Abstract
The use of research evidence to support clinical decisions is a growing trend in the healthcare field. Evidence-based practice (EBP) describes the systematic search, appraisal, and utilization of current research findings to guide clinical decisions. It has been fuelled by the advancement in technology that has improved the practitioners’ access to information and evidence from research. This paper analyzes the research process and the role of EBP in nursing practice. Part A gives a discussion of the importance of EBP in nursing practice, while part B provides an explanation of why understanding research methods can improve clinical practice. Part C analyzes EBP in smoking cessation in the UK while a summary of the key points of the paper is given in part D.
Introduction
Continuous research helps expand knowledge in a field of practice or profession. In particular, it is through research that new knowledge and scientific evidence are developed and validated. Research findings help guide decisions and practices in a particular field. Evidence from nursing research gives a scientific base for decisions related to patient care. In recent years, nursing research has taken center stage in nursing practice. To improve patient care delivery, it is crucial that nursing practice is guided by empirical evidence. Such evidence backs effective nursing interventions and supports new changes that improve patient outcomes. In this regard, research evidence, when implemented at an individual or organizational level, improves nursing care and translates to better patient outcomes.
Importance of EBP in Nursing Practice
Nurses frequently encounter clinical situations that require sound decisions regarding patient care. Ethical dilemmas, which are common in nursing practice, require a problem-solving approach that incorporates “relevant and current research findings, medical expertise, and patient values” to address a clinical question (LoBiondo-Wood & Haber, 2006, p. 17). Numerous research findings regarding improved health care delivery have been reported in articles published in medical journals. However, in the writer’s view, the information is poorly analyzed, making it less useful for clinical practice. Moreover, most of the research findings reported in these articles do not reflect the changing healthcare needs of patients. Given this, there is a need to conduct a critical appraisal of the clinical findings to make a sound decision regarding patient care.
Clinical decision-making is integral to daily nursing practice. However, the decisions must be grounded in valid and most relevant research evidence. LoBiondo-Wood and Haber (2006) state that nurses should evaluate their care continuously in the course of their practice. Through nursing research, nurses learn new developments and procedures in healthcare and thus, become more equipped to address the complex care needs of individuals and communities. Improvement in the care delivered to individuals and communities contributes to the betterment of public health.
EBP relies on various forms of evidence, including clinical findings, new theories and concepts, and nursing guidelines. Research findings can be used as proof for or against the use of a particular intervention like saline usage in intravenous catheters, which is not used in neonates due to insufficient research evidence (Shah, Ng, & Sinha, 2006). Research findings are also useful in supporting or rebutting unfounded beliefs and ideas in practice. Through a systematic review of studies, nurses can ascertain or refute the effect of a particular intervention. For instance, the notion that rest facilitates recovery among cancer patients was refuted by a systematic review of relevant studies (Cramp & Daniel, 2009). Nursing research also serves as evidence for the adoption of preventive treatment, in patient care, and as a clinical guideline for best practices.
Research Methods
The research process describes the procedure the researcher uses in designing, implementing, and reporting the study findings. Nurses should understand various study designs to critically evaluate the study’s findings and apply them in EBP. Study designs fall into two broad categories, qualitative and quantitative research methods. The choice of either method depends on the research question and the nature of the problem being investigated. Qualitative methods describe relationships between human health and individual experiences while quantitative techniques use numeric data to explain phenomena. Aspects of nursing care, such as pain, anxiety, and depression, can be better understood through qualitative research (Polit & Beck, 2008). Thus, understanding qualitative research methods can help nurses make evidence-based decisions regarding pain, anxiety, and depression management interventions.
Quantitative methods are common in nursing research. In quantitative studies, conclusions are made based on statistical analyses of data collected from human subjects. They aim to generalize the findings to populations in other contexts. Nursing research studies involve various quantitative techniques, including “surveys, meta-analyses, and experimental, quasi-experimental designs,” among others (Polit & Beck, 2008, p. 49). Understanding each of these methods helps nurses discern the suitability of each technique for examining certain phenomena and thus, determine whether the findings are reliable enough to be generalized. Meta-analyses, which evaluate numerical data from multiple types of research, give strong evidence for generalizations compared to surveys. In comparison, experimental studies, which involve randomized controlled trials, give useful findings of cause-effect relationships.
