With today’s easy Internet access, smarter healthcare practices and a better-trained nurse population, it’s not surprising that the very nature of nursing – and what’s expected of today’s professional staff – is changing.
“We need nurses who can stand on their own two feet and who are critical thinkers,” says Kimberly Porter, assistant professor of nursing at the University of Arkansas at Little Rock (UALR) and Arkansas for Nursing president.That sentiment is echoed by Tammy Jones, the UAMS Magnet Program director.
“Patient care can’t be dictated by old practices, the status quo. Instead, we must adapt our care to the new research,” she says.
This incorporation of the latest information into practice is called evidence-based practice, or EBP.
According to Yale University’s web site, “the idea of evidence-based practice for nursing has grown out of the evidence-based medicine movement. Evidence-based practice can be thought of as ‘integrating individual clinical expertise with the best available external clinical evidence from systematic research.’”(Sackett, 1996)
In other words, evidence-based practice gives nurses the latest and best options available in medicine - all based on research and, at times, clinical trials right in the nurse’s own hospital setting.
The American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program embraces the latest knowledge, innovations and improvements and insists that hospitals with Magnet status do the same.
“We’re looking at the best information to shape our care,” Jones says. “If a nurse comes across a situation and believes there is a new or better way to do a job, then that nurse should be willing to do the research to prove their position.”
For example, for years nurses would dry newborns immediately after birth and put the baby under a warmer. Despite long-held beliefs, “research showed that placing them skin-to-skin with the mother is better for the baby,” Jones says.
Jones feels it is each nurse’s professional responsibility “to look at the best evidence, appraise the process and then integrate it and evaluate the outcome.”
Joyce Cloud, business development director at Pinnacle Point Behavioral Care System, says evidence-based research is part of everyday life at the Little Rock hospital.
“We have an enhanced residential program, started this year, that reduced special procedures by 75 percent,” she says. “While our program is superior to most, you can always make a good record better.”
This program was developed by hospital personnel, including the nursing staff.
“We operate from a team perspective and we want to get our entire team involved,” Cloud says.
Cindy Kugel, chief nursing officer at Siloam Springs Memorial Hospital, says they have incorporated evidence-based practices into their day-to-day operations for several years.
“It produces better patient outcome because it focuses on the patient,” Kugel says.
Angela Green, director of nursing at Arkansas Children’s Hospital, says evidence-based practices are part of their professional practice model for nursing at ACH.
As such, they see it as critical to achieving excellent outcomes in patient and family-centered nursing care.
“To help nurses build expertise in EBP, the Nursing Research Department offers quarterly education for beginners and additional courses to help nurses build expertise, including a six-month EBP mentoring program that we call the EBP Academy,” Green says.
“Nursing staff at ACH have a powerful impact on patient care through their EBP activities. For example, this year, one of the neonatal intensive care unit (NICU) nurse practitioners, Luann Jones, led a multidisciplinary team that developed an evidence-based pathway to help infants in the NICU transition from tube feedings to oral feedings.”
This was a major change that allowed nurses to take a more active role in helping infants learn to feed orally. Data shows that as a result, infants display a shorter transition time to oral feedings and stay in the nursery for a shorter period of time.
Another major practice change focused on decreasing the pain associated with needle sticks. “Carol Wright and the Patient Care Services Quality Management Council developed an evidence-based protocol and order set that incorporated both pharmacologic and non-pharmacologic interventions to decrease needle stick pain,” Green says.
As a result of this change, nurses are using pharmacologic interventions more frequently and children are reporting lower pain scores with their needle sticks.
Arkansas Tech University Professor Cheryl Smith says her students learn to incorporate EBP into their classes and clinicals.
She wants her nursing students to learn how to research best practices, and “to stay actively involved in research” long after graduation because health care is always evolving.
For nursing students at UALR and Arkansas State University, EBP is the norm.
“We teach it to our students as we go along,” says Dr. Sue McLarry, chair of the school of nursing at ASU.
“It has been found to be the best practice and forces students to think about why they are doing what they’re doing. EBP research is more than a concept. It should be an integral part of every nurse’s day,” McLarry said.
It’s a concept that Jones says is changing the nature of nursing.
