What exactly is "evidence based practice"?

[Clovery]

When care planning, is evidence-based practice the same thing as a rationale? The exact definitions of these terms aren't clear to me.

I'm doing a care plan and I need to include rationales with citations for my interventions. I have the Ackley & Ladwig care plan book, which is nice because they list a rationale & citation for you, for each suggested intervention. However, many of the interventions they suggest are not specific enough as I'd like for my patient, and the rationales sometimes are weak or far-fetched, in my opinion. So I decided to look for articles in journals for rationales to better support my interventions. I haven't had trouble finding information and I've actually been enjoying the process because I feel like I'm enhancing my understanding so much more than if I'd just copied Ackley & Ladwig's rationales.

Is there a certain set of criteria a published article must meet before it's deemed appropriate as "evidence based practice" or "rationale" for an intervention? For example, if I find an article published in a well-known nursing journal and the author states "Choice of clothing is important to ensure comfort and avoid rubbing against the sore, inflamed incision." is that appropriate as a rationale for the intervention of teaching the patient about appropriate clothing choices that will not irritate a c-section incision? Or does the article actually need to contain a study, like "women who wore high waist briefs post-surgery had a significantly lower rate of infection than women who wore low cut bikini briefs" ?

Maybe I'm overthinking this, but I want to make sure I'm doing this right. I'll feel like an idiot if I put all this extra work into my care plan (my instructor really doesn't expect us to go to the literature for rationales) and then get it handed back to me because I did it wrong.

Thanks to anyone who read all this, sorry it was long. If anyone can provide any clarity I'd really appreciate it.

[llg, PhD, RN]

I hate to say this ... but it depends on your instructor's expectations. Most instructors would accept the expert opinion you found in a textbook or journal article as sufficient for the rationale on a care plan. However, there may be some assignments where they want to see decisions based on actual research evidence -- and not just expert opinion.

There are different levels of evidence. As you seem to realize, the opinion of an uneducated layman is at the bottom of the totem pole ... expert opinion is above that ... and research results are above that. (And there are various levels within the category of "research results". Some types of research produce higher levels of evidence than others.)

Your real question is: "What level of information will my instructor want me to list as the source for my rationales?" Only your instructor can answer that -- but most instructors are OK with "expert opinion taken from a reputable source" for a careplan.

When writing protocols/policies, etc. for continued use ... most people would prefer to base those on actual research findings at a fairly high level. When establishing national guidelines, health policy, etc. ... people usually want mostly the highest levels of research evidence.

[Clovery]

thanks for your reply! i think my instructor will accept my rationales that are "expert opinion" since I don't believe anyone else in my class will bother to research to find rationales on their own. Anyway, we'll see! your reply really did help; i get what you're saying about "expert opinion" vs varying degrees of clinical research. i think as long as i don't present something that is totally "out there" i'll be okay. thanks again

[kiwinarz]

hi, just be careful in selecting a website or books etc. as you can only retrieved a good and reputable article from a reputable author/internet site. As well as a peer-reviewed published articles are providing you with facts through their research evidence/outcome. :)

[nurseprnRN, BSN, RN]

imho the example you gave (incision being irritated by tight clothes) doesn't need research support to be credible and useful, as it is what the engineers in my family call "intuitively obvious to the casual observer."

i recommend you find a nifty little book called "ritualistic practices in nursing," which i think also has a follow-up with a name that escapes me at the moment. you'll get a great handle on what needs and doesn't need research back-up in it, and a chuckle or two besides.

[llg, PhD, RN]

i recommend you find a nifty little book called "ritualistic practices in nursing," which i think also has a follow-up with a name that escapes me at the moment. you'll get a great handle on what needs and doesn't need research back-up in it, and a chuckle or two besides.

i'm going to look for that book. as someone who teaches research and evidence-based practice, i think it sounds interesting.

thanks for the recommendation.

[Clovery]

imho the example you gave (incision being irritated by tight clothes) doesn't need research support to be credible and useful, as it is what the engineers in my family call "intuitively obvious to the casual observer."

i recommend you find a nifty little book called "ritualistic practices in nursing," which i think also has a follow-up with a name that escapes me at the moment. you'll get a great handle on what needs and doesn't need research back-up in it, and a chuckle or two besides.

thanks for the recommendation. i looked for it on amazon but the only title remotely close was published in 1967.

we have to list a rationale for everything. even the totally obvious stuff. and it can't be a text book. like the intervention of "practice hand hygiene" for risk for infection. my teacher even mentioned a previous student who, when asked where he got his rationale, said, "i made it up, it's obvious". apparently, with this particular instructor, that just doesn't fly. but everyone just uses these care plan books that list rationales with citations for you, but sometimes it really doesn't fit as well as i'd like it to.

i've always liked reading journal articles anyway, so i'm enjoying doing the research and learning more in the process. for example, i was trying to find a rationale to encourage fluids, particularly cranberry juice, to prevent uti. there's a big debate about the usefulness of cranberry juice, with just as many studies saying it has no effect. i personally thought it was common knowledge that cranberry juice prevents uti.

[VivaLasViejas, ASN, RN]

i've always liked reading journal articles anyway, so i'm enjoying doing the research and learning more in the process. for example, i was trying to find a rationale to encourage fluids, particularly cranberry juice, to prevent UTI. There's a BIG debate about the usefulness of cranberry juice, with just as many studies saying it has no effect. I personally thought it was common knowledge that cranberry juice prevents UTI.

The commercial cranberry juice that's found in most grocery stores (and healthcare facilities) doesn't do squat to prevent UTI. It's got too much sugar in it. You'd have to buy the natural version at a health food store to get any benefit at all, and after years of using both cranberry capsules and cranberry juice, I'm less than impressed with their efficacy. Not that it's bad to drink cranberry juice---preventing UTI takes lots of fluids, of which cranberry juice is only one. It's just not particularly useful.

[nurseprnRN, BSN, RN]

"i recommend you find a nifty little book called "ritualistic practices in nursing," which i think also has a follow-up with a name that escapes me at the moment. you'll get a great handle on what needs and doesn't need research back-up in it, and a chuckle or two besides.

thanks for the recommendation. i looked for it on amazon but the only title remotely close was published in 1967."

yep, that's the one. still a classic and well-worth your time. hint: just because something is older than 5 yrs does not invalidate it. i wouldn't recommend you pull my thirty-year-old cardiology text or even a ten-year-old physiology text off the shelf for much beyond the basics (i just keep 'em for sentimental value and use more current resources for those), but "rpn" is definitely still pertinent today. some things never do change.