This month we are publishing a number of abstracts that were presented at the second annual NANN research symposium held in Scottsdale, Arizona, in 2007. It is always exciting to see the work that NANN members are doing to expand the body of nursing knowledge. Our goal is to advance the art and science of newborn care, and publishing new research is one way to do that. As we continue to focus on providing care to our newborns and families based on evidence, we need research to help us establish the best way to provide that care.
What is evidence-based practice (EBP)? It means that in clinical practice, the actions that we perform should be based on evidence that they actually work. The actions should achieve the outcome that we desire and is best for the patient. The Institute of Medicine defines evidence-based practice as "the integration of best research evidence, clinical expertise, and patient values in making decisions about the care of individualized patients."1(p56) Evidence-based practice can also be used as a way to determine how to spend healthcare dollars. If there is no evidence that a drug or treatment works, then insurance companies are increasingly reluctant to pay for that treatment.
This sounds like a good idea. None of us want to spend time or money doing things that either do not work or are actually harmful. So why does there continue to be barriers to implementation of research into practice?
The first barrier to EBP is that many nurses lack the skills and knowledge to put research into practice. A survey done in 2005 noted that 54% of nurses surveyed were not familiar with the term EBP.2 Sixty-seven percent sought information from a colleague rather than from nursing literature, 58% had never searched MEDLINE, and 82% had never used a hospital library.2 Many nurses noted a lack of time as the reason for not searching out literature in answer to questions, others reported they did not have a good understanding of how to use electronic databases, they lacked computer skills or ready access to computers, and they had difficulty understanding research articles.2 This suggests that nursing schools need to do a better job teaching students how to access, read, and understand research, and that employers need to do a better job providing ongoing education and access to databases and information. As nurses, we need to make more of an effort to spend time exploring the evidence for the things that we do on a daily basis.
The second barrier is that the problem arises when the evidence is lacking, or when the evidence is focused on only one aspect of care. A significant emphasis on quantitative research and randomized controlled trials is important to grow empirical knowledge. Nursing is a science, and we cannot ignore scientific findings. Indeed, we must closely look at all of our practices and determine whether they are achieving the outcomes we desire or are actually harmful. Many of our practices in the NICU have changed over the years as evidence has determined that we were, in some cases, actually doing harm. Routine suctioning is one example. Unfortunately, there are many practices that have not been studied, or for which there is inadequate evidence to support what we do.
While we cannot deny the importance of empirical knowledge, nursing is also an art. A third barrier to the use of EBP, as it is typically defined, is that as nurses we are subjected to questions that are not scientific. We must consider aesthetics, which includes empathy or the art of nursing-what nursing actions help the patient cope with the situation. It is what enables us to connect with other human beings in common human experiences, birth, suffering, recovery, and death. Ethical questions, considering the complex personal choices involved in healthcare, impact all of us, particularly in neonatal intensive care. Personal knowledge and the ability to know ourselves and others are what makes interaction with our patients meaningful.
Nursing is a complex discipline because people are complex. We must look at evidence in a broad perspective that includes all aspects of nursing and human nature. A holistic approach gives us more information than one individual focus. We need a wide range of evidence that incorporates all aspects of nursing care.3,4 Breastfeeding is an example. We can do many empiric, quantitative studies that give us great insight into the physiology of lactation, differences in preterm milk, and rates of breastfeeding in mothers of preterm infants. What is more difficult to study in a quantitative way are the why factors. What are the barriers to breastfeeding experienced by mothers of preterm infants? What influence does cultural background have? These questions are equally important and cannot be studied easily with a randomized controlled trial.
Our responsibility as nurses is to give our patients the best care possible, based on the best available knowledge that we have: scientific, ethical, and human experience and values. We must encourage rigorous quantitative and qualitative research that looks at all aspects of nursing practice. We must take the time to read this research, learn how to evaluate it, and incorporate it into our nursing practice. The goal of advancing the art and science of newborn care depends on this.
Catherine L. Witt
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