Are you Ready for Evidence Based Practice?
Are you familiar with evidence-based practice (EBP)? This is a movement within healthcare to utilize evidence gleaned from clinical studies rather than opinions and hunches. We all know that the medicine is part art and part science. However, good data exists that isn’t always being utilized.
Some critics of EBP claim that it is only driven by protocols and guidelines. Nothing can be further from the truth! EBP is about finding the best available evidence and tailoring the treatment plan to the individual patient in conjunction with their own cultural beliefs. After all, we can offer a patient the best available evidence yet if it is not congruent with their beliefs, values and culture, it will surely be wasted.
So how does one practice in an evidence based way? First, you should start with formulating a PICO question. PICO is a pneumonic and it stands for:
- P – Population – i.e., Do adult hypertensive patients from 18 years of age to 64 years of age
- I – Intervention – i.e. performing Yoga
- C – Comparison – i.e. compared to patients taking antihypertensives
- O – Outcome – i.e. have a lower incidence of cardiovascular events?
Two great places to start are the Cochrane Library of Systematic Reviews and the Joanna Briggs Library of Systematic Reviews. (Oftentimes, you will need to access these via your institution’s library portal). These are libraries of systematic reviews and meta-analyses. These studies look at all the published evidence and attempt to draw a conclusion based on the original clinical study data.
If a systematic review has not been published based on your PICO question, the fun really starts! Now, it is up to your searching skills to see if any studies haven been done on this topic (While Google should be part of your search, it should not be the main component as their are better search engines for clinical data). Here is a hint: Make friends with your librarian. These highly trained folks are search experts and are always willing to help and give you pointers in an attempt to help you uncover the best clinical data. Your search should include all studies but randomized control trials (RCTs) are the gold standard and at the top of the hierarchy for types of clinical trials.
Now that you have your studies, it is time to critically appraise them. This is a process that attempts to help you determine if the study has the required rigor among other variables for inclusion into your evaluation of the data. After your studies are critically appraised, now you can draw some conclusions from the data and then use this information to help guide and shape your clinical practice.
This is an overly simplified breakdown of EBP. It can take hundreds or thousands of hours of research to answer your clinical question and draw a conclusion. In fact, it took me three years in my doctoral program to understand these concepts and ultimately conduct a systematic review and meta-analysis for publication. However, there is a push to simplify the process so that we can quickly draw conclusions and apply it to practice.
One of the facts that are soon discovered during this EBP research process is that there may not be studies in existence that answer your question. Perhaps that is an opportunity to partner with some experienced colleagues and perform your own research!
Many nurse practitioner schools have embraced EBP and replaced their old nursing research courses with it. NPs will have some background in this practice model and will be able to adapt and apply the best clinical evidence for their patients. Finally, be sure to check out the National Library of Medicine for more EBP tools and discussion.
