Evidence-based nursing (EBN) is part of the broader concept of evidence-based practice (EBP), which has gained a lot of traction with healthcare professionals over the past few decades.
While evidence-based practice applies to all healthcare professionals, EBN is specifically focused on nursing practice. Its main goal is to ensure that the patient care provided by registered nurses (RNs) leads to the best positive patient outcomes.
Nursing, like other healthcare professions, has evolved from being a practice based on tradition to one that now heavily integrates research findings and evidence-based practices. Evidence-based nursing perfectly demonstrates this shift.
Doctors also have a version of this, called “evidence-based medicine.” What this all means is that, as health care professionals, we are making decisions about patient care using the best available, relevant evidence.
At the same time, we also consider nurses’ own clinical expertise, along with each patient's individual preferences. It's become a way of ensuring that modern nursing is grounded not only in science, but also in quality patient care.
4 Key principles of evidence-based nursing practices
There are several important factors that go into evidence-based nursing practice. These elements of the EBP process work together to help nurses make well-rounded and effective clinical decisions.
1. Seek out the best available evidence
The foundation of evidence-based practice in nursing is the use of high-quality, extensive research. Nurses need to stay up to date with current nursing research to ensure they are using the latest findings to guide their care. There are numerous ways nurses can gather evidence, such as reading peer-reviewed journals, analyzing clinical trials or examining systematic reviews.
2. Apply clinical expertise
While research evidence is crucial, it’s not enough on its own. Nurses must also use their critical-thinking skills and refer to their clinical experience to guide their judgment when applying evidence-based guidelines to real-world situations.
Clinical expertise helps bridge the gap between research findings and practical patient care.
3. Accommodate patient preferences and values
Nursing is all about patient-centered care, so evidence-based practice shouldn’t override patients’ preferences. Nurses need to consider each patient’s unique needs, values and even cultural background when deciding on interventions.
As a nurse, honoring your patients’ wishes helps ensure you’re delivering quality clinical care that’s not only effective, but also meaningful to the patient.
4. Account for the unique challenges that accompany clinical settings
The healthcare environment itself can have a substantial impact on the quality of a patient's care.
Currently, the number of healthcare systems, healthcare organizations and healthcare professionals implementing evidence-based practice is increasing. Yet, despite the growing popularity of evidence-based practice, healthcare providers continue to face obstacles as they attempt to adopt EBP protocols.
Some of these obstacles are limited resources, restrictive hospital policies and other external factors. These challenges inhibit the use of certain evidence-based research in practice.
How to implement evidence-based practice in nursing
Implementing evidence-based nursing in everyday nursing practice requires a systematic approach. It’s a bit of a process, but when done correctly, it has shown to lead to better decision-making and better patient outcomes.
Here are five steps nurses generally follow to apply the evidence-based process in their work.
1. Ask a clinical question
The first step to implementing evidence-based practice is identifying a specific question or issue that needs answering. The topic can be anything from how to best manage a patient with community-acquired pneumonia to the most effective ways to prevent catheter-acquired urinary tract infection.
A helpful way to structure these questions is by using the PICO(T) framework:
Patient population or problem
Intervention
Comparison (if any)
Outcome
Time frame (if relevant)
For example, you might ask, "In elderly patients with chronic pain (P), does using non-drug therapies (I), compared to medications (C), improve pain management (O) over six months (T)?"
2. Search for evidence
Once you have your question, the next step is to look for research you can use to help answer it. Browse through online databases like PubMed or CINAHL, and look for studies that address your question.
For the sake of evidence-based practice in nursing, focus on high-quality research. For example, randomized controlled trials and systematic reviews will provide the strongest support for clinical decisions.
3. Appraise the evidence
Not all research is created equal, so it’s important to thoroughly evaluate evidence before implementing research findings. Consider factors like the age of the study and the methodology.
As science and technology advance, researchers may disprove or expand upon past findings. This is why medical schools and graduate nursing programs generally encourage students writing research papers to refer to studies published no more than five years earlier. Healthcare providers engaging in evidence-based practice should also refer to the most recent studies available to them.
There are other factors to consider as well, such as how the study was conducted, how large the sample size was, and whether the results apply to your patients.
This step helps ensure that you’re relying on the best relevant evidence.
4. Apply the evidence
After evaluating the research, it’s time to apply it to your individual clinical expertise.
You need to decide how to implement your findings to address the problem at hand. Let's say you’re treating a bed-bound elderly male in a hospital, and you want to prevent him from suffering catheter-acquired urinary tract infections.
