Since the earliest days of the modern nursing movement, nurses have been connecting scientific evidence to clinical expertise to provide the best patient outcomes. In the 1990s, researchers dubbed the approach “evidence-based practice” (EBP) and have been working to apply it across nursing care.
EBP is now considered essential to the delivery of quality nursing care and has been utilized in everything from hand hygiene to dress code. It connects clinical decision-making to the best current evidence, clinical expertise and patient preference. The purpose of EBP is to reduce variations in practice and standardize healthcare.
As healthcare continues to shift from volume-based to value-based, EBP is becoming even more critical. Baccalaureate-trained nurses are expected to know more than ever about problem-solving and best practices to support patient safety and healthy outcomes.
“Nurses arguably spend more time with the patient than anyone else in healthcare,” said Chief Nursing Officer Christina Dempsey for the patient satisfaction consulting firm Press Ganey. “As such, they are not only the gatekeepers, they are the ‘thin white line’ between patient safety and both the patient experience and suboptimal outcomes — much like police officers are the thin blue line between anarchy and order.”
The Institute of Medicine (IOM) set a goal of 90 percent of all healthcare practice to be evidence-based by 2020. As the United States moves toward the goal, nurses are at the forefront of implementing this evidence-based practice in healthcare. Key to this effort are registered nurses (RNs) who earn Bachelor of Science in Nursing (BSN) degrees and work in direct patient care.
Origins of Evidence-Based Practice
Historians have linked the earliest use of evidence-based practice to Florence Nightingale and her treatment of sick and injured soldiers during the Crimean War in the 1850s. Among her important insights were connecting poor sanitary conditions and the death rate of wounded soldiers.
In the 1970s, British researcher Archie Cochrane published Effectiveness and Efficiency: Random Reflections on Health Services, which criticized the lack of credible evidence behind many commonly accepted healthcare interventions. Cochrane became widely known as the father of EBP. In the 1990s, Dr. Gordon Guyatt, an internal medicine specialist, coined the term evidence-based medicine.
Models of EBP
In the past two decades, researchers have created dozens of EBP theoretical models and frameworks to help educators and clinicians advance the science behind EBP and facilitate changes. In general, all of the models follow the same basic structure:
- Identify the problem
- Review and analyze research that addresses the problem
- Evaluate the need for change and potential barriers
- Consult with stakeholders who will support the practice change
- Implement the change
- Evaluate outcomes
Because no single model meets the needs of all healthcare settings, several are commonly used in nurse-led research for quality improvements to healthcare. The most commonly used models are adaptable to a variety of environments:
ACE Star Model of Knowledge Transformation (ACE)
The ACE Star Model is a five-step process that has been used in both educational and clinical practice. ACE is used because it provides a simple yet comprehensive approach:
- Discovery of key research
- Summarizing and review of the research studies
- Translating the studies into clinical application
- Integrating changes into practice
- Evaluating the effectiveness of the change
Advancing Research and Clinical Practice through Close Collaboration (ARCC)
The ARCC model focuses on providing healthcare systems with ways to implement and sustain EBP for improved patient outcomes. ARCC contains five steps:
- Assess organization culture for change readiness
- Identify barriers to change
- Identify EBP mentors
- Implement EBP into practice
- Evaluate outcomes
The Iowa Model is intended to provide nurses and other clinicians with guidance while making decisions about day-to-day practice. Frequently used in clinical research, the model encourages clinicians to identify problems or “triggers” and solutions through seven steps:
- Select topic
- Form research team
- Retrieve and develop evidence
- Grade the evidence
- Develop an EBP to address the topic
- Implement the EBP
- Evaluate outcomes
Benefits of EBP in BSN Nursing
The role of EBP in nursing begins in nursing school, where BSN students are expected to apply critical-thinking skills, professional accountability and clinical knowledge to bedside care. The use of EBP benefits BSN nursing because it provides tangible proof of healthcare successes. Some EBP-based studies have been implemented into practice today:
- Hand Hygiene
Evidence that hand washing reduces the incidence of disease and infection dates to the 1890s when researchers recognized a connection between patient mortality and providers who handled cadavers. After Dr. Ignaz Semmelweis implemented hand washing with chlorine, the rate of patient deaths decreased. His research and subsequent practice launched what has become an essential public health tool.
- Dress Code
A Richmond, VA-based hospital changed the nursing staff dress code based on research that found a positive correlation between standardized attire and the identification of staff and the appearance of professionalism. The group recommended nurses wear discipline-specific scrubs (For example, RNs wear solid ciel blue, solid white or a combination and nurse practitioners wear solid teal, solid white or a combination). Based on EBP recommendations, nurses were also issued gold and black tags that identified their professional titles.
- Oxygen for chronic obstructive pulmonary disease (COPD) patients
Researchers found COPD patients must be provided ancillary oxygen despite the previous practice of withholding oxygen. In the past, providers thought ancillary oxygen could cause illness or death in COPD patients. However, EBP has proven oxygen can prevent hypoxia and organ failure.
- Nurse education
In 2003, the IOM published its Health Professions Education: A Bridge to Quality report that stated healthcare providers, including nurses, were not receiving adequate training and education. The IOM included EBP as one of the core competencies for all providers. Since then, nursing education programs have put a significant emphasis on teaching EBPs and methods.
EBP has impacted all realms of healthcare practice, so providers must be prepared to implement new standards based on facts and evidence. Approaches that have been used for decades but have no evidentiary value are on the way out. The top nursing schools, including Duquesne University, use evidence-based practice in nursing and healthcare education.
About Duquesne University’s Online Bachelor of Science in Nursing (RN-BSN) Program
Duquesne University’s RN-BSN online program has been recognized among the best in the United States. The RN-BSN online program can be tailored to fit each nurse’s background and experience, whether he or she has a nursing diploma or associate degree in nursing.
Duquesne University has been educating nurses for more than 80 years and is an expert in online education. The university introduced the first BSN program in Pennsylvania in 1937 and created the nation’s first online nursing Ph.D. program in 1997.
To learn more, visit Duquesne University’s online RN-BSN website.