Evidence-based practice (EBP) is defined as integration of the best scientific evidence with clinical expertise and patient preferences. It is well established that EBP improves patient care, increases patient safety, and reduces costs. EBP seemed somewhat mysterious to many of us when the term began to be used in the nursing and medical literature, but over the years, understanding of the positive impact of EBP has grown. However, nurses still report challenges to incorporating EBP, including time constraints, and lack of knowledge and institutional support. These are real and present concerns that institutional nurse leaders should address, particularly when implementing unit-based or large-scale projects. However, they are not "good enough" excuses for failing to use the best evidence to improve patient care. EBP is the responsibility of every nurse and can be practiced individually even without large institutional changes. It is a fairly simple straightforward process requiring a fairly basic set of skills and is not really mysterious at all!
The seven simple steps in EBP start with cultivating a spirit of inquiry that leads to identifying a clinical problem or question. The next step involves transforming the question into a searchable format, frequently referred to by the acronym PICOT (Patient/population, Intervention of Interest, Comparison intervention, Outcome of interest, and Time span or temporal aspect). Then the PICOT question is used to assist in a search for relevant literature, and appraisal/evaluation of the discovered evidence. If the appraisal process seems daunting, there are simple tools called Rapid Critical Appraisal Tools that lead us through this process. These tools, and directions for their use, can be found on Web sites such as the Center for Evidence-Based Medicine at the University of Oxford (http://www.cebm.net/index.aspx?o=1157). The next step involves combining clinical nursing expertise and knowledge of patient and family preferences with the best evidence, and crafting targeted, patient-centered interventions. Finally, as with all clinical care, the outcome of the evidence-based intervention is assessed. The last step is dissemination of results, formally, as a presentation or publication, or less formally, during interdisciplinary rounds, during shift reports, committee meetings, and other discussions with peers. Nurses who adopt this simple process can become leaders of EBP efforts on their units. Nurses who take on this informal leadership role are often referred to as "EBP champions."
The current issue of MCN, includes three articles that illustrate nurses' use of EBP principles to improve patient care. Jakubowski et al. demonstrate how a evidence-based clinical guidelines can help nurses with accurate prescription of physical activity for obese or sedentary children. They go "beyond the guidelines" to present findings from recent research on children's fitness; findings that are not yet incorporated into the major national physical activity guidelines. Kartoz reviews best practices in reproductive healthcare for women with systemic lupus erythematosus (SLE) to promote understanding of the unaddressed needs of women with SLE. Byrne and Collins describe use of evidence to approach the case of a Haitian child with lymphatic filariasis, a disease common in that country, but rarely seen by American nurses. This article shows how EBP resources can assist nurses to address a clinical entity that is urgent, yet unfamiliar.
Resources for EBP are plentiful, many available free on the Internet. An important example is the National Guidelines Clearinghouse (http://www.guidelines.gov), a reliable source of clinical practice guidelines. The methods demonstrated in the articles in the MCN special topics series, including literature retrieval, appraisal, and clinical application, are relatively straightforward, which suggests that EBP is within the scope of all nurses. We should strive to integrate EBP into our own nursing practice as a way to demonstrate our commitment to patient safety and maternal child healthcare. So come on-let's all be champions!