Evidence-based practice in delivering safe and quality patient care

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This is my presentation on how relevant Evidence-based practice, or EBP, is in delivering safe and quality patient care and the challenges faced in its implementation process.

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EBP is a systematic approach to healthcare decision-making that integrates the most reliable data from research studies, clinical expertise and patient preferences (Greenhalgh et al., 2020). EBP considers the organisational and environmental factors influencing care delivery, ultimately leading to cost-effective solutions and improved patient outcomes.

 Slide 3

The three components of EBP are:

1. Best available evidence: 
2. Clinical expertise: 
3. Patient values, preferences and situation (Berg, 2020)

Slide 4 

Let's discuss the first component of EBP.

High-quality research and a clinically informed research approach are crucial components of EBP (Kumah et al., 2022). This entails utilising the most reliable and well-founded evidence to inform decision-making in healthcare, which is also supported by Nursing and Midwifery Board of Australia (NMBA) Standard: Standard 7 - Provision of Quality and Safe Practice (NMBA, 2018). A rigorous process is employed to identify and assess research literature, ensuring its credibility and impartiality. The evidence hierarchy pyramid, depicted in the diagram, is a valuable tool for discerning the most reliable evidence ranking different types of research based on their robustness and reliability (‌Ebrall et al., 2020). Nurses are encouraged to formulate specific research queries using a structured method like the PICO framework (Population, Intervention, Comparison, Outcome) using unbiased objectivity to focus their search on the most relevant sources for their clinical inquiry (Eriksen & Frandsen, 2018). 

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A vital aspect of EBP is the application of clinical expertise, aligning with NMBA Standard 3 - Nursing Practice Decision Making (NMBA, 2018). This encompasses utilising knowledge and skills to facilitate problem-solving and collaborative decision-making, considering each patient's unique circumstances and medical history (Ajibade, 2021). To ensure proficiency, nurses must stay updated with the latest research and clinical practice guidelines for continuous professional development  (Mlambo et al., 2021). This also involves seeking input from peers and experts, allowing for self-reflection, and exchanging insights and experiences that aid decision-making. 

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The last element of EBP centres on the patient's values, preferences, and circumstances. EBP strongly emphasises involving patients and their families in the decision-making process to ensure that care is tailored to each unique situation (Den Hertog & Niessen, 2019). This aligns with NMBA Standard 1 - Critical Thinking and Analysis in Nursing Practice (NMBA, 2018). When engaging with patients and their families, nurses must consider factors such as age, gender, cultural background, and health literacy. They should also establish a welcoming environment that respects patients' autonomy and dignity by respecting their beliefs and socioeconomic status. Nurses must develop trust and maintain open communication with patients and their families, actively listening to their concerns and integrating their input into the treatment plans (Den Hertog & Niessen, 2019).

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EBP combines research evidence, clinical expertise, and patient values to inform healthcare decisions. Research evidence, derived from rigorous studies, provides a foundation for clinical decisions, reducing practice variability and ensuring reliable outcomes (Kumah et al., 2022).. Clinical expertise, based on provider knowledge and experience, allows for personalized care, crucial when evidence is limited. It also aids in problem-solving in complex situations (Ajibade, 2021).. Patient values and preferences integrate the individual's perspective, fostering shared decision-making, aligning care with their goals, and improving satisfaction and treatment adherence (Den Hertog & Niessen, 2019).. Together, these components enhance the delivery of safe, high-quality patient care.

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A significant obstacle in healthcare settings to the secure implementation of EBP is the limited access to resources for nurses (Sharplin et al., 2019). Even though many workplaces are digitised, not all nurses have equal access, and obtaining subscriptions to specific databases can be expensive, especially for smaller organisations. Nurses may need extra assistance to apply EBP proficiently. To overcome this organisational barrier, organisations can provide nurses training, support and resources on how to find and use evidence effectively and ensure that relevant databases and resources are accessible to them (Alatawi et al., 2020).

