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Evidence-Based Practice...your thoughts


Specializes in Med-Surg, NICU. Has 5 years experience.

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?

Edited by Joe V

Can you give some examples of current nursing interventions that are not evidence based? What is being practiced in your clinicals by licensed RNs that is considered malpractice by your school? I am an ICU nurse and our practice is hopefully completely evidence based. Do tell more.

Basically, EBP has been around all along, we just didn't call it that. For example, we've been taught for years that early ambulation prevents pneumonia and DVT after abdominal and other surgeries. Now, there is studies and research to actually back that theory up, hence EBP

RNperdiem, RN

Has 14 years experience.

Our hospital has a nursing practice committee which writes our nursing policies/procedures/protocols.

Practices change over time because of evidence based nursing.

I remember when pain scales were introduced, concentrated potassium vials disappeared, and a whole new skin care policy based on the latest research was started.

The way I practice nursing today is not the same way I practiced 14 years ago.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

I can't stand the term -- I think it's meaningless. Any clinical practice -- the latest and greatest gold standard or the very dubious -- I can probably find you some study, some evidence -- that it's best. And if you practice long enough you will find returns to "old" practices based on "new" evidence. :smokin:

I'm a bit inclined to agree with Altra.

EBP has always been around, just not called that and perhaps the studies hadn't been done as rigorously or 'correctly' as would be insisted upon today.

Anecdotal evidence is sort of frowned upon now but years of anecdotal evidence all pointing the same way does show something.

I find that often you're still going to be fighting facility policy which states 'you shall do x' when x has been shown to be unnecessary or of no benefit. It's usually not the nursing staff fighting to retain outdated practices. It's true that there's sometimes some resistance to new practices though.

Best practice, current guidelines, call it what you will, it doesn't necessarily mean that anything outside the guidelines is harmful. Guidelines become rules far too quickly in my experience and you run the risk of suddenly finding that what was fine in the vast majority of circumstances has now become unacceptable in all circumstances. It gets silly all too easily.

There's a certain amount of 'we've always done it this way' in every field - we do need to keep in mind that sometimes it's always been done that way because it works.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 40 years experience.

i think the term "evidence based practice" is just the newly coined "buzz" word. just like we used ami for acute mi and now it's stemi (whatever:cool:)......they are both heart attacks with ekg changes that include st elevation. there will always be the new "buzz" words out there making it the "new and improved" something or other........bu the fact remains, nursing has always had the "approved and best" practice developed into policy and procedure as the "standard". these standards were the tried and true ways to care for the patient and they were the standard to be followed and taught to students on how to care for the patient safely and properly.

these practices became the "golden rule" on how to care for patients that any "reasonable and prudent" practitioner would use in the care for the patient to maintain safety and consistency. someone came along and said......."prove it"......and so someone said "ok"......and so, they did studies and proved why it was the best way to do something......tada!!......evidence based practice. then they figured out that if they published and charged people they could make money off the stuff we already knew and give it a fancy name. bingo! evidence based practice....can you imagine the new jobs that were created when the government developed the ahrq........agency for healthcare research and quality (ahrq) who is the lead federal agency charged with improving the quality, safety, efficiency, and effectiveness of patient quality and care that is a branch of the us department of health and human services. (another bureaucracy)

evidence-based practice health care: evidence-based practice subdirectory page

as far as calling it "evidence based practice",whatever, it's the new buzz word. as far as having a standard of care.....yes it's necessary to keep patient care safe and practiced similar across the board......and we have done it for years. they are kind of like the nursing care plans for all. every profession has a standard that you should be measured by. variances are better tolerated in other professions. we are dealing with people lives. there has to be an approved method to their care that is safe and sound. if everyone was allowed to do whatever they want there would be no consistency nor safety for the patients entrusted to our care. anyone who goes rogue and decides they are going to do whatever they wish should be held accountable and is malpractice.....you are acting outside the rules. if you hurt someone you should be sued and loose your license. it's that simple.

there are rules to playing this game and they must be followed......there are people lives at stake.

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator.

Yes, I "believe" in it, just like Florence Nightingale did > 100 years ago. Whenever I write policies I reference the evidence. Whenever I teach I reference the evidence. Staying on top of the evidence thru journals, etc is what makes us professional.

It is not necessary to change. Survival is not mandatory - E. Edward Deming

there's a nifty little book called "ritualistic practices in nursing" (you can google it) that may make you change your mind. nothing new under the sun.

and when i went to nursing school in nineteen-smumblemumble and in grad school a decade later, our faculty called it evidence-based practice.

HouTx, BSN, MSN, EdD

Specializes in Critical Care, Education. Has 35 years experience.

In my organization, we have specific EBP standards that must be followed to create/modify any clinical policies, procedures or guidelines. Each document must have references - since they are all online now, these are embedded as links. We are also integrating EBP references into our electronic charting system to provide real-time decision support.

My clinical educators have also adopted EBP - to ensure that instructional design, test construction, competency assessment, curriculum, etc. is congruent with current professional education practice rather than "that's the way we have always done it" design.

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

Yup, EBP is here to stay. We use it everyday in hospice.

im only in my 1st year of nursing. i find EBP has it's place in nursing but accessing the info while on the wards is virtually impossible. i also find it useful for other modules such as sociology as you can relate EBP to the conformity or unionship between nurses on our wards. this in turn creates concepts for change and there is a lot of change happening lately in the psychiatric services.........

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

Specializes in NICU, PICU, PACU. Has 30 years experience.

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.

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....

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......


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

Specializes in Critical Care. Has 7 years experience.

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

Specializes in Nursing Professional Development. Has 43 years experience.

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.