Florence Nightingale, who was a nursing student in the 1840s, is known as the founder of modern nursing. She may not have used the term "evidence-based practice" in her tireless efforts to improve healthcare outcomes, but she is widely known as an early evidence-based practitioner. Today, evidence-based practice (EBP) goes hand-in-hand with improving patient safety and quality of care.
Registered Nurse to Bachelor of Science in Nursing (RN to BSN) programs are helping to build a nursing workforce that is prepared to integrate EBP. The University of Louisiana Monroe (ULM), for example, offers an online RN to BSN program that incorporates the study of EBP throughout. From reading and understanding research to using data to monitor outcomes, students gain the competencies they need to develop an evidence-based nursing practice.
What Is Evidence-Based Practice?
One way to understand EBP is to look at Nightingale's work during the Crimean War in the 1850s. She found that more soldiers were dying as a result of poor sanitary conditions than from their injuries. Nightingale's heroic actions to improve sanitation — including plenty of scrub brushes and soap — are credited with drastically reducing the death rate.
The National Council of State Boards of Nursing (NCSBN) defines evidence-based practice as "the integration of the best research with clinical expertise and patient values." EBP starts with a question that drives the process. Questions often relate to the effectiveness of an intervention, such as addiction treatment.
In Health Professions Education: A Bridge to Quality, the Institute of Medicine (IOM) — now the National Academy of Medicine — identified five core competencies for enhancing quality and patient safety. Employing EBP at the point of care is one. EBP involves:
- Asking a question related to patient care.
- Taking a systematic approach to identify the best, most relevant evidence.
- Integrating evidence with clinical expertise.
- Considering patient preferences, concerns and expectations to improve the patient experience.
- Applying the results to guide clinical decisions and improve patient outcomes, which includes reducing preventable medical errors.
Keeping up with the latest innovations and research is an important piece of EBP, and RNs cannot be expected to memorize everything. ULM's RN to BSN program emphasizes the relationship of technology to quality patient care and safety, with a focus on learning to evaluate electronic sources of healthcare information. Younger RNs who have grown up with technology may be more comfortable with this aspect of EBP and can serve as mentors to their colleagues.
What Is the Value of EBP in Nursing Today?
The American Nursing Association (ANA) describes 21st century nursing as "the glue that holds a patient's health care journey together." As the health professionals who spend the most time delivering patient care, RNs play a central role in making sure that healthcare journey is a safe one. Studies show EBP is the way to get there.
The importance of EBP in nursing practice is underscored by "To Err Is Human," the IOM's report on patient safety. This report calls attention to the serious consequences of preventable medical errors. (Medical errors cause more deaths than motor-vehicle accidents, breast cancer and AIDS.)
Key recommendations to address quality of care followed, including, "Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place." The IOM Roundtable on Evidence-Based Medicine set a goal that by 2020, 90 percent of clinical decisions will be based on the best available evidence.
Hand hygiene is a simple evidence-based practice with a sizeable impact on patient safety. Florence Nightingale insisted on handwashing. In Notes on Nursing, she wrote, "True nursing ignores infection, except to prevent it." She recommended that "every nurse ought to be careful to wash her hands very frequently during the day." Frequently indeed. The Centers for Disease Control and Prevention (CDC) cautions that healthcare workers may need to clean their hands 100 times in a 12-hour shift!
Yet, according to the CDC, healthcare workers clean their hands less than half as often as they should. This contributes to the spread of healthcare-associated infections (HAIs), a serious patient safety concern. The CDC reports that 1 in 25 hospitalized patients have at least one HAI at any given time. Performing proper hand hygiene is a simple EBP that can significantly reduce the incidence of HAIs.
Of course, not all EBP is as straightforward as hand hygiene. Evidence-based care factors into everything from managing asthma to monitoring the fetal heart rate during labor. But with what many call a "spirit of inquiry" and the tools to support an evidence-based nursing practice, RNs can deliver quality care that protects patient safety and improves outcomes.
Learn more about ULM's online RN to BSN program.
Sources:NursingCenter: Remembering Florence Nightingale
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