Evidence-Based Practice Models to Maximize Nursing’s ...

1 Asian J. Nursing Edu. and Research 6(1): January-March 20161 ISSN2231-1149 (Print) (Online)RESEARCH ARTICLEE vidence-Based Practice Models to Maximize Nursing s Contributions toGlobal HealthLynda Wilson1,Radha Acharya2,Sita Karki2,Henna Budhwani3,Prajina Shrestha2,Pratibha Chalise2,Unisha Shrestha2,Kabita Gautam21 School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama USA2 School of Nursing, Kathmandu University School of Medical Sciences, Dhulikhel,Nepal3 School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA*Corresponding Author Email:ABSTRACT:Despite the growing recognition of the importance of Evidence-Based Practice (EBP) and Evidence BasedNursing (EBN), there remain barriers to the implementation of EBP and EBN in many countries including lackof knowledge as well as time and resources for full EBP implementation. The International Council of Nursing,recognizing the need to prepare nurses and midwives in EBP, has published a toolkit to help nurses betterunderstand EBP so that they can make optimal contributions to global health care.

2 This paper is based on apresentation made at the first International Nursing Conference on Enhancing Evidence Based NursingPractice, held at Dhulikhel Hospital, Kathmandu University in Nepal in November 2014. The purpose of thispaper is to review thehistory of the EBP movement in nursing and health care, compare concepts of EBP withthe concepts of translational science, implementation science, and improvement science, and describe theprocess of Evidence Based Nursing (EBN) Practice . The paper concludes with a discussion of barriers to EBP,recommendations for strategies to address these barriers, and implications for improving EBN in Nepal and otherAsian : Evidence-Based Practice , Nursing Research, Evidence-Based :Despite the enormous global investments in researchover the past decades, there remain serious challenges intranslating the research evidence to actions that canaddress challenges with inequities in global health anddevelopment.

3 One reason for the failure to translateevidence to Practice relates to the difficulty in accessingand critically appraising the enormous amount ofinformation that is available to health care workers. In2006, the Health Information for All by 2015 networkwas formed to address the problem with inadequateessential healthcare information in the developing HIFA 2015 Foundation Document noted that Tensof thousands of people die every day from commonillnesses that can be easily on on on A&V Publicationsall right reservedAsian J. Nur. Edu. and Research6(1): ; Page 1-DOI:A major factor in these deaths is that the parent, carer, orhealth worker very often does not know what to do, andwhen and where to seek help. In other words, people aredying for lack of basic healthcare knowledge [1].Nurses constitute the largest group of health careprofessionals in the world.

4 In 2012 the InternationalCouncil of Nurses (ICN) published a toolkit to helpnurses to understand and implement evidence-basedpractice (EBP), recognizing the challenges that resultfrom poorly-informed decision making, and inequities inthe availability of quality health services[2]. In theintroduction to this toolkit, the authors noted that it isimportant for nurses to feel informed enough to askgood questions, develop our skillsand ensure that wework closely with colleagues to ensure the researchinvestment is used to best are often wellplaced to supply important information about context,about different systems, population groups, and the roleof local politics and social factors (p. 3).Asian J. Nursing Edu. and Research 6(1): January-March 20162 The purpose of this paper is to review the history of theEBP movement in nursing and health care, compareconcepts of EBP with the concepts of translationalscience, implementation science, and improvementscience, and describe the process of Evidence BasedNursing (EBN) Practice .

5 The paper is based on akeynote presentation made at the first InternationalNursing Conference on Enhancing Evidence BasedNursing Practice , held atDhulikhel Hospital, KathmanduUniversity in Nepalin November 2014l. The paperconcludes with a discussion of barriers to EBP andrecommendations for strategies to address these barriers,and implications for advancing the use of EBN in Nepaland other Asian and Definitions ofEBP and EBNThe beginning of the EBP movement is generallycredited to Dr. Archie Cochrane, a Britishepidemiologist who published a landmark report thatcriticized contemporary medical Practice for the failureto incorporate current research evidence in makingdecisions about health care interventions andtreatments[3, 4]. Cochrane reviewed current practiceswithin the NationalHealth Service in England, and notedmany examples of policies and practices that were basedon tradition or personal preference, rather than onobjective data or research evidence.

