Evidence based practice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Many areas of professional practice, such as medicine, psychology, psychiatry and so forth, have had periods in their pasts where practice was based on loose bodies of knowledge. Some of the knowledge was simply lore that drew upon the experiences of generations of practitioners, and much of it had no truly scientific evidence on which to justify various practices.

In the past this has often left the door open to quackery perpetrated by individuals who had no training at all in the domain, but who wished to convey the impression that they did for profit or other motives. As the scientific method became increasingly recognized as the means to provide sound validation for such methods, it became clear that there needed to be a way of excluding quack practitioners not only as a way of preserving the integrity of the field (particularly medicine), but also of protecting the public from the dangers of their "cures." Furthermore, even where overt quackery was not present, it was recognized that there was a value in identifying what actually does work so it could be improved and promoted.

Evidence based practice (EBP) is an approach which tries to specify the way in which professionals or other decision-makers should make decisions by identifying such evidence that there may be for a practice, and rating it according to how scientifically sound it may be. Its goal is to eliminate unsound or excessively risky practices in favour of those that have better outcomes.

EBP uses various methods (e.g. carefully summarizing research, putting out accessible research summaries, educating professionals in how to understand and apply research findings) to encourage, and in some instances to force, professionals and other decision-makers to pay more attention to evidence that can inform their decision-making. Where EBP is applied, it encourages professionals to use the best evidence possible, i.e. the most appropriate information available. For example, in medicine, it is used to make clinical decisions for individual patients. EBP promotes the collection, interpretation, and integration of valid, important and applicable patient-reported, clinician-observed, and research-derived evidence. The best available evidence, moderated by patient circumstances and preferences, is applied to improve the quality of clinical judgments and facilitate cost-effective care.

Best practices v. intuition

Evidence-based practice (EBP) involves complex and conscientious decision-making which is based not only on the available evidence but also on patient characteristics, situations, and preferences. It recognizes that care is individualized and ever changing and involves uncertainties and probabilities.

EBP develops individualized guidelines of best practices to inform the improvement of whatever professional task is at hand. Evidence-based practice is a philosophical approach that is in opposition to rules of thumb, folklore, and tradition. Examples of a reliance on "the way it was always done" can be found in almost every profession, even when those practices are contradicted by new and better information.

The theories of evidence based practice are becoming more commonplace in the nursing care. Nurses who are “baccalaureate prepared are expected to seek out and collaborate with other types of nurses to demonstrate the positives of a practice that is based on evidence. ”Looking at a few types of articles to examine how this type of practice has influenced the standard of care is important but rarely internally valid. None of the articles specify what their biases are. Evidence based practice has gotten its reputation by examining the reasons why any and all procedures, treatments, and medicines are given. This is so important for refining practice so the goal is met. The goal being that patient safety is of our greatest concern.

Research based evidence

Evidence-based design and development decisions are made after reviewing information from repeated rigorous data gathering instead of relying on rules, single observations, or custom. Evidence-based medicine and evidence-based nursing practice are the two largest fields employing this approach. In psychiatry and community mental health, evidence-based practice guides have been created by such organizations as the Substance Abuse and Mental Health Services Administration and the Robert Wood Johnson Foundation, in conjunction with the National Alliance on Mental Illness. Evidence-based practice has now spread into a diverse range of areas outside of health where the same principles are known by names such as results-focused policy, managing for outcomes, evidence-informed practice etc.

This model of care has been studied for 30 years in universities and is gradually making its way into the public sector. It effectively moves away from the old “medical model” (You have a disease, take this pill.) to a “evidence presented model” using the patient as the starting point in diagnosis. EBPs are being employed in the fields of health care, juvenile justice, mental health and social services among others. The theories of evidence based practice are becoming more commonplace in the nursing care. Nurses who are “baccalaureate prepared are expected to seek out and collaborate with other types of nurses to demonstrate the positives of a practice that is based on evidence.”

Key elements in using the best evidence to guide the practice of any professional include the development of questions using research-based evidence, the level and types of evidence to be used, and the assessment of effectiveness after completing the task or effort. One obvious problem with EBP in any field is the use of poor quality, contradictory, or incomplete evidence. Evidence-based practice continues to be a developing body of work for professions as diverse as education, psychology, economics, nursing, social work and architecture.

Psychology

According to Norcross et al. (2006) "the burgeoning evidence based practice movement in mental health attempts to identity, implement, and disseminate treatments that have been proven demonstrably effective according to the empirical evidence". However, Norcross et al. (2006) also state that perhaps it is more useful to identify what does not work. They conducted a survey rating experts opinions of "not at all discredited" to "certainly discredited" for a range of treatments. Examples of the range of discredited psychotherapies includes: angel therapy, the use of pyramid structures, orgone therapy, past lives therapy, chiropractic manipulation, neurolinguistic programming and Erhard Seminars Training. The limitation to the study was that some subjects may not have been discredited even though there was no evidence for efficacy. It was recommended that future polls take this into consideration, though the researchers concluded that the study does identify the dark side or "quack factor" of modern mental health practice.

Social Policy

There are increasing demands for the whole range of social policy and other decisions and programs run by government and the NGO sector to be based on sound evidence as to their effectiveness. This has seen an increased emphasis on the use of a wide range of Evaluation approaches directed at obtaining evidence about social programs of all types. A research collaboration called the Campbell Collaboration has been set up in the social policy area to provide evidence for evidence-based social policy decision-making. This collaboration follows the approach pioneered by the Cochrane Collaboration in the health sciences [2]. Using an evidence-based approach to social policy has a number of advantages because it has the potential to decrease the tendency to run programs which are socially acceptable (e.g. drug education in schools) but which often prove to be ineffective when evaluated. However it also has the downside that it is more difficult to undertake robust evaluations in regard to many social policy areas than it is to undertake such studies in traditional areas of evidence-based practice (e.g. pharmaceutical effectiveness studies). Sometimes demands to provide evidence can be simply used as an excuse to close down programs which either have not yet been evaluated or which because of their nature are very difficult to evaluate.

See also

• Epidemiology
• Evidence-based design
• Evidence-based management
• Evidence-based medicine
• Evidence-based pharmacy in developing countries

References

• Dale AE (2005). "Evidence-based practice: compatibility with nursing". Nurs Stand. 19 (40): 48–53. PMID 15977490.
• French, P. (2002). What is the evidence on evidence-based nursing? An epistemiological concern. Journal of Advanced Nursing, 37(3), 250-257.
• Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2002). Policy and politics in nursing and health care (4th ed.). St Louis, MO: Saunders/Elsevier.

External links

• Evidence Based Practice Definitions
• The Joanna Briggs Institute - International Collaborative on Evidence-based Practice in Nursing.
• Indiana Center for Evidence Based Nursing Practice: A JBI Collaborating Center
• Evidence Communicate leading research in order to promote international cooperation and evidence-based treatments
• Evidence based Practice clinic intitiatives
• Evidence Based Practice studies at the University of Massachusetts
• Center for the Advancement of Evidence-Based Practice (CAEP) at Arizona State University College of Nursing and Healthcare Innovation