Evigence-based nursing

Agnus · Jan 17, 2002

I assume you mean evidence based nursing.

This is practice based on reasearch.

That is paractice that has some imperical or scientific basis rather that antidotal basis or tradition.

Here is an example. Yesterday I attended a critical care class. There is and old saw that say if you have a radial pluse you BP is at least 80, If you have a femeral pulse it is at least 60 etc. Even though it sounds good, there is no scientific evidence that supports this.

The first instructor pointed out there was no evidence to support this. All we can really know is that if you have a pulse you have BP. But we don't know what BP.

That afternoon another instructor presented in her lecture that if you have a femeral pulse you have at least of 60 BP.

Her practice is based on tradition rather than emperical evidence. Which do you think is more valuable the practice of the first instructor or the second?

There are a lot of things we do in nursed based on a tradition of always having done it that way. There are practices that seem logical and a good idea but we really have little more than tradition to support their use. For years we said drink cranberry juice to acidify the urine so you won't get UTI's. The scientific evidence though says that there are (I'm sorry I don't just recall if it is amino acids pheno protiens or what it is) actually a chemical (not acid) that is in cranberry jucie that prevents bacteria from sticking to the wall of the bladder. (this makes sense as OJ and grapefruit juice are not equally effective yet are very acidic)

Some times we do the right thing by tradition or antidotal evidence, but for the wrong reason. Some times we are right in traditioal nursing. However, reasearch is more valuable in supporting a practice. Because tradition can be wrong, antidotal evidence doesn't always stand up to scientific scrutney. Not all nursing reasearch is based on the experimental method. By it's complex nature nursing practice is often hard to test using this method but other types of reasearch can be used to support a practice, and should be.

The reason I say this is we waste a lot of time, money suffering doing thing that may be ineffective, inefficient, useless, not cost effective. In todays health care world we can't afford this.

Everything cannot be supported by emperical evidence in our practice (ethical issues come into play) however, It is important to try to have some reproducable reasearch to support these expendatures. Our goal is to provide best possible care. We can't say we do if we can't prove it. The world is becomming more sophisticated and the public and others in the health care industry and insurance compananies are starting to demand evidence based treatments. We risk loosing control of our profession (or even the profession all together)and practice if we fail to do the reasearch to support our practice.

Wow! did I say that?! I'm not sure where this disertation came from. I appologize for getting on a soapbox here.

prn nurse · Jan 19, 2002

China Rose cannot interpret your reply through her Chinese-English software as you wrote it. Do you know how to click on edit and correct spelling? Edit at the bottom of your reply (post).

WashYaHands · Jan 19, 2002

Evidence based practice is a term that has recently gained popularity within the nursing profession. Evidence based practice is used as a synonym for research utilization and research based practice. The term evidence based practice seems closely related to the medical model. It is suggested by some nurse leaders that professional nursing practice be referred to as research based theory guided practice because the essence of nursing is caring for human beings as they experience personal health situations, and nursing does not solely rely on the medical model to care for patients.

I hope this translates correctly.

a-rose · Jan 20, 2002

Thank you very much!

A introduce about the Evidence-based nursing says that the Evidence-based nursing model includes four concatenation process: Evidence triggered, Evidence supported, Evidence observed, Evidence based.

Do you perform it?

Mijourney · Feb 1, 2002

Hi. I think that most nurses include some level of evidence-based nursing in their practices as most state practice acts require a certain level of this for license maintenance. Most states also require nurses to get a certain number of CEUs each year. I would guess that that's one way of ensuring that nurses keep some knowledge of standard practice. I don't know how many, but I would also guess that a fair percentage of nurses subscribe to at least one professional journal to keep current.

What's not routine for many bedside or frontline nurses is doing research and making contributions as such. Most nursing research I believe is done at the graduate level. I believe the failure of most nurses to directly participate in or routinely use research in our practices is one of many reasons we get questioned on our professional status. The irony of course is that our employers heap piles of work and other requirements on us that prevent us from doing any in depth study of patient care. If we do get prompting from our employers, there's generally very little quality time to do the research. That may be done on purpose for all I know. In addition, nursing schools particularly at the diploma, ADN, and LPN levels historically have not prompted nurses to perform nursing research. I feel this is one of the areas we must change if we as nurses will gain dominance over our profession.

RNKitty · Feb 1, 2002

I whole-heartedly support evidence based practice, but let us not ignore a possible treatment just because there is no actually research to scientifically back you up.

Mijourney · Feb 1, 2002

Hi RNKitty. I agree with you we should not ignore alternatives to the conventional. However, what I think is happening is that third party payors are getting increasingly into evidence based practice and will refuse to pay if there's nothing to support what you did and if it has not been certified by accepted groups or agencies. This IMO is one way they will seek to reduce their outgo.

RNKitty · Feb 1, 2002

We see the same thing happening in the education system. Young children are made to sit for 4 hours for standardized exams to prove to the politicians and public that they are learning what they are "supposed" to learn. I don't always think it is a good thing.

However, in court a jury is much more likely to award for a nurse who can site literature and research as the reason behind her actions. It is a good thing.