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Making Evidence-Based Decisions in Nursing

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Abstract

The demands of the current health care system provide a powerful reason for evidence-based practice. It is undeniably a responsible approach to providing best possible care to patients. Nurses are required to integrate evidence-based clinical decisions as they solve problems regarding patient care during the nursing process. Nursing knowledge, as well as patient values, expert opinions, and evidence on how best to care for the patient are incorporated during the nurse’s clinical decision making. Evidence-based nursing practice as a concept is widely embraced by nurses as a means to improve quality outcomes for patients receiving care. It is also identified as important to the nursing discipline as an expression of scientific competence. Evidence-based nursing practice allows nurses to apply the best knowledge in time to the current situation, but can continually question what is known to create new possibilities for moving patients toward health and well-being (Chinn P, Kramer M (2004) Integrated Knowledge Development in Nursing. Mosby, St Louis). There are multitudes of evidence-based resources such as research studies, performance improvement projects, systematic reviews, and clinical guidelines, that nurses can use to enhance or support clinical decisions; to improve quality care, contain cost, and promote patient satisfaction.

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Acknowledgments

Thanks to Dr. Carol Porter, DNP, RN Senior VP of Nursing, Chief Nursing Officer, Mount Sinai Medical Center, for her support to evidence-based practice in nursing.

Thanks to Dr. Francesco Chiappelli, PhD, for his guidance and patience during the completion of this section.

Author information

Authors and Affiliations

  1. Mount Sinai Medical Center, One Gustave Levy Place, New York, NY, 10029, USA

    Corazon B. Cajulis, Pauline S. Beam & Susan M. Davis

Authors
  1. Corazon B. Cajulis
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  2. Pauline S. Beam
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  3. Susan M. Davis
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Corresponding author

Correspondence to Corazon B. Cajulis .

Editor information

Editors and Affiliations

  1. School of Dentistry, Div. Oral Biology & Medicine, University of California, Los Angeles, Los Angeles, 90095-1668, USA

    Francesco Chiappelli

Addendum

Addendum

Sample models:

  1. (a)

    ACE Star Model of Knowledge Transformation

ACE Star Model

This model depicts forms of knowledge in a relational sequence. The model illustrates five major stages or star points of knowledge transformation [70].

  1. 1.

    Knowledge discovery – new knowledge becomes available (research).

  2. 2.

    Evidence summary – synthesis of all research knowledge into a single meaningful statement.

  3. 3.

    Translation – practice recommendations.

  4. 4.

    Integration – implementation of change into practice.

  5. 5.

    Evaluation – endpoints and outcomes.

  1. (b)

    John Hopkins Nursing Evidence-Based Practice Model (JHNEBP)

This model incorporates the “best available evidence” as the core component necessary to make decisions that affect professional nursing in the domains of nursing practice, education, and research. Guidelines provide nurses with the tools necessary to acquire EBP knowledge and skills to implement change [26]. A three-step process is used:

  1. 1.

    Practice question – identifies EBP question, multidisciplinary team recruited.

  2. 2.

    Evidence – internal and external evidence collected, critiqued, summarized, recommendations developed.

  3. 3.

    Translation – action plan created, change implemented, evaluated, communicated.

  1. (c)

    The Iowa Model of Evidence-Based-Practice

This model provides a guide for clinical decision making, details for implementation of evidence-based change, and enlists both the practitioner and the organizational perspectives [72]. In this model:

  1. 1.

    Problem-focused (PI data, risk issues) or knowledge-focused (new research, standards) triggers are identified

  2. 2.

    The question is this a priority for the organization is asked

  3. 3.

    A team is formed

  4. 4.

    Current knowledge and evidence is assembled, critiqued, and synthesized

  5. 5.

    A pilot to institute change is implemented

  6. 6.

    Change is instituted

  7. 7.

    Structure, process, and outcome data related to change is monitored and analyzed

  8. 8.

    Results are disseminated

  1. (d)

    Rosswurm and Larrabee Model

The Rosswurm and Larrabee [60] model guides nurses through a systematic process for the change to evidence-based practice. This model recognized that translation of research into practice requires a solid grounding in change theory, principles of research utilization, and use of standardized nomenclature. The model has the following five phases:

  1. 1.

    Assess the need for change in practice.

  2. 2.

    Link the problem with interventions and outcomes.

  3. 3.

    Synthesize the best evidence.

  4. 4.

    Design a change in practice.

  5. 5.

    Implement and evaluate the practice.

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Cajulis, C.B., Beam, P.S., Davis, S.M. (2010). Making Evidence-Based Decisions in Nursing. In: Chiappelli, F. (eds) Evidence-Based Practice: Toward Optimizing Clinical Outcomes. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-05025-1_4

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  • DOI: https://doi.org/10.1007/978-3-642-05025-1_4

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