Definition Of Evidence-Based Nursing
Evidence-based nursing (EBN) is a system that is used in the nursing field whereby a nurse will use a scientific approach to find out what is wrong with a patient and how to treat them accordingly without spending wasted time and money on clinical trials to establish the cause of the illness, discomfort or injury. The current situation is researched on a database of similar situations faced in past cases and can use the recommendations of the professionals who treated the patients in question to treat the current problem.
The human body is a complex machine and there are many things that could possibly go wrong which have the same symptoms. For this reason, it is important for the nurse to gather as much information from the patient as possible and to take their views and comments into consideration when assessing and treating them. This system leads to greater quality healthcare and helps to keep the bottom line profitable for both the health care system as well as the patients who make use of these systems.
The skills which are needed to perform these tests and trials properly are taught in as part of the modern nursing educational curriculum. The research done on patients and patient care helps the modern nurse to cope with all of the expected responsibilities so that caring for patients becomes second nature. The EBN system gives the nurse an easy to follow step-by-step guide as to how they should approach a situation. Once the nurse knows how to begin searching for answers, they can tap into a wealth of information which may match up to the current situation they are facing.
Steps Of EBN
In order for EBN to work, there are certain steps that need to be followed. Some guidelines have a 5 step approach where others add additional steps to the process. The steps can be explained as follows:
It may seem a simple enough step to think of and it may seem that it should come naturally, but how to ask the question is not always second nature. You may or may not have heard about the PICO system of formulating a question. Asking a question is not always the problem, but knowing which questions to ask and in which way they should be asked could pose a problem.
PICO stands for:
- P – Patient Population – do you need information about patients in a hospital or a clinic.
- I – Intervention or area of Interest – do you need to know about using a certain apparatus or having an assigned team such as rapid response.
- C – Comparison intervention or Control group – if you did not have this intervention what would you like to compare it to.
- O – Outcome – what would be the likely outcome if you did not have the above criteria or what do you think the outcome would be.
When you use the PICO system to ask a question, the result could be something like:
- In Private Hospitals (patient population) how does isolating patients in private rooms (intervention or area of interest) compare with having patients in general wards (comparison) help to combat patient depression (Outcome).
Once you know the outline of the situation of your patient, you can use search engines to find the correct articles which will help solve any problems you may be facing and give you all the information you will need regarding how a previous patient in a similar situation was treated and what the outcome of the treatment was.
Doing medical research is never easy, but knowing where to start looking for the answers makes the time spent on research shorter and gives you more time to spend with your patient. When the PICO system of formulating a question is used, then the search is more direct and more streamlined instead of asking an abstract question or typing keywords which will give you millions of results of which only a few would be relevant to your situation.
This step can also be described as searching for the best evidence. Once you have asked your question according to the PICO system of formulating your question, you can now sift through all of the information that you have received to find the answer that is most relevant to your question. The search can also be streamlined by adding additional keywords such as human and adding timeframes so that you can eliminate any searches that could be relevant to the veterinary field as well as any searches pertaining to archived material that is no longer relevant in modern practices.
All of the information that has been obtained by typing in the search criteria individually as well as combined can now be gathered and stored for further research. Electronic searches are not the only way to gather information, but it is the fastest way. Searching library records and hard copies of medical journals can also yield helpful results, but many of the books that have been printed can also be found in electronic format on the Internet.
All of the relevant information can be condensed and streamlined even further now by targeting a more specific search criteria and filtering out information which is either not relevant or incomprehensible, such as information in a foreign language.
As soon as the search results have been put together and have been narrowed down, they now need to be appraised to see which ones are as close to the current situation at hand as possible. Each article or piece of information needs to be scanned through to make sure it is as close to the criteria of your search as possible. How relevant is the answer to your question? When the question has been asked about private hospitals and you have answers that pertain to old age homes then you may want to search again or you need to discard those results.
You need to then see if the results you found are important. The results of your search may be relevant, but if the outcome was negative or if the treatment was unsuccessful, the information you gain will be of no use.
The last question you should ask yourself while appraising your results is whether the information will help your patient. Should your patient be a diabetic and the treatment is relevant to your search and have helped the patients in the study done, but would pose a threat to the health of a diabetic then the treatment will be of no use as well.
Appraising your research is mostly about finding the most appropriate solution that is safe and practical.
Once all of the information has been researched and the correct procedure and treatments found then it is time to put them to use. The evidence that has been found cannot always be followed through to the letter though. The research has to be applied in accordance with the research that has been done on the patient already and should be in line with treatment that is already in place. There may not always be information on the treatment that is compatible with your case to the last letter and it will have to be adapted and executed in line with laboratory tests that have already been performed on the patient.
There are quite a few variables that have to be considered when implementing EBN so that it is effective and safe for the patient and this method should not be followed blindly, but relied on with an open mind and flexibility. The treatment prescribed could also be prohibited by budget constraints or a lack of staffing.
Unfortunately there is not magic cure for all problems and treatment that worked in one case, will not always work in all other cases. It is therefore very important that the results of the trial be monitored very closely and that any changes are charted and studied closely. Results from a clinical trial in a controlled environment will not always work exactly as a practical application of the treatment will and there are many things which could influence the result from the patient right through to the environment.
Any flaws in the theoretical application of a treatment can be pointed out in this way and by monitoring your patient or test subject closely will help you to point out any threat to the well being of your subject before the condition becomes life-threatening.
Mapping out the progress of the clinical application of the treatment will also help others in future when they want to apply the same theory and they will be able to build on your work as well which will benefit the entire system of EBN.
Other Steps Sometimes Added
Cultivating a Spirit of Inquiry
Some institutions add this step before all of the others. It is important to cultivate a working environment or a study environment where questions come naturally. How would one type of treatment compare with another? Without the necessary experience, one would not have anything to base questions on. If a set procedure is in place for set treatments then the culture of asking questions would be pointless because the answers to all questions would all point to one result, but when you open up the possibility of finding answers outside of the set framework based on the trials of other professionals, then the foundation for the entire EBN system is formed. Without this step in the process the other steps would not exist as there would be no place for them.
When there is a need and an opportunity to ask questions, then the frame work of how to ask the question will naturally follow.
Share Your Results
New medical advances are constantly found and new ways of treating patients are found daily. In order for the rest of the medical profession to benefit from these finds, the individuals need to post their findings and get the information out there so that it can be used and shared. It is of no use being able to help patients in your hospital while others with the same affliction suffer elsewhere because you do not want to share your knowledge with other professionals. Likewise, if you have a problem that you do not know how to solve, would it not be helpful when you have access to the information which can help you and your patient to reach a positive outcome?
Often when the information is not available to health care professionals, even when someone has the information and refuses to share it, the old systems are relied upon to treat patients. This leads to duplication of work and incurs unnecessary costs as well as a waste of time for the patient who may not have the time to waste. By following this simple step, which is often forgotten, you can save so many other professionals the time and effort and you can help save the lives of those you may never even have the privilege of meeting or have knowledge of.
EBN Acting For The Greater Good
Databases and journals with medical information are updated all the time and it is because of the findings of medical professionals that the medical health organization as a whole can move forwards and grow as an entire sector of the economy and to better the lives of society as a whole. It is therefore very important to know what you are looking for when searching through medical files and articles so that the correct information is used and to make sure that you have quality checked your facts against the situation you are dealing with in order for this system to work.
It is also very important for all medical staff to make sure they are literate enough with the current technology available to ensure that the system is carried forward and not held back by the lack in technological knowledge or experience. When everyone works together towards a common goal, the medical and especially the nursing sector can only benefit from the efforts.