Today in the chart

Imagine you just read a study whose significant finding contradicts a medical practice you’ve been following for years — maybe it’s about anesthesia or heart failure. What do you do next? Present the research to your superiors? Make changes during your next shift? Or what about an evidence-based practice (EBP) approach?

“Providers are inundated with a tremendous amount of information daily,” says Katherine Hinic, Ph.D., RN, CNE, CNL, professor in residence at Morristown Medical Center, who recently spoke about the value of EBP at the 2019 Magnet Conference. “We get those emails with the tables of contents of the journals, or you’re on Twitter … and it can be overwhelming. EBP is a good slant for how you process all this information.”

Defining “Evidence-Based Practice”

While the term may seem self-explanatory, EBP actually “refers to a distinct process to answer a question,” Dr. Hinic says. “It starts with a clinical problem, which we then turn into a searchable question.”

The overall exposure of nurses and APPs to EBP varies. Some people seek out the latest studies through journals and other publications or attend conferences because they understand the value of research to medical practice. Others prefer the “oral tradition” of healthcare — “people passing along, ‘This is how I did it, this is how it was taught,’” Dr. Hinic adds.

But for both groups, it’s crucial to reinforce the notion that evidence-based practice is a “distinct process to answer a clinical question or problem,” she says. “It’s an especially practical approach now that there are so many more journals and studies coming out daily that people must grapple with.”

It’s also important to note that EBP is not original research. Many nursing and PA programs focus on the latter to the detriment of EBP, Dr. Hinic says.

“Human subjects research is trying to determine, ‘Is this the best way or the best way to do the treatment?’” she explains. “With EBP, someone else has already done the research. You have your question, and look at what the evidence says to answer it. All you’re doing is implementing the best practice.”

Solving a Clinical Problem

“Step zero,” as Dr. Hinic calls it, establishes the question, usually the result of wondering why you’ve been doing a specific practice in a certain way.

Next, ideally, you will find a mentor with EBP experience to guide you through the process, especially if you’re a first-timer. Then, Dr. Hinic suggests turning to your organization’s health sciences library. If there’s a librarian to help you search the literature, meta-analyses, and studies, even better. Be sure to ask about existing guidelines and how the practice has changed.

Before gathering the evidence, you should create an interdisciplinary team to join you. “Most problems we encounter are not just nursing or medical problems,” Dr. Hinic says. “If you can have all the stakeholders at the table looking at the practice you’re investigating, it’s much better and more effective if you need to implement some practice change.”

When analyzing the evidence, use a preexisting EBP model, Dr. Hinic advises, adding that her facility employs Johns Hopkins’.

These tools are designed to make sense of what you find by posing questions, such as:

• How many level-one and -two studies did you find?

• How many non-research sources did you find?

• What’s the overall consensus of the body of knowledge?

• Do you have compelling evidence supporting the best practice?

• Do you have sufficient evidence to support any change?

EBP and Your Organization

The culture of your organization will likely determine how your EBP process concludes. Some have established pathways for conducting EBP and implementing change. But other, smaller institutions often don’t prioritize inquiry similarly. In this case, before beginning your EBP journey, assess how your organization will respond if you find compelling evidence to implement a new practice.

Common barriers to implementing EBP include lack of time, mentorship, knowledge, and organizational support, Dr. Hinic says. But the good news is you can start to plant the seeds of EBP on your own, even with minimal resources. For example, turn patient rounds into a time to practice forming questions or establish a journal club that meets regularly to discuss interesting studies.

“It’s about bringing the evidence to the table and getting people to talk about it,” she adds.

Going Back to That One Interesting Study

You should never change your practice based on one article or research study, Dr. Hinic stresses.

“If there’s an established practice, and one study comes out saying, ‘That might not be the best way,’ then more research is needed,” she says. “We need a robust body of evidence to show a compelling reason to change.”

What you should do to start is assess the study’s legitimacy and relevance to your patient population.

Partnering with someone experienced in interpreting research can help. Some guiding questions from Dr. Hinic:

On Relevance

• Did the study take place internationally?

• Was the study performed in an urban or rural setting? If the answer is different from where you practice, does it matter?

• What’s the patient population? Did the study involve a comparable demographic?

On Legitimacy

• Is it from a peer-reviewed journal or a reputable, professional organization?

• Was there any funding for the study that could bias the results?

• Was the sample size reasonable? If it was small, did the researchers justify it?

If you find the study’s conclusion relevant and credible, start to gather existing research on the topic in the same way you would if you thought of a clinical question at work. From there, it’s the same systematic EBP process.

Lastly, remember that EBP doesn’t require you to follow the same protocol with every patient.

“One thing that sets EBP apart from ‘research utilization’ is we’re looking at how the best evidence fits with our patient population, the patient and family values, and the clinician expertise,” Dr. Hinic explains. “It’s about personalizing the evidence out there to fit with the patient and family needs and based on the resources in your setting.”