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The Importance of Evidence-Based Practice in Nursing

Sophie A. Singer

College of Nursing, University of South Florida

NUR 4165 Evidence-Based Practice

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The Importance of Evidence-Based Practice in Nursing

Florence Nightingale stated “It is not for the sake of piling up miscellaneous information

or curious facts, but for the sake of saving life and increasing health and comfort” which

emphasizes the importance of evidence-based practice in nursing (Melnyk & Fineout-Overholt,

2019). The goal of evidence-based practice in nursing is to provide patients with better

outcomes, satisfaction, and to uphold the highest standard of quality care. Hospital protocols and

policies are constantly changing to keep up with the most current evidence-based knowledge and

nurses must adapt their care. The concept of evidence-based practice is very broad but consists of

three components: external evidence, internal evidence, and the patient's own personal beliefs

and values (Melnyk & Fineout-Overholt, 2019). Nurses can implement evidence-based practice

in their patient's plan of care daily by staying up to date on current policies, protocols, journal

articles, and specific patient preferences. Evidence-based practice is vital to nursing because it

changes the way care is delivered, how situations are approached, and challenges healthcare to

improve.

Stakeholders, experts, and individuals each have their own role in the development and

implementation of evidence-based practice. Communication between these different parties can

help to bridge the gap between evidence and clinical practice. The stakeholders must be made

aware of current evidence, provide funding for research, and implement new policies to promote

evidence-based practice in the clinical setting (Quanbeck, 2019). Experts conduct research and

offer their clinical expertise to promote patient well-being while individuals advocate for their
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care to be patient-centered, cost-effective, and successful. Collaboration with different personnel

is essential for change to occur and for patient outcomes to improve. In this paper, the

importance of evidence-based practice will be addressed by including personal clinical

experience and highlighting different evidence-based practice models used in nursing to enhance

the care provided to patients.

Clinical Experience

To just pick one situation where I observed a nurse stray away from what I learned in

nursing school is a difficult task to do, but I will choose the one that has had the largest impact

on me. The situation that stood out the most to me was a nurse not following the correct

precautions listed on the doors of patient rooms such as droplet precaution, contact precaution, or

airborne precaution. The nurse would walk in and out of rooms not even caring to look at the

label on the door before they entered. This is a huge concern and greatly increases the risk of

infection which puts patient safety on the line because of the precautions the nurse did not

follow. This behavior endangers not only the nurse but the patients, coworkers, and anybody

whom they may encounter. The precaution labels are on the door due to evidence-based practice

and are a way to notify healthcare personnel of the level of PPE needed to be worn and how to

prevent infections from spreading.

In this situation, the evidence-based priority is patient safety. Many factors come into

play when this situation is reviewed, and questions come to my head as to why the nurse was not

following the correct hospital policy. Was the education the nurse provided not based on

evidence-based practice? Was the nurse burned out from constantly donning and doffing PPE?

Was the nurse overwhelmed with the patient load assigned? Was this policy not strongly

enforced by nursing managers or hospital administrators? All of these questions could be

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probable causes as to why the nurse strayed away from what practice I learned in nursing school

but could all be preventable or avoidable. Hospital policymakers develop rules and regulations

that all employees of the organization must follow, as many of their protocols are developed

upon experience, expertise, evidence, and patient outcome.

The nurse's actions caused me to have a concern about the patient care being provided

and the level of safety that was established. Interdisciplinary collaboration could have greatly

contributed to this situation as other hospital staff could have checked in on this nurse to make

sure the policies were being followed. The nurse manager or charge nurse should address this

situation and if it is deemed necessary more education is needed to supply the nurse with the

correct knowledge on transmission-based precautions than other disciplines may need to be

involved such as educators.

Evidence-based Practice Models

The John Hopkins Nursing Evidence-Based Practice Model was designed for bedside

nurses to apply evidence into practice in clinical settings. The goal of this specific model was to

improve leadership, enhance autonomy and encourage communication between the

interdisciplinary team (Melnyk & Fineout-Overholt, 2019). There are 19 steps in the JHNEBP

which are divided into subcategories labeled “Practice Question”, “Searching for the Evidence”,

and “Translation into Practice” (Vera, 2023). Six steps are contained in the “Practice Question”

which include recruiting an interprofessional team, defining the problem, developing and

refining your evidence-based practice question, identifying your stakeholders, determining

responsibility for project leadership, and scheduling team meetings (Vera, 2023). Five more

steps are listed in the “Searching for Evidence” which are conducting an internal and external

search for evidence, appraising the level and quality of each piece of evidence, summarizing the
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individual evidence, synthesizing overall strengths and quality of evidence, and developing

recommendations for change based on evidence synthesis (Vera, 2023). The last category is

“Translation into Practice” which contains eight steps which are, determine the fit and feasibility

of recommendations for the translation plan, create an action plan, secure support, and resources

to implement the action plan, implement the action plan, evaluate outcomes, report outcomes to

stakeholders, identify next steps and finally disseminate findings (Vera, 2023). An example of

the JHNEBP model applied to nursing practice is the use of alcohol-impregnated caps.

