Evidence-Based Practice in Nursing: From Theory to Application

Dorothy Canfield Fisher

Canada

Nursing

Dorothy Canfield Fisher, RN, PhD, is a distinguished nursing scholar at the University of Toronto, specializing in maternal healthcare and public health.

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In today's healthcare landscape, change is the only constant. With medical technology advancing at breakneck speeds and new research continuously shaping our understanding of diseases and treatments, nurses can't afford to rely solely on traditional practices or anecdotal experiences. This is where Evidence-Based Practice (EBP) in nursing becomes invaluable in helping to complete your nursing assignment. EBP is more than a buzzword; it's a rigorous approach to clinical care that integrates the latest credible research evidence, the clinician’s expertise, and the patient's unique needs and preferences. By adopting EBP, nurses can enhance the quality of patient care, reduce errors, and contribute to more cost-effective healthcare. The crux of EBP lies in its systematic methodology, which involves questioning current practices, searching for research findings, and applying the relevant data judiciously. This enables a nurse to validate their clinical decisions, providing a framework that is both adaptable to individual patient needs and grounded in solid scientific evidence.

Real-world Situations that Nurses Face: Navigating Ethical Principles

In such complex situations, nurses are often caught in an ethical quandary. Balancing the imperatives of medical science with the realities of human emotion and cultural beliefs is no simple task. Here, Evidence-Based Practice (EBP) serves as an indispensable tool. EBP can guide nurses to make well-informed decisions that are not just clinically sound but also ethically responsible. While the evidence may suggest a specific treatment is highly beneficial, EBP also stresses the importance of patient autonomy and cultural sensitivity. Nurses need to employ their clinical judgment, interpersonal skills, and ethical understanding to engage in meaningful dialogue with the patient. This involves explaining the evidence supporting the treatment while also respecting the patient's cultural beliefs and decision-making autonomy. Through this delicate balance, nurses can aim for an outcome that respects individual preferences while also striving for optimal medical care. How should the nurse respond?

There are several ethical principles at play:

Navigating the crossroads of clinical evidence and ethical principles is a daily reality for nurses. When confronted with situations where these ethical tenets seem to be at odds, the application of each principle must be carefully weighed and considered.

• Autonomy: Honoring the patient's autonomy means respecting their values, beliefs, and right to self-determination. While it's essential to present evidence-based recommendations, the ultimate choice belongs to the patient.
• Beneficence: This principle propels nurses to act in the best interest of the patient, which usually aligns with evidence-based practice. However, what is scientifically beneficial may not align with the patient's wishes, posing a dilemma.
• Non-maleficence: This is the commitment to do no harm. Sometimes, respecting a patient's autonomy may result in decisions that could lead to worse health outcomes. Nurses must reconcile this with their commitment to cause no harm, which could involve providing alternatives or compromises.
• Justice: In offering treatments and interventions, nurses must ensure that all patients are treated with fairness, irrespective of their background, culture, or personal beliefs. This involves making evidence-based practice accessible and understandable to everyone, facilitating equitable healthcare outcomes. In the scenario mentioned above, there's a conflict between autonomy and beneficence. The nurse might be torn between respecting the patient's decision (autonomy) and wanting to provide the best care (beneficence). Navigating such situations requires not only a deep understanding of ethical principles but also a commitment to EBP. EBP can guide nurses in these scenarios by offering a balanced perspective between the evidence and the patient's unique circumstances and values. Evidence-based practice (EBP) in nursing is a multidimensional concept that goes beyond the simple application of scientific research into clinical settings. It's a nuanced approach that fuses three core elements to deliver comprehensive, individualized patient care.
• Best Available Evidence: This is the foundation of EBP. The process starts with a clinical query, followed by a thorough search of the latest scientific literature. Nurses must critically appraise the information, sifting through various studies to identify the most valid, relevant, and applicable evidence. However, even the best evidence can be ineffective if not appropriately implemented.
• Clinical Expertise: Every nurse brings a unique set of skills, knowledge, and experience to the clinical environment. These attributes contribute to interpreting and applying research evidence. Clinical expertise helps nurses to adapt general findings to specific patient circumstances. For example, a medication effective for the general population may not be suitable for a patient with multiple comorbidities. Here, a nurse's clinical judgment is invaluable.
• Patient Values and Preferences: EBP isn't merely a top-down application of medical knowledge. It involves an understanding and respect for the patient’s cultural, ethical, and personal values. These elements are crucial in shared decision-making, and they contribute to personalized, patient-centered care.

