Evidence informed vs. evidence based practice
This week my nursing informatics class discussed the
concepts of evidence based and evidence informed nursing practice. Prior to the
class, I had no knowledge of these concepts. Through class discussion I began
to grasp a basic understanding of the concepts. My concept of evidence based
practice developed to include that it is rigid and "black and white".
By this I mean that research leads to evidence that clearly and directly
informs the nurse of the appropriate intervention. In addition, I learned that it consists of
applying relevant and reliable nursing research to a clinical situation. In
comparison, I understand evidence informed practice to be more holistic in that the nurse needs to think critically and consider multiple factors
other than relevant research that may relate to a clients' care. Furthermore, I
understand that clinical decisions are based not only on nursing research, but
factors unique to a given situation including the following: culture, religion
and ethics. Through the exploration of nursing literature my understanding of
evidence based and evidence informed nursing practice has continued to grow and
develop.
In nursing literature, evidence informed practice is
defined as a continuous process that considers evidence from nursing research
and other sources including clinical expertise, client preferences, available
resources, and cultural and religious norms to inform decision making (CNA,
2010). Potter and Perry (2010) state that evidence informed practice
"deemphasizes ritual, isolated and unsystematic clinical experience;
ungrounded opinion; and tradition as bases for nursing practice" (pg. 86).
However, the definition of evidence informed practice is not always the same in
nursing literature, and frequently overlaps with the definition of evidence
based practice.
In nursing literature evidence informed practice and
evidence based practice can have very similar definitions. Melnyk and
Fineout-Overholt (2011) define evidence based nursing as continuous approach to
clinical decision making that involves the selection of the best available
evidence to inform practice, nurses' personal clinical expertise and patients
values and preferences. Furthermore, evidence based practice has been described
as the integration of research evidence, information about patient preferences,
clinical skill level, and the available resources to inform practice (Ciliska
et al, 2001).The overlapping theme in the definitions of evidence based
practice seem to be that it involves more factors than just research based
evidence. This concept of evidence based
practice contradicts the Canadian Nurses Association (CNA) which states that main
distinction between evidence based and evidence informed practice is that
evidence informed practice considers factors beyond evidence to make clinical
decisions and evidence based nursing does not (CNA, 2010). The differences in
how evidence informed and evidence based practice are defined in nursing
literature make it difficult to understand how the concepts differ. However, I
believe this may be due to the developed of the concept of evidence based
practice in the nursing profession.
The idea of what constitutes evidence based practice has
evolved over time in the nursing literature. Malone et al. (2004) states that
evidence used in evidence based practice comes from a variety of sources
including research, clinical experience, clients, and the context or
environment (Rycroft-Malone, Seers, Titchen, Harvey, Kitson, & McCormack, 2004). It
considers the different sources of knowledge that inform practice other than
"technical or propositional" knowledge, such as clinical experience
and Carper's ways of knowing (Rycroft-Malone, Seers, Titchen, Harvey, Kitson, &
McCormack, 2004, pg.84). However, Rycroft-Malone et al. (2004) state that there is an
underlying assumption in nursing that knowledge from clinical experience
lacks credibility, and challenges this assumption by suggesting that evidence
based practice requires knowledge from clinical experience. An earlier definition
of evidence based nursing stated that it nursing practice based on research
results or evidence (Beyers, 1999).
Putting it all together...
In conclusion, the definitions of evidence based and
evidence informed nursing are not always clear in the nursing literature. My
concept of these terms has developed to include that they are not mutually
exclusive, and that is it important to consider the client holistically
including both research based evidence and other factors to inform practice.
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| Evidence Based Practice |
This image of a evidence based model shows that evidence based practice is considered to include factors other than research.
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| This image is the John Hopkins Nursing Evidence Based Model |
References
Canadian Nurses Association. (2010). Evidence informed decision making and nursing practice. Retrieved from http://www2.cna-aiic.ca/CNA/documents/pdf/publications/PS113_Evidence_informed_2010_e.pdf
Beyers, M. (1999). About evidence-based nursing practice. Nursing Management , 30(6), 56, Retrieved from http://search.proquest.com.proxy1.lib.uwo.ca/docview/231439882/fulltextPDF?accountid=15115
Rycroft-Malone, J., Seers, K., Titchen, A., Harvery, G., Kitson, A., McCormack, B.(2004). What counts evidence in evidence based practice? Journal of Advanced Nursing, 47, 81-90. doi: 10.1111/j.1365-2648.2004.03068.x
Potter, P.A., & Perry, A.G. (2010). Canadian Fundamentals of Nursing. Toronto: Elsevier Canada
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