6 For example,Cochrane questioned recommendations by numerouscommittees related to midwifery care, noting that it issurprising how successive committees have been contentto accept trends as something God-given which must befollowed, instead of demanding a more rigorous analysislooking into causality [4]. Cochrane advocated for a marked increase in knowledge through applied medicalresearch [4]. Nearly 20 years later, in February 1992, theBritish National Health Service approved funding for theCochrane Centre "to facilitate the preparation ofsystematic reviews of randomised controlled trials ofhealth care"[5]. In June of that same year, a meeting washeld at Macmaster University in Canada to plan for aglobal organization to support the Cochrane Center andin November the Evidence Based Medicine WorkingGroup published a landmark paper in theJournal of theAmerican Medical Associationproposing EBP as a newparadigm for medical Practice (that).

7 De-emphasizesintuition, unsystematic clinical experience, andpathophysiologic rationale as sufficient grounds forclinical decision making and stresses the examination ofevidence from clinical research. Evidence-basedmedicine (EBM) requires new skills of the physician,including efficient literature searching and theapplication of formal rules of evidence evaluating theclinical literature [6]. The Cochrane Center openedofficially in October 1992 in Oxford, England[5].Melnyk and Fineout-Overholt[7]expanded on theoriginal definition of EBP proposed by Sackett et al.[8],and proposed a definition of EBP as a lifelong problem-solving approach to clinical Practice that integrates: asystematic search for as well as criticalappraisal andsynthesis of the most relevant and best research ( evidence) to answer a burning clinical question;one s own clinical expertise, which includes internalevidence generated from outcomes management orquality improvement projects, a thorough patientassessment, and evaluation and use of availableresources necessary to achieve desired patient outcomes;and patient preferences and values [7].

8 Theydifferentiated the concept of EBP from the more specificconcept of research utilization which refers to the use ofresearch findings in clinical Practice , often based on asingle study. Research utilization is seen as only onecomponent of the broader concept of EBP[7].Scott and McSherry[3]traced the expansion of the EBPmovement to encompass the a diverse group of healthprofessionals and healthcare practices such as Evidence-Based midwifery, health visiting, health promotion, andnursing. These authors analyzed 13 definitions of EBNand EBP and identified 11 key elements in the variousdefinitions (identify research, evaluate research, applyresearch to Practice , best evidence, evaluatecare,problem solving, decision making, use ofclinical/professional expertise, theory driven, patientinvolvement, and process). Scott and McSherry proposeda definition of EBN based on a synthesis of this reviewas an ongoing process by which evidence,nursingtheory, and the practitioners clinical experience arecritically evaluated and considered, in conjunction withpatient involvement, to provide delivery of optimumnursing care to the individual [3].

9 The EBP movement has expanded across the globe, andled to demands for Evidence-Based policy making andevidence-based public health[9, 10]. In the United States,the Institute of Medicine devoted the 2007 annualmeeting to EBM and set a goal that by 2020, 90 percentof clinical decisions will be supported by accurate,timely, and up-to-date clinical information, and willreflect the best available evidence [11].Relationships of Translational Research,Implementation Science, and Improvement Science tothe EBP MovementConcurrent with the growing institutionalization of theEBP and EBN movements, the new fields oftranslational research, implementation science, andimprovement science have emerged to study factors thatinfluence health care decision-making and methods forcreating change in health care organizations to applyevidence and translate research to Practice .

10 AlthoughAsian J. Nursing Edu. and Research 6(1): January-March 20163these approaches complement the EBP movement, theyeach have distinct areas of focus and et al.[12]noted that the term translational research appeared in a Medline search as early as 1993, but mostearly references focused on work spanning severaldisciplines within a particular type of research. Theseauthors proposed the following definition of translationalresearch: Translational research fosters the multidirectionalintegration of basic research, patient-oriented research,and population-based research, with the long-term aim ofimproving thehealth of the public. T1 research expeditesthe movement between basic research and patient-oriented research that leads to new or improved scientificunderstanding or standards of care. T2 researchfacilitates the movement between patient-orientedresearch and population-based research that leads tobetter patient outcomes, the implementation of bestpractices, and improved health status in communities.