Reviewing evidence

Evidence-based nursing: clarifying the concepts for nurses in practice

AIM

To provide a critical analysis of key concepts associated with evidence-based nursing (EBN) to substantiate an operational definition for nurses to use in practice.

BACKGROUND

Despite the plethora of literature surrounding what evidence-based nursing is and is not and how it differs from its cousins, evidence-based medicine and evidence-based practice, nurses still struggle to get evidence into practice. Several reasons for this have been reported, for example, a lack of understanding about what evidence-based nursing means or time to engage with and apply the evidence into practice.

DESIGN

An in-depth critical review and synthesis of literature was undertaken.

METHOD

Using the key words; evidence-based nursing, evidence-based medicine and evidence-based practice 496 articles were yielded. These articles were limited to 83. Using Burns and Grove's (2001) phased approach to reviewing the literature the articles were critically reviewed and categorised into key concepts and themes.

RESULTS

The in-depth critical review and synthesis of the literature demonstrated that evidence-based nursing could be defined as a distinct concept. The review clearly shows that for evidence-based nursing to occur, nurses need to be aware of what evidence-based nursing means, what constitutes evidence, how evidence-based nursing differs from evidence-based medicine and evidence-based practice and what the process is to engage with and apply the evidence.

CONCLUSION

The in-depth critical review and synthesis of the evidence-based nursing literature reinforces the need to consolidate a position for nursing in the evidence-based field. The review confirms that evidence-based nursing can be defined and conceptualised; however, for nurses to engage and apply with the evidence-based processes they need to be informed of what these are and how to engage with them in practice.

RELEVANCE TO CLINICAL PRACTICE

This paper examines the concept of evidence-based nursing and its application to clinical practice.

Steps toward massage therapy guidelines: a first report to the profession

The massage profession has grown rapidly since the late 1980s. As with business startups that begin informally and successfully mature into larger enterprises, growth brings new organizational challenges, together with greater visibility and opportunity. The maturation of massage as a health care profession increases the need for a process to formalize the synthesis of massage therapy knowledge from clinical experience and research-to collect what we know and to make such baseline knowledge widely available to practitioners, consumers, and other health care stakeholders. In short, we need to create a process for setting guidelines.The present paper lays out the motivations and framework for creating massage therapy guidelines that are informed both by research and by clinical experience. It also acts as a report to the massage therapy profession and to other stakeholders about the work of the Best Practices Committee of the Massage Therapy Foundation since 2006. And it has the additional goal of providing a health care literature basis for future academic discussions of massage.The discussion here is based on a definition from the Institute of Medicine and on research into the nature of expertise. Guidelines are targeted for submission to the National Guideline Clearinghouse. Challenges in creating guidelines for massage therapy are discussed. Various stakeholders are considered. Current literature from the wider scope of health care is extensively reviewed. Topics addressed include guideline creation, credentialing of complementary and alternative medicine practitioners, definition of competence, and the increasing role of technology (that is, informatics) in managing training and task-necessary competencies. Finally, a process for creation of massage therapy guidelines is proposed. A central feature of the proposal is the use of a "World Café" symposium to elicit knowledge and solutions from diverse experts. The role of transparency and broad and open peer review is emphasized as essential to the usability and credibility of guidelines.

Tensions and contradictions in nurses' perspectives of evidence-based practice

AIM

To explore nurses' understanding and interpretation of evidence-based practice (EBP).

BACKGROUND

EBP has been welcomed into the nursing lexicon without a critical examination of its interpretation by practitioners. The literature suggests that there is a great deal of confusion and contradiction over the meaning and application of EBP. Although work has been conducted on how EBP might be implemented, the general issue of how nurses understand and use EBP is largely unexplored. This paper seeks to examine in depth the understandings of EBP, to enable managers, educationalists and policy makers to implement it more effectively.

METHODS

All registered nurses, midwives and health visitors in one UK National Health Service (NHS) Trust were asked to complete a questionnaire in October 2006.

RESULTS

Despite a disappointing response rate (8.9%, 218/2438), the survey revealed interesting tensions and contradictions in nurses' understanding of EBP. National and local guidelines, practitioners' own experience and patients' preferences were the main influences on nurses' practice. Published research had relatively little impact, particularly among nurses graded E, F and G and those who had not attended a study day on EBP.

CONCLUSIONS

The hierarchies of evidence propounded in local and national guidelines are not adopted by practising nurses, who use other sources of evidence, such as reflection on their own experiences, when making clinical decisions. However, subsuming published evidence to clinical judgement does not contradict the original tenets of EBP.

IMPLICATIONS FOR NURSING MANAGEMENT

Unless it is incorporated into national or local guidelines, research has relatively little impact on practice. To develop nursing practice and nursing knowledge, nurse leaders need to foster the synthesis of experiential knowledge and published research, in accordance with the founding principles of the EBP movement.

Towards a geology of evidence-based practice—A discussion paper

We begin this paper with a consideration of the significance of a historical perspective in presentations of evidence-based practice in the nursing and medical literature. We suggest that whereas writers often produce coherent historical narratives as justification for particular views of the nature of EBP, an examination of its origins reveals no such signs of historical development or progress in our conception or understanding of it. We then explore alternative modes of thought for attempting to understand and critique the variety of definitions and descriptions of EBP to be found in the literature. We eventually reject the linear mode of historical thinking in favour of Deleuze's notion of rhizomatic thought and the metaphor of geology. Finally, we employ the rhizomatic mode of thinking and writing to construct a geology of evidence-based practice which attempts to expose and embrace contradictions in definitions and uses of the term rather than discount them in an authorised historical narrative written from the perspective of the dominant discourse.

The issues for nurses involved in implementing evidence in practice

Evidence-based practice (EBP) is currently high on political and professional agendas. However, there is a suggestion that despite apparent enthusiasm for EBP, it is not becoming a reality. A variety of reasons for evidence not being implemented in practice exist, including the way in which evidence is communicated, how staff are involved in changes in practice, the availability of resources, patient expectations and the priority afforded to EBP by individuals and organizations. These issues must be addressed if EBP is to succeed.

Clinical guidelines and care protocols

Clinical guidelines and care protocols are intended to provide information, based on an appraisal of the current best evidence of clinical and cost-effectiveness, regarding therapeutic interventions for given conditions. With the establishment of the National Collaborating Centre for Nursing as a part of National Institute for Clinical Excellence (NICE), it is anticipated that an increasing number of clinical guidelines that focus on aspects of nursing care will be developed at a national level. The Department of Health also aims to introduce nationally agreed multidisciplinary care protocols which will dictate how certain conditions are to be managed. These developments have the potential to enhance healthcare provision and nursing practice. However, they also introduce potential dilemmas for nurses. This paper discusses some of the issues involved in the development and implementation of clinical guidelines and care protocols in intensive care nursing.