Evidence-based practice has been integrated into clinical settings to improve patient outcomes and promote quality nursing care. As health professionals, nurses’ must make judgements through clinical reasoning to ensure the best available evidence, including the most valid, current, and peer-reviewed research findings, informs their care. By integrating evidence- based practice, nurses can actively foster a culture of safety, better health outcomes, and reduce risk and harm for patients, family members and colleagues. This essay will discuss evidence- based practice and why it is essential in nursing. Furthermore, the author will utilise an example from clinical placement to demonstrate how evidence-based nursing can improve patient care.
The utilisation of evidence-based practice is imperative in clinical settings to improve patient outcomes and enhance the consistency and quality of nursing care. Evidence-based practice is an approach to problem-solving that integrates the best findings from well-designed studies, the patient’s values, the nurse’s clinical expertise and assessments, and the clinical practice guidelines in which the nurse works (Kalavani et al., 2019). Based on the hierarchy of evidence, systematic reviews, meta-analyses, and randomised controlled trials are considered the best quality research. Additionally, up-to-date nursing standards and guidelines are considered high-grade, evidence-based documents and should inform nursing practice (Crable et al., 2020). In addition to utilising the highest quality evidence, nurses should formulate a research question and critically appraise the literature to discover whether the research is suitable or reliable to inform clinical practice.
Nurses commence the evidence-based practice process via articulating a well-crafted research question to answer a specific clinical dilemma. According to the literature (Crable et al.,
2020), an appropriate clinical question is developed utilising the PICOT method, considering the
population, intervention, comparator, outcome, and whether it is time specific to the nurse’s practice. Zuzelo (2018) illustrated that a well-designed research question informs the subsequent steps of the evidence-based practice process by providing the topic, research boundaries, and context of the literature search and critical appraisal. By critically appraising the literature, the nurse can better understand a study’s weaknesses and strengths and thus evaluate whether the research is a suitable and reliable method to guide practice. Spratling and Hallas (2020) suggest that nurses utilise the Critical Appraisal Skills Programme checklist to evaluate the study systematically to assess its usefulness in practice. After developing a research question, appraising the research findings, and uncovering the best scholarly literature, the nurse can then incorporate clinical expertise, hospital guidelines, and the patient’s needs and preferences to implement evidence-based nursing principles.
Evidence-based practice is beneficial for both the nursing profession and the patient, as it allows nurses to make the most appropriate clinical decisions for their patients based on the best available evidence and the patient’s unique circumstance and values. Evidence-based practice enables nurses to implement a patient-centred approach, link theory to practice, and build clinical knowledge by remaining up to date with current literature; therefore, improving clinical outcomes, the quality of care, and reducing healthcare costs (Abu-Baker et al., 2021). The literature (Melnyk et al., 2021; Schaefer & Welton, 2018) illustrated that nurses’ who utilised evidence-based practice experienced greater autonomy and job satisfaction and a lower nursing turnover. Sonğur et al. (2018) revealed that nurses who implemented evidence-based practice could communicate more effectively with patients, families, and multidisciplinary team members to prepare the most appropriate healthcare plans and rational decisions.
Additionally, by adhering to the Nursing and Midwifery Board of Australia [NMBA] (2016) and the Australian Commission on Safety and Quality in Health Care [ACSQHC] (2021) standards for practice, nurses can protect patients from harm and provide safe care by adhering to the conduct expectations, professional boundaries, and legal requirements of these documents which support best practice and are based on quality evidence. Therefore, the most up-to-date evidence and nursing standards must guide nurses’ clinical decisions to benefit patients, families, healthcare providers, and the hospital system. However, this is not always the case, as barriers prevent nurses from implementing evidence-based practice.
Although many research studies have emphasised the importance of evidence-based practice, it is still not standard practice throughout many healthcare systems worldwide. According to Melnyk et al. (2021), healthcare professionals continue to deliver care based upon outdated procedures, policies, and traditions not supported by research. Despite access to current clinical practice guidelines, randomised controlled trials, meta-analyses, and systematic literature reviews, nurses continue to encounter organisational and individual barriers that prevent the implementation of evidence-based nursing. Camargo et al. (2018) discovered that obstacles included an inability to understand the research, lack of desire to change, limited time, and workplace overload prevented nurses from engaging in evidence-based practice. Melnyk et al. (2021) reported that barriers encompassed a lack of evidence-based practice mentors and leadership, inadequate research knowledge and skills, and insufficient infrastructure and resources. Without evidence-based nursing care, the patients do not receive the highest quality of care; therefore, safety and health outcomes reduce, and healthcare costs skyrocket as medical errors may increase.
Currently, Australia is facing a shortage of nursing practitioners; therefore, empowering nurses to implement evidence-based practice principles may lead to greater job satisfaction, lower vacancy rates, and thus improve the quality of nursing care (Melnyk et al., 2021; Schaefer
& Welton, 2018). According to the literature (Kalavani et al., 2019), education is the key to empowering nurses to implement evidence-based nursing principles. Therefore, this essay will utilise a learning experience from clinical placement at Sir Charles Gairdner Hospital on the dialysis ward to discuss how a clinical facilitator (CF) applied evidence-based practice principles to educate a nursing student on how to perform a central venous catheter dressing change safely.