On the other hand, the findings of qualitative studies, which usually involve a few subjects, cannot be generalized to other samples or populations. Nevertheless, the methodology should be explicit enough to allow for repetition in other settings. Some studies use qualitative methods to complement quantitative research findings. Such triangulation studies provide sufficient evidence for recommending new changes or interventions in nursing practice. Nurses should use triangulation studies when seeking to gain a deep understanding of a phenomenon, as they combine multiple research methods. Research methods give insights into the approach used to arrive at the findings and enable nurses in selecting the best evidence to support their decisions. Nursing research also supports the development of interventions for a particular clinical decision.
EBP begins with the search for relevant and current findings on the subject matter. It requires nurses to conduct systematic reviews to gain in-depth knowledge about the clinical question at hand. A systematic review summarizes the research findings on a given subject after a thorough appraisal of relevant studies (Polit & Beck, 2008). Meta-analyses also give a synthesized analysis of research evidence that can help shed light on a particular subject. In both cases, it is after examining the study’s methodology that a nurse can be able to evaluate the quality and relevance of the research findings. Thus, understanding the research methodology allows one to draw conclusions about the quality of the data and the credibility of the evidence. In a systematic review, a research methodology defines the inclusion criteria used and explains how researcher bias was avoided. This allows the nurse to assess the quality and reliability of the findings. Besides meta-analyses and systematic reviews, randomized controlled trials also give reliable findings for clinical decision-making.
Evidence Utilization
There are many categories of evidence available for clinical decision-making. The most common type is articles that report clinical studies on a particular topic. For subjects that have attracted extensive research, numerous published articles exist that can be used as a source of evidence for EBP. In EBP, the reader has the sole responsibility of sifting through the volumes of articles and reviewing each study before selecting the best evidence for use. This process is termed research utilization. In recent years, systematic reviews exist that analyze and report multiple studies (Polit & Beck, 2008). In this regard, a nurse can utilize the findings summarized in meta-analytic studies as evidence in clinical practice. Such studies integrate the findings of recent studies and thus, give the best evidence for research utilization.
In the UK, several published studies archived in the Cochrane library provide evidence for several healthcare interventions. Moreover, clinical guidelines, grounded in systematic review findings, have been developed in the UK. An example of EBP is the systematic review by Rice and Stead (2013), which examined 29 empirical studies on smoking cessation interventions in the UK. The review found that “nurse counseling increases the tendency to quit” among smokers (Rice & Stead, 2013, p. 516). The findings of the review gave sufficient evidence to support nurse counseling of smokers about the health effects of tobacco smoking. Thus, the review findings have been used to make recommendations and as a guideline for public health policy.
When implementing a smoking cessation intervention, due to cost considerations, it is often a norm to evaluate available care options first to determine the best alternative. The study identified counseling by nurses to be an effective intervention in smoking cessation. Thus, in EBP, health care interventions are compared based on the available evidence to determine the alternative that would yield the best outcomes. Systematic reviews help distinguish interventions that have no scientific proof from those that have been tested in clinical practice. The review findings often form the basis for EBP. In the UK, nurses play a crucial role in smoking cessation in primary health care centers and community settings. They counsel smokers through group support programs or refer them to agencies that offer counseling services. Trained nurses offer such services in multiple settings where they interact with smokers.
Conclusion
Healthcare professionals, including nurses, must learn how to search, appraise, and utilize evidence in clinical practice. This requires adequate academic preparation regarding research methods, study critique, and synthesis of findings to enable them to appreciate the role of EBP in quality care delivery. Nurses have a responsibility of implementing EBP protocols in their practice. Various nursing interventions require research evidence to support their use in patient care. The best source of evidence for clinical decision-making is systematic reviews. The reviews integrate findings from relevant studies conducted within a given period. They compare interventions in a bid to determine the best alternative that can guide practice and health policy. Healthcare professionals must keep abreast of recent studies in their area of practice to provide quality and evidence-based care to patients.
References
Cramp, F. & Daniel, J. (2009). Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews, 1, 213-221.
LoBiondo-Wood, G. & Haber, J. (2006). Nursing Research: methods and critical appraisal for evidence-based practice. St. Louis: Elsevier.
Polit, D. & Beck, C. (2008). Nursing research: generating and assessing evidence for nursing practice. Philadelphia: Lippincott Williams & Wilkins.
Rice, V. & Stead, F. (2013). Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews, 8, 514-520.
Shah, P., Ng, E. & Sinha, K. (2006). Heparin for prolonging peripheral intravenous catheter use in neonates. Cochrane Database of Systematic Reviews, 4, 419-428.