Consider whether the evidence you’ve sourced fits the specific patient you’re working with and the environment you’re in. Sometimes this means adjusting the evidence to fit the reality of your practice setting. This is where clinical expertise comes in.
5. Evaluate the outcomes
After putting the evidence-based intervention into action, the final step is to evaluate if it worked--and how well it worked.
Did the patient not develop a catheter-acquired urinary tract infection? Were the outcomes what you expected?
Based on these results, you might continue with the intervention, make adjustments or go back to the drawing board.
What are the barriers to evidence-based nursing implementation?
Even though there are many benefits associated with evidence-based practice in nursing, EBN isn’t always easy to put into practice. There are several challenges that often get in the way.
Time constraints
As nurses, we can often be swamped, and it can be difficult to find the time to search for and read through research studies on top our already-busy day.
Limited access to research
Access to research with well-designed control trials can be costly. Nurses may not have the funds to spend on databases or the latest journals, which can making it difficult for them to stay informed.
Resistance to change
Some nurses may be hesitant to adopt new clinical practices, especially if they have been accustomed to their routines for a long time. Change can be difficult, particularly if there is a sense of attachment to a long-established process.
Lack of relevant knowledge or skills
Not all nurses feel confident in their abilities to judge and critically dissect research, which is a key part of evidence-based practice. Healthcare organizations must therefore properly prepare nurses to implement EBP through trainings.
Organizational constraints
The environment you work in also plays a big role in your professional abilities. If there’s a lack of support from management or a shortage of resources, it becomes harder to implement evidence-based research.
Does evidence based nursing make a difference in patient outcomes?
Research has shown that evidence-based medicine can reduce the likelihood of complications, improve recovery times and enhance the quality of patient care.
Here are some specific ways evidence-based practice has helped to improve patient outcomes.
Evidence-based practice creates better infection control
Evidence-based practices, like prioritizing hand hygiene, wearing personal protective clothing and understanding proper catheter care have significantly reduced hospital-acquired infections, which are a major concern in healthcare settings.
Pain management techniques advance through evidence-based research
EBN has led to more effective pain management strategies by incorporating both pharmacological and non-pharmacological approaches. This has directly led to improving overall patient outcomes, since we know chronic pain significantly affects our patients' quality of life.
Research enables us to reduce incidences of pressure ulcers
Another measure we may take for granted in the nursing profession is pressure ulcer (AKA bedsore) prevention. But by following evidence-based guidelines for repositioning patients and using pressure-relieving devices, we can greatly reduce the occurrence of pressure ulcers, particularly in bed-bound patients.
Evidence-based research fuels advancements in patient safety protocols
EBN has played a significant role in improving patient safety. Practices like medication reconciliation and patient identification protocols have helped reduce errors and improve patient outcomes in healthcare environments.
For more on this, check out 5 Factors that Can Improve Patient Safety in Hospitals.
Evidence-based practice in nursing education
If we want more nurses to integrate evidence-based practice into patient care, we need to incorporate EBP principles more in nursing education.
Nursing students should understand the importance of evidence-based practice, as well as how to search for and critically appraise research. Likewise, nurses and other healthcare professionals in clinical practice should have access to continuing education opportunities to keep our skills up to date.
Leaders in the nursing field also play a huge role in EBP implementation. For example, nurse managers can encourage a culture of continuous learning and evidence-based practice by supporting professional development. They can also work to improve nurses’ access to research.
There are many journals that are specifically targeted towards nurses, such as Nursing Research and Practice, Journal of Nursing Scholarship and Evidence-Based Nursing, to name a few.
Looking forward: the future of evidence-based nursing
Looking ahead, evidence-based nursing will likely continue to grow in importance. With the rapid pace of technological advancements, such as electronic health records and decision support systems, it’s becoming easier for us nurses and healthcare professionals to access and apply research in real-time.
And, as personalized medicine becomes more prominent, we’ll likely see even more individualized approaches to evidence-based nursing, where care plans are tailored to each patient’s specific genetic, environmental and lifestyle factors.
Evidence-Based Nursing is essential for providing high-quality, patient-centered care. EBN will most likely remain a cornerstone of modern nursing practice for the foreseeable future.
For all these reasons, quality nursing education needs to be built on the basis of evidence and research. This is an important principle at Rasmussen's Nursing school.
To see some of the other considerations that make a huge difference in quality nursing education, check out 11 Facts You Didn't Know About the Rasmussen University Nursing Programs.