Before commencing the procedure, the CF and I guaranteed that we were familiar with the hospital policies to ensure that the dressing was performed safely. Vaismoradi et al. (2020) found that the prevention of practice errors and quality of nursing care is dependent on the nurse’s adherence to the hospital policies and guidelines. Practice guidelines and policies are evidence-based methods developed by professional organisations to achieve a reliable and safe healthcare system by improving patient outcomes and the consistency of care (McArthur et al.,
2021). Therefore, the CF and I ensured that we were familiar with the Sir Charles Gairdner hospital nursing practice guideline concerning a dressing change on a patient’s central venous catheter (CVC). Furthermore, the CF and I ensured the CVC guideline was current and specific to our clinical care. Therefore, adhering to evidence-based practice principles and providing safe and quality nursing care by practising under relevant and current hospital policies and guidelines (NMBA, 2016, Standard 6.5).
Before performing the central venous catheter dressing change, the facilitator educated me on the importance of adhering to evidence-based nursing principles, including infection prevention and control policies to reduce healthcare-associated infections. Healthcare-associated
infections are preventable illnesses acquired through direct or indirect interaction with the healthcare system. These infections profoundly impact healthcare systems by decreasing patients’ quality of life and increasing morbidity, mortality, and the hospital’s financial burdens (Berry et al., 2020). The CF expressed that when caring for a patient’s CVC, adhering to correct infection control principles is particularly important as the central line is inserted into either the
subclavian, femoral, or internal jugular veins and advanced until the terminal lumen has direct access to the right atrium or inferior or superior vena cava of the heart. Therefore, given the central line’s connection to the heart and the fact that the CVC remains insitu for weeks or months, a severe or life-threatening bloodstream infection can develop if incorrect nursing care is provided when tending to a CVC.
Therefore, the clinical facilitator highlighted the importance of adhering to the five moments of hand hygiene and aseptic techniques to prevent and control infections (ACSQHC,
2017, Standard 3). The CF’s emphasis on correct hand hygiene and aseptic techniques while performing a CVC dressing is supported by a recent peer-reviewed meta-analysis and systematic review published in the Nursing and Health Sciences Journal (Conceição de Jesus et al., 2020), suggesting quality research to inform nursing practice. The authors stated that the utilisation of correct hand hygiene, aseptic techniques, the use of sterile gloves, and allowing the CVC site to air dry improved patient safety by reducing the development of bloodstream infections.
However, upon critically appraising this study, the articles obtained for the analyses were considered low-quality due to bias and the lack of randomised-controlled studies available. Therefore, further high-quality evidence is needed to inform nursing practice.
When changing the dressing of a patient’s central venous catheter, high-quality evidence must inform the nurse’s practice to ensure the most effective care. Huang et al. (2020) performed
a current and peer-reviewed meta-analysis and systematic review based upon the one hundred most cited studies from twenty countries, including Australia. The studies included were mainly randomised-controlled trials and meta-analyses and thus quality evidence to inform nursing practice. The studies supported the utilisation of sterile dressings, aseptic techniques, and hand hygiene when caring for a patient’s CVC to reduce the risk of catheter-related bloodstream infection. This evidence supports the CF’s education, as she educated me on aseptic techniques, including cleaning the trolley with pre-diluted detergent as well as opening and preparing the dressing pack, equipment and sterile field utilising hand hygiene and non-touch technique to prevent contamination.
Additionally, the study (Huang et al., 2020) supported the facilitator’s education on utilising correct hand hygiene throughout the dressing change to prevent infections. For example, the CF high-lightened performing hand hygiene when necessary, including before commencing the procedure and before preparing the sterile field, before donning non-sterile gloves to remove the old dressing, and before donning sterile gloves to clean the catheter site utilising chlorhexidine, and when applying a sterile occlusive dressing. After the procedure, the CF educated me on the importance of performing hand hygiene when removing personal protective equipment and when re-cleaning the trolley with detergent wipes to prevent the spread of healthcare-associated infections. By utilising evidence-based practice principles, the facilitator educated me on maintaining patient safety by preventing and controlling infections via correct hand hygiene and aseptic techniques when changing the dressing on a CVC. Therefore, the CF ensured that evidence-based practice and quality improvement principles would continue to be implemented by future nursing professionals and thus improve patient safety and the quality of nursing care as per NMBA (2016) Standard 6.
Evidence-based practice has been integrated into clinical settings to improve patient outcomes and promote quality nursing care. Systematic reviews, meta-analyses, randomised controlled trials, and up-to-date nursing standards and guidelines should inform nursing practice. In addition to utilising the highest quality evidence, nurses should formulate a research question and critically appraise the literature to discover whether the research is suitable or reliable to inform clinical practice. However, nurses continue to encounter organisational and individual barriers that prevent the implementation of evidence-based nursing. Education is the key to empowering nurses to implement evidence-based nursing principles into practice. By integrating Evidence-based practice, nurses can actively foster a culture of safety, better health outcomes, and reduce risk and harm for patients, family members and colleagues.
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