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What is Evidence-Based Practice?

The following tutorial is based upon a series of articles from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice.

What is Evidence-Based Practice?

Evidence-Based Practice (EBP) is a problem-solving approach to the delivery of healthcare that uses the best evidence from well-designed studies and patient care data together with the expertise of clinicians as well as patient preferences and values (Melnyk, B et al. 49).  The term 'evidence-based medicine' is also used.
                                  Evidence-based Medicine
                                            STEP ZERO:  Igniting a Spirit of Inquiry

In their article, "Igniting a Spirit of Inquiry:  An Essential Foundation for Evidence-Based Practice" nursing scholars Bernadette Mazurek Melnyk, Ellen Fineout-Overholt, Susan Stillwell, and Kathleen Williamson, describe how a spirit of inquiry, defined as "an ongoing curiosity about the best evidence to guide clinical decision making" along with an organizational culture that supports it, are necessary components to lay the groundwork for Evidence-Based Medicine (49). This continual cultivation of a spirit of inquiry is the first step, or "Step Zero" according to Melnyk and her colleagues.  They pose the question, "Do you ever wonder why nurses engage in practices that aren't supported by evidence, while not implementing practices substantiated by a lot of evidence?" (Melnyk et al. 49).  

Old Practices not supported by the evidence

- Changing IV dressings daily.

- Children with asthma are treated with albuterol delivered with a nebulizer in the ER.

- Nurses disrupt patients' sleep to document blood pressure and pulse rate because it is the hospital's policy.

 Evidence-Based Practice approach

- When clinical trials explored how often to change IV dressings, results indicated that daily changes led to higher rates of phlebitis than did less frequent changes (Gantz et al.)

- Evidence shows that when albuterol is delivered with a metered-dose inhaler plus a spacer, children spend less time in the ED and have fewer adverse effects. (Cates et al.)

- There is no evidence which supports disrupting patients' sleep improves potential complications.  Sleep is important for restorative healing.

"Everyday, health care professionals across the care continuum perform a multitude of interventions that should stimulate questions about the evidence supporting their use...  When a health care professional possesses a spirit of inquiry, within a supportive EBP culture, she or he can routinely ask questions about clinical practice while care is being delivered" (Melnyk et al. 49). 

In the next unit, we discuss how to ask clinical questions in a PICOT format.


References

Cates, CJ, et al.  Holding chambers (spacers) versus nebulisers for beta-antagonist treatment of acute asthma.  Cochrane Database Syst Rev 2006:(2):CD000052.

Gantz, NM, et al.  Effects of dressing type and change interval on intravenous therapy complication rates.  Diagn 
Microbiol Infect Dis 1984:2(4):325-32.

Melnyk, Bernadette Mazurek, PhD, RN, CPNP/PMHNP, FNAP, FAAN, Ellen Fineout-Overhold, PhD, RN, FNAP, FAAN, 
Susan B. Stillwell, DNP, RN, CNE, and Kathleen M. Williamson, PhD, RN.  Igniting a spirit of inquiry:  an
essential foundation for evidence-based practice.  American Journal of Nursing, November 2009; 109(11):49-52.

 Evidenced Based Medicine Information Literacy Modules|

Unit 5:  Integrate the Evidence with Clinical Expertise & Patient
             Preferences and Values
Unit 6:  Evaluate the Outcomes of the Practice Decisions or
             Changes based on the Evidence
Unit 7:  Disseminate EBP Results

copyright 2013 Napa Valley College                                      Updated April 17, 2013 
                                                                                              by Nancy McEnery, Reference Librarian-Instructor