Evidence-based nursing is a fundamental approach to healthcare that involves using the latest research evidence to inform and guide clinical decision-making. It involves gathering reliable evidence, critically appraising and analyzing it, and integrating it with clinical expertise and patient preferences to provide the best possible care. The aim of evidence-based nursing is to improve patient outcomes by ensuring that interventions and treatments are based on the best available evidence.
The first step in the evidence-based nursing process is formulating a well-defined and focused clinical question. This is typically done using the PICO framework, which stands for Population, Intervention, Comparison, and Outcome. PICO helps to structure the question and specify the key components for a research or literature review.
For example, let’s consider a nurse working in the post-anesthesia care unit (PACU) who is interested in finding ways to decrease the use of pain medication in post-operative patients. Using the PICO framework, the nurse might formulate the question as follows: In post-operative patients (Population), does the use of classical music or guided imagery (Intervention) compared to standard pain medication (Comparison) result in decreased pain levels (Outcome)? This question helps the nurse identify what specific information is needed to make an informed decision.
Similarly, a nurse may be faced with a question about the safety of a medication in a specific patient population. For example, a 17-year-old African American woman has been diagnosed with hepatitis B and has been taking acetaminophen for headaches. Her mother is concerned about the potential impact on her liver and asks if she should continue taking the drug. The nurse could formulate the PICO question as follows: In a 17-year-old African American female with hepatitis B (Population), is acetaminophen use (Intervention) associated with an increased risk of liver problems (Outcome) compared to alternative treatments (Comparison)?
Another scenario involves a hospital committee exploring best practices in inpatient oncology nursing. The committee wants to improve patients’ sleep quality and quantity without relying on sleep medication. They decide to investigate relaxation techniques, noise reduction, bed/pillow comfort, and ambient temperature changes. In this case, the PICO question could be: In inpatient oncology settings (Population), do relaxation techniques, noise reduction, bed/pillow comfort, and ambient temperature changes (Intervention) lead to improved sleep quality and quantity (Outcome) compared to standard care (Comparison)?
In addition to guiding clinical decision-making, evidence-based nursing also involves the critical appraisal of research studies. This involves assessing the quality and validity of the evidence through the examination of study design, sample size, data collection methods, statistical analysis, and other key factors. Critical appraisal helps to determine the reliability and applicability of the evidence to the clinical question at hand.
Furthermore, evidence-based nursing emphasizes the integration of research evidence with clinical expertise and patient preferences. Nurses need to consider their own knowledge and experience, as well as the unique circumstances and preferences of each patient, when applying the evidence to clinical practice. This process of integration ensures that the care provided is both evidence-based and patient-centered.
In conclusion, evidence-based nursing is a systematic and rigorous approach to clinical decision-making that is founded on the collection, interpretation, appraisal, and integration of valid, clinically significant, and applicable research evidence. The PICO framework is commonly used to formulate clinical questions and guide the search for evidence. Critical appraisal helps to assess the quality of the evidence, and the integration of research evidence with clinical expertise and patient preferences ensures that the care provided is both evidence-based and patient-centered. By following this approach, nurses can improve patient outcomes and promote the delivery of high-quality care.
