(Editor’s note: This post, originally published in February 2017, was updated with new information.)
There was a time when milking chest tubes and bathing children in alcohol were standard practices. Although at the time the nursing interventions may have seemed rational, evidence-based practice has proven otherwise. EBP continues to change the way nurses care for their patients. For example, during one of my clinical rotations, a seasoned nurse corrected me for not aspirating a syringe during an intramuscular injection. Current evidence-based research suggests that aspirating intramuscularly is no longer a standard of practice since no evidence supports its practice and it can cause trauma to patients.
One of the key points we learn in nursing school is about the importance of evidence-based practice. As students we are taught to be a generation that provides high-quality care. This high-quality care is supported by evidence, which took many years to become standards of care through translation from research to clinical practice. Nursing EBP continues to expand and several resources such as journals, models and books are available to help nurses understand the concepts and process. Gaining knowledge of EBP and learning strategies for implementation are critical skills for nurses, no matter the setting.
Expand your knowledge about EBP with these tips:
Evidence-based practice is a clinical decision-making process in which clinicians use theory-derived, research-based knowledge to inform their decisions about care delivery. Consideration of individual needs, preferences and resources are also included. EBP replaces policies and procedures based on other sources of evidence such as tradition or authority. It takes into account three things nursing students should consider at all times: best practice evidence, patient preferences and clinical expertise.
Here are just a few examples of how EBP has changed nursing care. You can find many more examples in the literature.
The BRAT (Bananas, Rice, Applesauce, and Toast) diet is no longer a nutritional recommendation for gastrointestinal upset in children. The American Academy of Pediatrics now recommends that children be return to a well-balanced diet as soon as possible.
• Nurse-driven protocols now guide nursing practice regarding the best time for removing urinary catheters to prevent urinary tract infections.
• Aspirin was previously used to control fever in the pediatric population, but it is no longer a standard practice because it increases the risk of Reye’s syndrome.
• ICU ABCDEF Bundle is a combination of multiple evidence-based interventions that can collectively reduce delirium, improve pain management and reduce long-term consequences for patients in the ICU. (A: Awakening trials for ventilated patients; B: Spontaneous breathing trials; C: Coordinated effort between the RN and respiratory therapist to perform the spontaneous breathing trial when the patient is awakened by reducing or stopping the patient’s sedation; D: A standardized delirium assessment program, including treatment and prevention options; E: Early mobilization and ambulation of critical care patients.)
• Turning patients every two hours is no longer a standard of care. The timing for turning patients should be dependent upon their condition and their risk for skin breakdown. For example, one patient may need to be turned every 15 minutes and another patient may need to be turned every hour.
The evidence-based interventions we learn can improve patient outcomes, help to provide high quality care, reduce costs and eliminate practices that have become obsolete or are not effective. As nursing students and future nurses, we hold a promise of continuous learning, and it is essential to build evidence-based knowledge over time. As students, it is never too early to start thinking like a nurse who is driven by evidence-based practices.
You probably will notice on the units where you work there are specialty populations and patients with similar diseases. To provide a higher level of care, look up evidence-based practices for that particular population. Hospital units or your university library usually have nursing databases to search for specific journal articles.
One of my clinical assignments each semester is to find new evidence-based practices that can help nurses on the unit improve care. Not only do we as nursing students have the power to educate staff, but we also can serve as a great resource, helping staff to provide better care and improve patient outcomes.
As a student, you can suggest implementing evidence-based practices as a standard of practice. Embrace its positivity knowing it will help the care of your patients. You can print out evidence-based practices for your unit and perhaps leave it at the nurses’ desk or in the break room. Start a journal club or join one and come together with nurses who are willing to bring change to the units where you work.
Evidence-based practice change starts with you as a student. Be the change agent, and never be afraid to advocate for the care of your patients.
• It’s important for student nurses to learn the value of evidence-based practice, in order to provide high-quality care. It is never too early.
• EBP is a based on research, evidence on best practices, and the consideration of individual patient’s needs, preferences.
• During clinicals, do research on the medical conditions your patients have. It will help you provide a higher level of care.
• Be proactive in suggesting EBP during clinicals or helping to bring more attention to EBP research.