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Evidence-Based Practice and Nursing Research: Avoiding Confusion

February 02, 2010

The ANCC Magnet Recognition Program® (MRP) requires hospitals to have evidence-based practice embedded in the culture of the organization. In the documentation, hospitals must demonstrate that nurses evaluate and use published research in all aspects of clinical and operational processes.

The ANCC also expects nurses to conduct research projects and that knowledge from these projects will be shared with nurses within and outside the organization.

Although the two requirements have the potential for overlapping concepts in the minds of many nurses, evidence-based practice and research projects are distinctly different—and, if the differences are not recognized, it is possible for an organization's documentation to fail to adequately explain how it meets both requirements.

Evidence-based practice
What is evidence-based practice in the most basic terms? Evidence-based practice looks at research findings, quality improvement data and other forms of evaluation data, and expert opinion to identify methods of improvement.

It's identifying what exactly differentiates evidence-based practice from research that can be challenging for staff members.

"Evidence-based practice is used to close the gap between the research being conducted and the practice—the 'research/practice gap,' " says Marquetta Flaugher, ARNP-BC, DSN, an APN at Bay Pines (FL) VA Hospital.

Evidence-based practice challenges nurses to look at the "why" behind existing methods and processes in the search for improvement.

"So much is based on opinion and tradition, and we can't do that anymore," says Flaugher. "We need to use evidence and speak that language."

Best practices in nursing are always evolving.
"It's amazing how things change," says Flaugher. "I remember being taught things in nursing school, and once I got out into practice, I saw how things are done differently."

The example Flaugher likes to use is treatment for acute muscle strain.

In school—"many moons ago," she jokes—nurses were taught to use ice for the first 24 hours and then heat to increase blood flow to the muscle after that point.

"Now we look at the evidence … we didn't really question our faculty," says Flaugher. "Now if you look at the evidence, research says that we just use heat. We've validated our outcomes."

The language of research
Why do we struggle to understand the difference between evidence-based practice and nursing research? It is often a matter of education and experience—and learning a foreign language.

"A lot of nurses know research but haven't done research," says Flaugher. "If you don't understand the concepts and rules of research, there's potential for confusion."

Not all staff members have the background to immediately differentiate between the two. It's a matter of education.

"If you don't understand research, then levels of study won't make sense. … If you don't have the foundation on research, it's hard to use it in evidence-based practice," says Flaugher.

Research is generating new knowledge about a phenomenon or validating existing knowledge, she explains. Although evidence-based practice may have opinion—expert opinion, but opinion still—woven in, research is built in such a way to avoid bias.

"Research is pretty cut-and-dry," says Flaugher. "You take so many safeguards against bias."

Building understanding
You need to have a good understanding of research and then you can make use of it. In many ways, research is a foreign language. You must be able to speak and understand it to truly do it.

"We start talking about variables and phenomena and statistical analysis, things we don't use in everyday language," says Flaugher.

But there is hope: Every hospital has people who do speak the language of research.

"You have a lot of people in the hospital who have had experience with research and can become mentors to others," says Flaugher. "They should be seen as leaders in the facility and active in councils and committees" where their experience is needed.

Look at who the people are in your facility currently doing research; in smaller facilities, these names will already be well known.

In addition, look at who is sitting on the institutional review board. Take note of what questions are being asked—what they are looking at when examining proposals.

These experts do not have to be nurses; look for help across other disciplines as well.

Gaining buy-in
Once you have established the difference between evidence-based practice and nursing research, the next trick is obtaining buy-in from the nursing staff for both requirements.

"You somehow need to show the staff how this is directly going to benefit not only themselves, but also the patient," says Flaugher. "A lot of what we do can be changed, and it will save time and energy."

For example, if the research shows that taking vital signs every hour instead of every 30 minutes for a given population is beneficial, you could potentially save a lot of time and documentation, and in the end also give the best care to patients as supported by the research.

Flaugher points to the benefits of ownership as a way of promoting buy-in for evidence-based practice and nursing research among staff members. If they are part of a major change that is supported by leadership, implemented, and demonstrated to be successful, this can lead to greater buy-in for future improvements.

"If nurses can start asking, 'Do we need to do [this particular process]?' they can start doing a literature review and find evidence for support," says Flaugher.

This is the key thing with MRP and looking at evidence-based practice, she says.

"Nurses want to be recognized as a professional discipline in control of our own practice," she says. "Evidence-based practice can help all nurses regardless of where they are to help them improve."

Examples of evidence-based practice projects:

  • Developing a rapid response team to decrease incidents of code blue outside the ICU
  • Evaluating appropriate clinical parameters for placement and removal of urinary catheters
  • Instituting a hand hygiene educational video for visitors in the NICU
  • Discussing how to determine whether chlorhexidine is a more effective skin antiseptic than other cleansing agents in preventing probable peripheral IV catheter-related infection
  • Developing an orientation on hospitalization for patients and families and monitoring its effect on patient satisfaction
  • Evaluating an inservice intervention aimed at increasing the use of alternatives to restraints
  • Assessing adequacy of pain treatment in first 24 hours postoperatively
  • Determining how you can promote smoking cessation

This article was adapted from one that originally appeared in the February 2010 issue of HCPro's Advisor to the ANCC Magnet Recognition Program®, an HCPro publication.

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