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Evidence-Based Practice

Evidence-informed Decision-making

Evidence-based practice, evidence-based medicine, evidence-based nursing and evidence-informed decision-making began with Florence Nightingale in the 1850s during the Crimean War. She noted a connection between poor sanitary conditions in the hospital and rising death rates among wounded soldiers (Bite-Sized History of Mathematical Resources, n.d.). “It is Nightingale who developed the coxcomb, a visual display to demonstrate how military deaths could be prevented” (Morin, 2010, p. 2). Her subsequent efforts to sanitize hospitals to save soldiers led to dramatic drops in patient mortality.

Historical Overview 

Much of the original work on evidence-based practice (EBP) focuses on EBP in medicine. Although the term “evidence-based medicine” (EBM) reportedly was first used in the 1980s, the practice gained wide recognition in 1992 when the Journal of the American Medical Association published an article by the evidence-based medicine working group on its role in medical education. According to Montori and Guyatt (2008), that article brought both the term and the concept to the attention of a wider medical community. The working group published a series of 25 articles between 1993 and 2000 that outline criteria to evaluate current evidence to support clinical decisions. This body of work forms the basis of most of the critical appraisal tools used today (Guyatt & Rennie, 2002). 

Definitions galore

Read varying definitions of evidence-based practice, evidence-informed decision-making, and other related terms. Read more

Relevance of evidence-informed decision-making to nursing practice 

Patients depend on nurses to do the best on their behalf. As part of their professional accountability, nurses must continually examine the best way to deliver care. Read more

Types of evidence 

According to the Canadian Nurses Association, a variety of sources are being used by nurses to facilitate their use of evidence. These sources include systematic reviews, research studies and abstraction journals that summarize valid, clinically useful published studies, and clinical practice guidelines. “Guidelines are based on the most rigorous research available, and when research is not available, they are grounded in expert opinion and consensus” (Canadian Nurses Association, 2010, p. 4). Read more

Barriers to nursing: Evidence-based practice/Evidence-informed decision-making 

Barriers to evidence-based practice involve individual nurse characteristics, organizational characteristics, the nature of research information and the health-care environment. Read more

Strategies to promote evidence-based practice/evidence-informed decision-making by nurses 

There are several evidence-based strategies to promote a culture of evidence-based practice or evidence-informed decision-making. Read more

References

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Best Practice Guidelines

RNAO Best Practice Guidelines (Canada)

The Registered Nurses Association of Ontario (RNAO) launched the Nursing Best Practice Guidelines (NBPG) Program with funding from the Government of Ontario. This site offers: guidelines covering five broad clinical areas: Gerontology, Primary Health Care, Home Health Care, Mental Health Care and Emergency Care – some of these are available in French. The site also provides a toolkit for implementing these guidelines and health education fact sheets for patient teaching.


Scottish Intercollegiate Guidelines Network - SIGN (Scotland)

Includes evidence-based clinical guidelines for all health care professionals. SIGN is part of the NHS Quality Improvement Program for Scotland. Many of the SIGN guidelines relate to the NHS priority areas of cancer, cardiovascular disease, and mental health.


National Guidelines Clearinghouse (United States)

This site provides a comprehensive database of evidence-based clinical practice guidelines as well as links to full-text guidelines, Palm-based PDA Downloads; guideline comparisons called Guideline Syntheses prepared by NGC staff; an electronic forum for exchanging information on clinical practice guideline development, implementation and use; an Annotated Bibliography database of citations related to guideline development, methodology, structure, evaluation, and implementation This site is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. The Department of Health Human Services and the University of Alberta’s Evidence Based Practice Centre feeds into this resource.


New Zealand Guidelines Group (New Zealand)

The site provides searchable access to online guidelines organized by therapeutic area, specific population and by alternative medicines. Also offers an evidence-based electronic health care bulletin.


Western Australia Centre for Evidence Based Nursing and Midwifery (Australia)

The Western Australian Centre for Evidence Based Nursing and Midwifery is a collaborating centre of the Joanna Briggs Institute. This centre undertakes a range of practice-oriented research activities to improve the effectiveness of nursing practice and health care outcomes, with a particular focus on the health of women and children.


Canadian Medical Association InfoBase, Clinical Practice Guidelines, (Canada)

This bilingual site provides Clinical Practice Guidelines which are produced or endorsed in Canada by a national, provincial/territorial or regional medical or health organization, professional society, government agency or expert panel. 


The Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention

Is a central and early component of the Best Practices System.