Healthcare workers defined the problem of catheter infections due to pathogens entering the hubs

and decided to implement the use of alcohol-impregnated caps to reduce the risk of central line-

associated bloodstream infections (CLABSI). The alcohol-impregnated caps were effective in

preventing bloodstream infections as the control group was revealed to have 13.7 times increased

risk of infection (Taşdelen Öğülmen & Ateş, 2020). Since this practice seemed to be effective it

was implemented into hospital policies and is widely accepted.

The Stevens Star Model of Knowledge Transformation is a five-pointed star that

illustrates the process of the discovery of new knowledge transformed into best practices and

then outcomes. At the top of the star, point one is discovery research, point two is evidence

summary, point three is translation to guidelines, point four is practice integration, and finally

point five is process, outcome evaluation (Melnyk & Fineout-Overholt, 2019). This model was

used to create the EBP readiness inventory (ERI) which measures an individual's competency in

evidence-based practice. The ERI is used in clinical settings for hiring and educational purposes.

The Clinical Scholar Model encourages nurses to connect research to practice and is

based on the definition of EBP. This model motivates nurses to challenge current practices, have

discussions of new research findings with providers, establish clinical mentors with expertise,
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and critique and synthesize evidence (Melnyk & Fineout-Overholt, 2019). The Clinical Scholar

Program was created alongside the Clinical Scholar Model and follows the same guidelines. The

model goes through a series of steps starting with observing, determining, analyzing,

synthesizing, applying and evaluating, and finally disseminating (Melnyk & Fineout-Overholt,

2019). This model is used in current practices and has helped educate nurses to be leaders and

mentors. The program guides students through the steps of the model and builds skills needed for

advanced practicing nurses to create care plans for optimal patient outcomes.

The three models I listed contain similar properties to improve patient outcomes and

satisfaction. Many steps in the models overlap such as identifying problems, collection of

evidence, implementation, and evaluation. Each model has its own purpose and process of

determining the most efficient evidence-based practice to enhance patient outcomes.

Conclusion

Evidence-based practice is the core of the medical field. Many different models are used

to promote the best practice to ensure adequate patient outcomes and satisfaction. Some models

are better suited for educators, experts, providers, students, and nurses so it is important to make

sure the model aligns with the goal at hand. EBP models can empower nurses to connect with an

interdisciplinary team to be more involved in treatment and develop a specialized plan of care for

their patients. Nurses provide a more holistic approach to care, and it is crucial patient advocacy

is a main priority.

The situation I experienced allowed me to realize the kind of nurse I want to be and

showed me what not to do to ensure patient safety. Real-life experiences help expand upon the

knowledge learned in the classroom and allow students to deepen their understanding of the

clinical practice. Evidence-based practice is a crucial part of nursing school and the nursing
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profession as it establishes core understandings, evolution of nursing processes, and ensures

patients are receiving the best care based on scientific evidence.

There should be more opportunities for bedside nurses to get involved with research as it

motivates nurses to deepen their knowledge and understanding of best practices. If nurses are

more involved in the “why” behind policies, plans, and procedures it will compel them to take

better care of their patients and educate them appropriately (Mackey & Bassendowski, 2017).

Nurses must carry traits of persistence and patience for successful change to occur as it is a

lengthy process. I think it is important that evidence-based practice gets recognition in

undergraduate nursing degrees as it can empower a future generation of nurses to base their care

on evidence-backed research and reasoning.

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References

Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice in nursing

education and Practice. Journal of Professional Nursing, 33(1), 51–55.

https://doi.org/10.1016/j.profnurs.2016.05.009

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in Nursing &

Healthcare: A guide to best practice. Wolters Kluwer.

Quanbeck, A. (2019). Using stakeholder values to promote implementation of an evidence-

based mobile health intervention for addiction treatment in primary care settings.

JMIR mHealth and uHealth, 7(6). https://doi.org/10.2196/13301

Subject guides: Johns Hopkins Nursing Evidence-based practice: Translation Into

Practice. Translation into Practice - Johns Hopkins Nursing Evidence-Based

Practice - Subject Guides at SUNY Upstate Medical University. (2023, May 1).

https://guides.upstate.edu/c.php?g=1023176&p=7411262

Taşdelen Öğülmen, D., & Ateş, S. (2020). Use of alcohol containing caps for preventing

bloodstream infections: A randomized controlled trial. The Journal of Vascular

Access, 22(6), 920–925. https://doi.org/10.1177/1129729820952961

Vera, D. (2023, February 1). Evidence-based practice: Institute for Johns Hopkins

Nursing. Evidence-Based Practice | Institute for Johns Hopkins Nursing.

https://www.hopkinsmedicine.org/evidence-based-practice/model-tools.html
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