Proving the truth-value of something all depends on the evidence that warrants or support the statement or practice. Therefore, evidence plays a crucial role in determining whether something is reliable and practicable or not. In medical based practice, the presence of warrants and supports are basically based on previously held beliefs and facts that are inscribed in books and old-aged traditions.
Nonetheless, the twenty first century technology requires these dogmas to be questioned in light of new application and substantiation of recent facts and knowledge. To this end, evidence-based practice is being utilized by health practitioners to be able to deliver the best possible treatment and appropriate care for patients. Evidence-based practice generally refers to the act by which the best external research evidence/s are integrated to internal clinical expertise while taking into account the patient’s culture, beliefs and values (Blue et al. , 2003).
According to Melynk and colleague (2004), the evidence-based practice typically involves the formulation of a clinical question, the systematic searching of relevant research evidence, the appraisal of the evidence based on relevance, applicability and quality, the creation of evidence-based decision with the consideration of the research evidence along with the practitioner’s clinical expertise and the patient’s preferences, the implementation of practice change, and finally the evaluation of change in the practice.
The importance of evidence-based practice is associated with the recognition of human fallibility and the acknowledgement of medical, technological, scientific, and social changes that constantly transpire and affects current information, perspectives and techniques. The identification that different person has different needs regardless if they are suffering the same illness or disease display the relevance of evidence-based practice in clinical, medical, and nursing practice.
In evidence-based practice there are external research evidences that might reflect similar situations and procedures which can be effective and might be more preferable in the patient’s case. Thus, evidence-based practice is significant in creating a more effective means of treating, understanding and caring for patients. Evidence-based practice, as reiterated by Kenneth Goodman (2003), can be traced historically to an English physician named Thomas Beddoes. Accordingly, Beddoes saw the eighteenth century medicine as stagnant and secretive (Goodman as cited from Porter 1992).
Beddoes suggests that there should be a systematic collection, exchange of information and indexing of medical facts. Beddoes furthermore encouraged his colleagues to publish information which might be essential to save thousand of lives if used effectively. Beddoes believed that the medical system during his time does more harm than cure simply due to lack of systematized exchange of information between medical practitioners. On this account, another medical practitioner, Pierre Charles Alexandre Louis, founded the ‘Numerical Method’ (Goodman, 2003).
Louis considered the fact that one treatment is superior to others through a collection of data regarding the number of patients cured by one method or another. Goodman quoted Osler (1985) when he discussed the Numerical method as the ‘observation of facts, collating of data and analysis of information… from large series of cases… into the particulars’. Decades after, randomized clinical trials are held and considered as standards for generating information or considered evidence. During the 1970’s a trend towards ‘Research Utilization’ became popular (Feldman, 2008).
Medical Journals starts to develop and compile the latest trends and developments in medicine. At the introduction of the internet, the accessibility of medical information becomes easier. There are several models of evidence-based practice (EBP) that developed over time, each has distinct features that serves unique purpose/s and caters to specific need/s and instances. The most prominent models according to Polit and Beck (2007) are the Stetler Model, the Iowa Model and the Diffusion of Innovations Theory. The Stetler Model is generally divided into five phases.
The first phase is preparation then validation, followed by comparative evaluation, then there will be translation or application, and finally evaluation (Feldman, 2008). The Iowa Model on the other hand uses a sort of ‘algorithm format with multiple decision points along the way’. It begins with either the problem focused or knowledge focused approached followed by a more focus in-depth analysis of available data or evidence. The Diffusion of Innovations theory model is also a five-stage process starting from innovation development or the development of a strategic plan for the use of evidence-based practice (Elkins et al.
, 2007). Then it is followed by dissemination which is the plan for informing about the EBP. Adoption or the awareness and overall understanding of the EBP followed. Then there will be an initial implementation of the innovation or the EBP. Finally the goal of the Diffusion of Innovation Theory model is to work towards the possible maintenance and institutionalization of EBP (Elkins et al. , 2007). The first two models are useful in integrating research to EBP while Diffusion of Innovation Theory works best in introducing EBP into the existing system (Polit and Beck, 2007).
Both are useful in incorporating external clinical studies and up-to-date information into clinical practice while taking into consideration the individual subjected to the treatment. The models can be used depending on the situations for instance it is better to use the Stetler and Iowa models when EBP is already practiced. On the other hand, in cases wherein EBP are not yet known it is better to employ Diffusion of Innovation Theory. In nursing practice the EBP models are useful in analysis of the collected data. Through EBP there can be an interdisciplinary approach in the care or treatment of a disease.
It is important for nurses to take this into consideration and utilize EBP since there are times when they need to make decisions on their own or are asked for perspective or health care advice. Nurses must possess research capability, computer and internet skills, and interest towards their research for EBP to be successful. They must also develop teamwork and collaborate with other health care providers and clinic/hospital staffs if possible. Knowledgeable insights and well-supported arguments are the primary requirements for EBP.
Thus, nurses must be able to distinguish between relevant and irrelevant materials and take into consideration the credibility of their sources. Simply stated, nurses are expected to be critical and active in engaging EBP. Nursing Research seems to be particularly focus into the standard practices and methods of nursing. Nonetheless, a closer look at EBP reveals that the study of Nursing goes beyond the academe. The more important research lies ahead as a nurse tries to incorporate novel ideas to former knowledge in reference to the current situation or condition at hand.
EBP can change the way nurses act as passive, based-on-the book and standard operating procedures, health practitioners. In a way, it elevates the nursing status as it brings forth the integration of different health care professionals in a more visible level. Nonetheless, several barriers are recognized to deter the function of EBP. The first and the most sited includes the lack of time, followed by the difficulty involved in assessing research materials, and other difficulties involved in understanding the content of the material, such as language, lack of computer skills, and reluctance to change.
Evidence-based practice is essential to cope with the unyielding changes in the current society. Since there are several reasons and a variety of circumstances that leads to certain illness, evidence from external research must be studied to get a better view and understanding of the situation and employ the most convenient and effective treatment available based upon the medical practitioner’s expertise and judgment. Evidence-based practice takes into consideration the role of the patient as well, since in EBP the interest and preferences of the patient are taken into account.
EBP plays a crucial role in current nursing practice because it is catered towards innovation to deliver the best possible treatment and appropriate care for the patient. References: Blue, I. , Taylor, J. , and Walker-Jeffrey, M. , (2003). Getting evidence into practice for nurses and carers in rural aged care nursing homes. 7th National Rural Health Conference. Retrieved on January 29, 2009 from http://nrha. ruralhealth. org. au/conferences/docs/7thNRHC/Papers/general%20papers/blue_taylor_walker-jeffreys. pdf Elkins, M. , Diswood, L. , Phoenix, L. , Hodgins, D. , Accountius, D. , and Verbus, R. (2007).
Shiprock Service Unit’s Methods for Adoption of an Evidence-Based Nursing Model. The IHS Primary Care Provider. Vol. 32:8 pp. 226-231. Feldman, H. R. (2008). Nursing Leadership. New York: Springer Publishing Company. Goodman, K. W. (2003). Ethics and Evidence Based Medicine. United Kingdom: Cambridge University Press. Melynk, B. M. and Fineout-Overholt, E. (2004). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice. Philadelphia: Lippincott Williams & Wilkins. Polit, D. F. and Beck, C. T. (2007). Nursing Research: Generating and Assessing Evidence for Nursing Practice. 8th ed. Philadelphia: Lippincott Williams & Wilkins.