1.7 Evidence-Based Practice

Evidence-based practice looks at clinical expertise, research evidence, and patients’ needs and values (Figure 1.7).

Clinical Expertise

• Clinical expertise is the provider’s judgment about what works best for similar patients or in similar situations.
• Health is complex and there isn’t high-quality research on every topic.
• Through years of practice, health care providers develop clinical expertise that guides patient care decisions.
• This clinical judgment is essential for applying evidence-based practice.

Best Scientific Evidence

• The best scientific evidence comes from the results of the best available scientific studies. This evidence is used to find out which treatments, diagnostic methods, or ways of predicting a patient outcome work best.
• Scientists carefully design studies to measure how well things such as treatment and diagnostic tests work.
• Scientific evidence can provide a higher-level view than expert opinions or objective data to help inform health care decisions, and is one of the important pieces of evidence-based practice.

Patient’s Needs and Values

• Patients’ or clients’ needs and values are what is important for the patient or client and what health care options best match those values.
• There are many conditions where patient needs and preferences are important factors in choosing the right treatment or screening option.
  • Cost of care, quality of life, and personal beliefs are all important considerations.
• Patients should be partners in their care and help decide what type of health care is best for them.
• Evidence-based practice recognizes that patient values are essential in determining care.

Nursing Process

The nursing process is a critical thinking model based on a systematic approach to patient-centered care. Nurses use the nursing process to perform clinical reasoning and make clinical judgments when providing patient care. The nursing process is based on the Standards of Professional Nursing Practice established by the American Nurses Association (ANA). These standards are authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently.^[1] The mnemonic ADOPIE is an easy way to remember the ANA Standards and the nursing process. Each letter refers to the six components of the nursing process: Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, and Evaluation.

The nursing process is a continuous, cyclic process that is constantly adapting to the patient’s current health status. See Figure 1.8 for an illustration of the nursing process.

The ANA’s Standards of Professional Nursing Practice associated with each component of the nursing process are described below.

Assessment

The “Assessment” Standard of Practice is defined as, “The registered nurse collects pertinent data and information relative to the health care consumer’s health or the situation.”^[2] A registered nurse uses a systematic method to collect and analyze patient data. Assessment includes physiological data, as well as psychological, sociocultural, spiritual, economic, and lifestyle data. For example, a nurse’s assessment of a hospitalized patient in pain includes the patient’s response to pain, such as the inability to get out of bed, refusal to eat, withdrawal from family members, or anger directed at hospital staff.^[3]

Diagnosis

The “Diagnosis” Standard of Practice is defined as, “The registered nurse analyzes the assessment data to determine actual or potential diagnoses, problems, and issues.” A nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs. Nursing diagnoses are the bases for the nurse’s care plan and are different than medical diagnoses.^[4]

Outcomes Identification

The “Outcomes Identification” Standard of Practice is defined as, “The registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.”^[5] The nurse sets measurable and achievable short- and long-term goals and specific outcomes in collaboration with the patient based on their assessment data and nursing diagnoses.

Planning

The “Planning” Standard of Practice is defined as, “The registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes.”^[6] Assessment data, diagnoses, and goals are used to select evidence-based nursing interventions customized to each patient’s needs and concerns. Goals, expected outcomes, and nursing interventions are documented in the patient’s nursing care plan so that nurses, as well as other health professionals, have access to it for continuity of care.^[7]

Nursing Care Plans

Creating nursing care plans is a part of the “Planning” step of the nursing process. A nursing care plan is a type of documentation that demonstrates the individualized planning and delivery of nursing care for each specific patient using the nursing process. Registered nurses (RNs) create nursing care plans so that the care provided to the patient across shifts is consistent among health care personnel. Some interventions can be delegated to Licensed Practical Nurses (LPNs) or trained Unlicensed Assistive Personnel (UAPs) with the RN’s supervision.

Implementation

The “Implementation” Standard of Practice is defined as, “The nurse implements the identified plan.”^[8] Nursing interventions are implemented or delegated with supervision according to the care plan to assure continuity of care across multiple nurses and health professionals caring for the patient. Interventions are also documented in the patient’s electronic medical record as they are completed.^[9]

The “Implementation” Standard of Professional Practice also includes the subcategories “Coordination of Care” and “Health Teaching and Health Promotion” to promote health and a safe environment.^[10]

Evaluation

The “Evaluation” Standard of Practice is defined as, “The registered nurse evaluates progress toward attainment of goals and outcomes.”^[11] During evaluation, nurses assess the patient and compare the findings against the initial assessment to determine the effectiveness of the interventions and overall nursing care plan. Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated and modified as needed.^[12]

Benefits of Using the Nursing Process

Using the nursing process has many benefits for nurses, patients, and other members of the health care team. The benefits of using the nursing process include the following:

• Promotes quality patient care
• Decreases omissions and duplications
• Provides a guide for all staff involved to provide consistent and responsive care
• Encourages collaborative management of a patient’s health care problems
• Improves patient safety
• Improves patient satisfaction
• Identifies a patient’s goals and strategies to attain them
• Increases the likelihood of achieving positive patient outcomes
• Saves time, energy, and frustration by creating a care plan or path to follow

By using these components of the nursing process as a critical thinking model, nurses plan interventions customized to the patient’s needs, plan outcomes and interventions, and determine whether those actions are effective in meeting the patient’s needs. Using the nursing process and implementing evidence-based practices are referred to as the “science of nursing.”

Attribution

This chapter contains material taken from:

Evidence-Based Practice by Various Authors and is used under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Nursing Fundamentals 2e by Chippewa Valley Technical College and is licensed under a Creative Commons Attribution 4.0 International License.