Though the significance of evidence based practice (EBP) for nursing practice cannot be overrated due to its practical implications and the opportunities that it provides for nurses, the effects of the specified approach often appears to leave much to be desired, since, due to its success, the method is adopted in nearly every nursing or medical case without any regard for the nature of the problem. More to the point, because of the self-effective nature of the EBP practice, a range of nurses adopting EBP consider the acquisition of new knowledge and skills unnecessary. A reconsideration of the role of EBP in the nursing practice and the enhancement of the role of self-education for nursing specialists may be viewed as a solution to the current EBP-related problems.
Introduction: Global Health in the 21st Century
The breakthrough made in nursing in the 21st century due to the evolution of technology and science is truly breathtaking. The uniqueness of every patient has finally been recognized, and the adoption of the evidence-based approach (EBP) is a graphic example of that. Though EBP has been viewed as a silver bullet by most nurses, it should still be perceived as a tool rather than an end in itself. Relying solely on EBP leads to a considerable drop in the qualification of nursing specialists, which can be addressed by introducing balanced approach of training and EBP usage into the nursing practice.
Evidence Based Practice as a Healthcare Tool
The principle of EBP is comparatively new; introduced into the realm of nursing in the early 1990s, it presupposes that a nurse should rely not as much on the standard theoretical framework as they should on the analysis of the specifics of the target population. In other words, EBP requires that the nursing staff should cater to the specific needs of a particular group when addressing a certain disorder or disease (Majid, Foo, Luyt, Zhang, & Theng, 2011). Consequently, the analysis of the quantitative data is viewed as the priority, whereas the information acquired from the qualitative data is typically disregarded or viewed as complementary (Majid, Foo, Luyt, Zhang, & Theng, 2011).
The significance of the EBP approach is predetermined by the uniqueness of each case and the necessity to adopt nursing strategies to specific cases. Indeed, the existing theoretical framework is typically far too general to be useful in addressing a specific case with a patient, who has unique characteristics and, therefore, needs an individual treatment. The EBP, in its turn, allows modifying the theory so that it could be applied to a particular case; in order words, EBP is an approach that offers nurses a “method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific population” (Majid, Foo, Luyt, Zhang, & Theng, 2011, p. 229).
Research Methods as the Key to EBP
As it has been stressed above, the key problem in the realm of the present-day EBP application concerns the unwillingness of the nursing staff to rely solely on the analysis of the patient’s unique characteristics and, therefore, the lack of motivation for exploring the theoretical aspect of healthcare issues; as a result, a degradation of their nursing skills ensues. Consequently, the understanding of the nursing theory and, therefore, the research methods, is imperative for a successful implementation of the EBP.
The significance of research methods in EBP is huge, despite the disregard for methods in EBP by most nurses (Guyatt, O’Meade, Jaeschke, Cook & Haynes, 2000). A closer look at the specifics of the EBP approach will reveal that the approach presupposes an adoption of a qualitative research along with the analysis of quantitative data (Guyatt, O’Meade, Jaeschke, Cook & Haynes, 2000). To be more exact, the inclusion of the EBP principles into a particular nursing strategy requires that a thorough analysis of the secondary evidence based resources should be reviewed carefully before coming up with a design of the intervention strategy.
The inclusion of such resources into the EBP creates the premises for introducing the minimum validity into the nursing strategy and, therefore, allows for a more adequate treatment of a specific nursing issue (Guyatt, O’Meade, Jaeschke, Cook & Haynes, 2000).
Global Healthcare and EBP Efficacy
A closer look at the issue will reveal that the problem of linking the EBP concept with the actual research and the promotion of further knowledge acquisition among the nursing staff is characteristic not only of the U.S. healthcare system, but also for the nursing services all over the world. For example, a recent analysis of the application of EBP in Norway has shown that the evidence-based approach was more welcome among the nursing staff than the research-based one (Dalheim, Harthug, Nilsen & Nortvedt, 2012). Such tendencies for abandoning the scholarly foundations of the nursing process are rather menacing, even though they might signify the advent of a new foundation for nursing practice.
A closer look at the European principles of the EBP implementation in general and the Norwegian ones in particular will reveal that the European nursing staff prefers to use five key sources of information when collecting the data required for the EBP and the choice of an appropriate nursing procedure. As researchers explain, these sources include the data learned about each of the patients individually (Dalheim et al., 2012, p. 3), the nurse’s personal experience (Dalheim et al., 2012, p. 3), the data retrieved from local protocols (Dalheim et al., 2012, p. 3), the information shared with senior clinical nurses (Dalheim et al., 2012, p. 3), and the issues that doctors discuss with nurses (Dalheim et al., 2012, p. 3).
The above-mentioned approach facilitates a rather adequate choice of the nursing strategy, since the choice is made based on not only the nursing staff’s personal experience, but also on the existing documentation; for instance, the use of data protocols seems a legitimate support for the information retrieved from the nurse’s personal experience. The approach, however, clearly lacks a theoretical framework and, therefore, is slowly disintegrating into a set of half-baked principles that have little to no grounds to be based on (Dalheim et al., 2012).
It should be mentioned, though, that the specified issues should not be viewed as the defining feature of the European nursing solely – quite on the contrary, the aforementioned issue with the EBP strategy can be traced in the nursing systems all over the world, including the United States. A recent study has shown that the American healthcare specialists experience the same issue of the lack of motivation for nurses in terms of the search for methodology and the nursing research promotion: “Although it is widely recognized that EBP reduces morbidities, mortality, medical errors, and the geographic variation of healthcare, it is not implemented consistently by nurses and other clinicians in healthcare systems across the United States” (Melnyk, Fineout-Overholt, Gallagher-Ford & Kaplan, 2012, p. 411).
Therefore, it is imperative that the theoretical framework, which the EBP was initially based on, should be updated. While the assumptions of a nursing specialist are crucial for the outcomes of the therapy, the methodology of the approach is also a crucial part of the resulting success of the therapy. The fact that both European and American nursing specialists have encountered the same issue of the lack of methodological instruction presupposes that the theoretical foundation of EBP must be revisited. At present, it can be suggested that a patient-centered nursing theory should be adopted in order to solve the problem.
Summary and Analysis Implications
Even though EBP has led to considerable improvements in healthcare in general and nursing in particular, the concept of informed instruction, which it is based on, seems to have had its toll on the perception of knowledge and training among nursing specialists, triggering a major drop in the quality of nursing services provided by the latter. The issue, however, can be addressed quite successfully by incorporating the EBP principles and the concept of self-education and training into the nursing practice. Consequently, the overuse of EBP in the present-day nursing services demands that the very principle of nurse training should be revisited, with the adoption of a more sustainable approach that encourages self-education and promotes knowledge acquisition should be adopted.
Dalheim, A., Harthug, S., Nilsen, R. M., & Nortvedt, M. W. (2012). Factors influencing the development of evidence-based practice among nurses: a self-report survey. BMC Health Services Research, 12(367), 1–10.
Guyatt, G. H., O’Meade, M., Jaeschke, R. Z., Cook, D. J. & Haynes, R. B. (2000). Practitioners of evidence based care. BJM, 320(7240), 954–955.
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y.-L., Chang, Y.-K. & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229–236.
Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L. & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. JONA: The Journal of Nursing Administration, 42(9), 410-417.