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Evidence-Based Practice in Nursing


Known as the founder of modern nursing, Florence Nightingale's work over 100 years ago helped set today's standards in medicine.

In Notes on Nursing, Nightingale wrote, "Every nurse ought to be careful to wash her hands very frequently during the day." As Fidelindo Lim, MA, RN, points out in "Why Florence Nightingale Still Matters," her standards for nursing, including hand hygiene to prevent healthcare-related infections, are seen in evidence-based practice (EBP) even today.

Nurses interact more with patients than any other healthcare provider, and higher levels of nursing education are linked to better patient outcomes. Research skills and evidence-based practice are an important part of this advanced education.

RN to BSN programs are designed to help nurses develop these advanced competencies. At Northern Kentucky University (NKU), students in the RN to BSN program learn from the same faculty members who teach on campus. The difference? The online format provides the flexibility RNs may need to earn their degree while continuing to practice. NKU's RN to BSN program is accredited by the Commission on Collegiate Nursing Education (CCNE).

What Is Evidence-Based Practice and Why Does It Matter?

Research shows a gap between the practice that research supports and the care that patients receive. This research-practice gap can lead to failings in the care patients receive. Evidence-based practice is intended to close the gap between research and practice.

Evidence-based practice (EBP) is a driving force in the nursing profession today. The National Council of State Boards of Nursing (NCSBN) offers a widely accepted definition of evidence-based practice (EBP): "the integration of the best research with clinical expertise and patient values." Simply put, EBP means providing patient-focused care at the highest standard, based on solid research.

What Does EBP Look Like?

Nurses practice in diverse settings -- private and public hospitals, community health centers, outpatient care centers, home-health care settings, nursing and residential care facilities, schools, and more. Whatever the work environment, EBP drives healthcare decisions: What is the right thing to do in this situation, based on the best available evidence?

The following three examples provide a snapshot of how evidence-based practice supports improved patient outcomes.

"Save Lives: Clean Your Hands"

Florence Nightingale's call for hand-washing was to prevent the spread of infection. Today, hand-washing in healthcare settings is standard practice. The World Health Organization has a seven-page guide to hand hygiene, and ample evidence supports improved outcomes for patients.

The CDC shares an example from the 1800s that demonstrates the use of evidence in hand-washing and health outcomes.

In 1846, Ignaz Semmelweis found a higher mortality rate for women whose babies were delivered by students and physicians than for those whose babies were delivered by midwives. He noticed that physicians going from autopsies to obstetrics had an offensive odor on their hands, despite washing with soap and water.

Semmelweis suspected that postpartum infections were caused by "cadaverous particles" transmitted by the students' and physicians' hands. Based on findings related to hand-washing solutions published in 1825, he required students and doctors to wash their hands with a chlorine solution before seeing each patient. Outcome is an important part of EBP, and in this case, the maternal mortality rate dropped significantly.

No patient goes to the hospital expecting to get an infection. Yet, the CDC reports that healthcare providers clean their hands less than half as often as they should. RNs can take a leadership role in improving hand-washing adherence as a low-cost solution to a serious problem.

Diabetes and Depression

The authors of "Be an Expert: Take Action with Evidence-Based Practice" (Journal of Pediatric Nursing) share an EBP approach to nursing in an outpatient diabetes clinic: A young man being treated for diabetes seemed quiet and sad during an office visit. His nurse suspected depression but was unsure of a treatment plan.

In consulting with colleagues, his nurse learned that research shows 30 percent of adolescents with type 1 diabetes also have depression. The team decided to pursue whether the diabetes clinic should be screening for depression. In this case, implementation of EBP might involve screening the patient with a valid diagnostic tool, and if indicated, referring to the primary care provider.

Preventing Ventilator-Associated Pneumonia (VAP)

Mechanical ventilation is a common intervention in intensive care units (ICUs) when people cannot breathe on their own. A common complication of being on a ventilator is pneumonia. This can lead to longer hospital stays, increased costs and death.

Research shows that if the bed is elevated at a certain angle, patients are less likely to get pneumonia. By adhering to EBP, intensive care nurses play a critical role in reducing VAP.

Research is what makes something evidence-based. It's the underpinning of the decisions nurses make to provide the best possible care. It is well-accepted that EBP can improve patient outcomes. In support of this, the Institute of Medicine (IOM) -- now the National Academy of Medicine -- set a goal that by 2020, 90 percent of clinical decisions will be supported by the best available evidence.

Online RN to BSN programs such as NKU's can help nurses meet this goal. Through such programs, they can get the training in EBP they need to put research into practice and improve patient outcomes.

Learn more about NKU's online RN to BSN program.


Sources:

Nursing 2018: Why Florence Nightingale Still Matters

NCSBN: Evidence-Based Nursing Education

World Health Organization: Hand Hygiene: Why, How & When?

Centers for Disease Control and Prevention: Guideline for Hand Hygiene in Health-Care Settings

Centers for Disease Control and Prevention: Hand Hygiene in Healthcare Settings

Journal of Pediatric Nursing: Be an Expert: Take Action with Evidence-Based Practice

National Academies Press: Institute of Medicine: Roundtable on Evidence-Based Medicine

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