing, or some inferiority complex does not reflect the true history of the EBP movement.

Also, the contention that nursing has always based its practice on a proper review of the evidence is simply wrong. You'd be surprised how many of our standard practices are based on shaky information and minimal research. Much is still based on tradition, personal opinion, and a few anecdotal reports.

The EBP movement is a push for the systematic and objective review of evidence -- and many nurses are unprepared to evaluate evidence properly. Even many BSN programs do a poor job of teaching how to evaluate all types of evidence. That's one of my biggest pet peeves. BSN programs include research and theory courses, but many of them are not taught well and are not taught at the level of rigor that they need to be or with the focus on the types of knowledge and skills neede by the typical nurse. For example, many research courses focus on "how to write a research proposal" -- when in reality, few nurses with only a BSN will be responsible for writing research proposals. The class time would be much better spent learning how to do a good review of evidence.

I'll stop now. I could go on and on about this topic forever.