Another obstacle to implementing EBP is resistance to change or lacking an EBP-focused culture (Crawford et al., 2022). This resistance is often observed among staff who may be hesitant to alter established practices owing to a lack of awareness or acknowledgment regarding the substantial benefits EBP offers in enhancing patient outcomes and elevating the overall quality of care. To surmount this barrier, healthcare organisations should actively engage their leadership to champion EBP, setting a compelling example for the rest of the staff. Additionally, integrating EBP principles into the organisation's policies and procedures, which entails updating clinical guidelines, protocols, and workflows, is essential for fostering a culture that embraces evidence-based practices (‌Portney, 2020)..

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Summarising my presentation, EBP aims to deliver top-notch patient-centred care founded on the latest and dependable evidence, using clinical expertise and evaluating patients' values and preferences. However, implementing EBP can be challenging because nurses need more access to resources or resist change. However, it can be overcome using organisational support so that patients can receive safe, accessible and high-quality care.

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This is my list of resources that I used to create this presentation

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Thank you!

References

‌Ajibade, B. (2021). Assessing the patient’s needs and planning effective care. British Journal of Nursing. https://www.britishjournalofnursing.com/content/clinical/assessing-the-patients-needs-and-planning-effective-care/ 

Alatawi, M., Aljuhani, E., Alsufiany, F., Aleid, K., Rawah, R., Aljanabi, S., & Banakhar, M. (2020). Barriers of implementing evidence-based practice in nursing profession: A literature review. American Journal of Nursing Science, 9(1), 35. https://doi.org/10.11648/j.ajns.20200901.16 

Berg, H. (2020). Virtue ethics and integration in evidence-based practice in psychology. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.00258 

‌Crawford, C. L., Rondinelli, J., Zuniga, S., Valdez, R. M., Tze‐Polo, L., & Titler, M. G. (2022). Barriers and facilitators influencing EBP readiness: Building organizational and nurse capacity. Worldviews on Evidence-Based Nursing, 20(1). https://doi.org/10.1111/wvn.12618 

‌Den Hertog, R., & Niessen, T. (2019). The role of patient preferences in nursing decision‐making in evidence based practice: excellent nurses’ communication tools. Journal of Advanced Nursing, 75(9). https://doi.org/10.1111/jan.14083 

‌Ebrall, P., & Doyle, M. (2020). The value of case reports as clinical evidence. Chiropractic Journal of Australia (Online), 47(1), 1–15. https://search.informit.org/doi/10.3316/informit.900656263678270 

‌Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: A systematic review. Journal of the Medical Library Association, 106(4), 420–431. NCBI. https://doi.org/10.5195/jmla.2018.345 

Greenhalgh, T. M., Bidewell, J., Crisp, E., Lambros, A., & Warland, J. (2020). Understanding research methods for evidence-based practice in health (2nd ed.). John Wiley and Sons Australia, Ltd.

Kumah, E. A., McSherry, R., Bettany-Saltikov, J., & van Schaik, P. (2022). Evidence-informed practice: Simplifying and applying the concept for nursing students and academics. British Journal of Nursing (Mark Allen Publishing), 31(6), 322–330. https://doi.org/10.12968/bjon.2022.31.6.322 

‌Mlambo, M., Silén, C., & McGrath, C. (2021). Lifelong learning and nurses’ continuing professional development, a metasynthesis of the literature. BMC Nursing, 20(62), 1–13. https://doi.org/10.1186/s12912-021-00579-2 

Nursing and Midwifery Board of Australia (NMBA). (2018). Code of conduct for nurses. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx 

‌Portney, L. G. (2020). Foundations of clinical research: applications to evidence-based practice. FA Davis.

Sharplin, G., Adelson, P., Kennedy, K., Williams, N., Hewlett, R., Wood, J., Bonner, R., Dabars, E., & Eckert, M. (2019). establishing and sustaining a culture of evidence-based practice: an evaluation of barriers and facilitators to implementing the best practice spotlight organization program in the Australian healthcare context. Healthcare, 7(4), 142. https://doi.org/10.3390/healthcare7040142