Resources for students
Welcome to the JBI Student Resources site – for students of medicine, nursing and the allied health professions. Evidence based health care relates to all the health professions – medicine, nursing and allied health - as well as health policy makers, planners and executives. Simply defined, evidence-based practice is the melding of individual clinical judgement and expertise with the best available external evidence to generate the kind of practice that is most likely to lead to a positive outcome for a client or patient.
Evidence based clinical practice takes into account the context within which care takes place; the preferences of the client; and the clinical judgement of the health professional, as well as the best available evidence.
Improving Clinical Care
Evidence-based practice is the foundation of best practice and continuous quality improvement (CQI) in professional practice. The clinical CQI process provides a framework for health services and practitioners to audit and improve the quality of direct care. Critical to this approach is the need for practitioners (of medicine, nursing and the allied health professions) and carers to be actively and explicitly making judgements about how to achieve the best outcomes for patients or clients and to be making clinical decisions that are based on the best available knowledge.
The pursuit of quality includes consideration of the systems and management processes within a given aged care service. Quality improvement from a systems/management perspective involves the self-assessment by each organisation of all aspects of its operations to enable it to plan and implement strategies for improvement. This cycle must be continuous and standards or quality audits are conducted to look for evidence that strategies for improvement are in place. The objective of a standards or quality audit is to check that an organisation has systems in place, that those systems are being implemented, and that they do in fact sustain quality outcomes in the organisation. Most health care providers have implemented processes of this kind.
However, it is not uncommon for even the most effective organisations to concentrate on “best practice” in terms of the systems, management processes and documentation in place within the organisation and to overlook the central role of “best practice” in terms of the professional practice of medical, nursing and allied health professionals (often assuming that this is well established in the professions) and of carers. A commitment to “best practice” is fundamentally related to the identification of the best available evidence on the feasibility, appropriateness, meaningfulness and effectiveness of interventions and care practices. It should be ensured that this evidence is accessible to those who plan and implement care to support the decisions they make in partnership with patients/clients, their families and members of the multi-disciplinary team.
Establishing and maintaining evidence-based practice requires a continuous review of evidence and the production and dissemination of condensed information to service users (consumers), carers, nurses, doctors and allied health professionals.
Best Practice
Best practice is defined in many ways but essentially it means engaging in practices that are based on the best available evidence. Best practice in terms of systems frequently involves “benchmarking” between similar organisations. Best practice in terms of professional practice involves benchmarking between similar practice fields but, more importantly, it involves benchmarking against international evidence generated through research – or Evidence-Based Practice.
Evidence-Based Practice
The rapid development of medical, nursing and health science over the past fifty years has led to an enormous growth in knowledge. As a result, the expansion in the range of interventions and knowledge available to assist health professionals and carers in their clinical decision making and to inform service users in making care choices is unprecedented. This burgeoning of knowledge has not, however, led to an increase in the availability of knowledge to clinical practitioners1 and the need to embed evidence in practice settings is now considered to be a significant challenge for aged care services and health professionals. Merely disseminating information has been found to have little effect on changing practice.
Overcoming this challenge is a central component of most clinical improvement programs and there is some evidence emerging that suggests that, to be effective, dissemination needs to be planned; to follow a series of steps that involves those who use the information; and to be accompanied by a commitment to manage change. Funk et al suggest that research based information presented in such a way as to overcome corporate and individual barriers and good presentation of the material are facilitating factors of importance in this process.
Barnsteiner argues for the use of systematic methods for enhancing practitioner access to research, and the promotion of behaviours where clinicians are encouraged to critique their practice against standards arising out of research evidence to promote research utilisation processes. Others assert that, if it is embedded in practice, the best available information (at best, derived from high quality research) will improve practice, reduce variability in practice and improve the cost effectiveness of care delivery.
The benefits of evidence utilisation are well described in the international literature and most modern health systems are increasingly demanding an approach from practitioners that explicitly values and pursues quality based on evidence of feasibility, appropriateness, meaningfulness clinical effectiveness and cost effectiveness. Rutledge identify the contemporary demand for aged care interventions that demonstrate reliability – that is, for practice that has been proven to reliably effect desired health, social and economic outcomes.
Evidence suggests that a focus on best practice can be achieved in aged care through introducing an ongoing “Best Practice” program that includes:
- Identifying common care practices/interventions and conducting evidence reviews of published international research on those identified;
- Developing condensed information sheets and practice guidelines based on the review of published international research and making these available within the facility;
- Providing access for all staff to a comprehensive database of evidence reviews and best practice guides;
- Developing an organisational policy and practice manual based on the review of evidence and ensuring that this manual is readily accessible to all within the facility; and
- Conducting regular clinical audit/feedback/improvement cycles to establish the degree to which existing practice complies with “best practice” and to generate practice change to improve the quality of care practices.
Establishing Evidence-Based Clinical Practice
Clearly, if every single health care site established a “Best Practice” program that included all of the five components listed previously, a great deal of staff time would be needed and the costs associated with evidence reviews and the identification of best practice would be enormous.
JBI COnNECT offers an ongoing customer-focused service to health services and practitioners to establish and maintain an evidence-based approach to clinical practice improvement.
References:
Barnsteiner JH. Research-based practice. Nurs Adm Q. 1996;20(4):52-58.
Funk SG, Champagne MT, Tornquist EM, Wiese RA. Administrators’ views on barriers to research utilization. Appl Nurs Res. 1995;8(1):44-49.
Dickson R, Entwistle V. Systematic reviews: keeping up with research evidence. Nurs Stand. 1996;10(19):32.
Yorke M. Leaving Early – Undergraduate non-completion in Higher Education. Falmer Press London 1999.
Crane J. The future of research utilization. Nurs Clin North Am. 1995;30(3):565-577.
Pettengill MM, Gillies DA, Clark CC. Factors encouraging and discouraging the use of nursing research findings. Image: J Nurs Scholarsh. 1994;26(2):143-147.
Rutledge R, Oller DW, Meyer AA, Johnson GJ, Jr. A statewide, population-based time-series analysis of the outcome of ruptured abdominal aortic aneurysm. Ann Surg. 1996;223(5):492-502.
Last updated 04 June 2008