The synthesis of these three components ensures that healthcare interventions are not only scientifically sound but also tailored to individual patient needs and values. This integrative approach makes EBP a vital framework for modern nursing, serving as a bridge between scientific rigor, clinical intuition, and human compassion. It equips nurses with the tools to make well-rounded decisions that are ethical, relevant, and above all, conducive to the highest standard of patient care.

Insights into Common Medications: Safe Administration Practices

The safe administration of medications is a cornerstone of high-quality healthcare, and it's an area where Evidence-Based Practice (EBP) is particularly vital. Given the ever-expanding list of pharmaceutical options, nurses must be adept at understanding not just the therapeutic effects of medications, but also their potential side effects, drug interactions, and the intricacies of proper administration. EBP guides nurses in this realm by offering the latest research and guidelines on medication safety, which can range from correct dosages to ideal methods of administration. For example, some medications require specific timing with respect to meals, while others might need to be titrated carefully in certain populations, like the elderly or those with renal impairment. Combining this evidence with clinical expertise and patient preferences, nurses can make more informed decisions that optimize therapeutic benefits while minimizing risks. This aligns medication administration closely with the broader objectives of patient safety and effective care.

Here are some common medications, their side effects, and safe administration practices:

Aspirin:

• Common Uses: A household name, Aspirin is widely used for its analgesic (pain-relieving) properties. Additionally, its anti-inflammatory characteristics make it suitable for various conditions, ranging from minor aches to arthritis. Notably, in low doses, Aspirin serves as a preventive measure against heart attacks due to its antiplatelet effect, which reduces clot formation.
• Side Effects: While beneficial, Aspirin can cause discomforts like stomach pain, heartburn, and nausea. More concerning is its potential to increase bleeding risk, a side effect stemming from its antiplatelet action.
• Safe Administration: To mitigate its gastrointestinal effects, it's advisable to take Aspirin with food or after meals. Additionally, patients should be educated on the risks of combining Aspirin with other blood thinners.

Metformin:

• Common Uses: A first-line medication in the management of type 2 diabetes, Metformin works by improving the body's sensitivity to insulin, thereby reducing blood sugar levels.
• Side Effects: The drug is generally well-tolerated, but gastrointestinal symptoms like diarrhea, nausea, and stomach pain can occur. A rarer, yet serious side effect is lactic acidosis, especially if used in patients with certain contraindications.
• Safe Administration: Taking Metformin with meals can lessen gastrointestinal side effects. Patients should also be monitored for signs of lactic acidosis, especially if they have renal impairment or other risk factors.

Lisinopril:

• Common Uses: As an ACE inhibitor, Lisinopril is key in treating conditions like hypertension and heart failure, as it helps relax blood vessels and reduce blood pressure.
• Side Effects: Common side effects include dizziness and headache. A persistent cough can also develop. Importantly, Lisinopril can raise potassium levels (hyperkalemia), which can be dangerous if unchecked.
• Safe Administration: After administering Lisinopril, monitoring blood pressure is crucial. Furthermore, watching for allergic reactions is vital, especially for those with a history of reactions to ACE inhibitors.

Conclusion

Evidence-based practice in nursing is an integration of scientific evidence, clinical expertise, and patient values. It ensures that nurses provide care that's not only backed by research but also tailored to the individual needs of each patient. From understanding ethical dilemmas to safely administering medications, EBP is pivotal in every aspect of nursing.