Evidence Should Inform Critical Thinking in the Moment

Premier Nursing News

By Sylvain Trepanier, DNP, RN, CENP, vice president and system chief nursing officer   

According to the Academy of Medical-Surgical Nurses (2016), evidence-based practice (EBP) is a problem-solving approach that integrates a systematic search of the most relevant evidence, the clinical nurses’ own clinical experience, and the patient preferences and values. In other words, it is a practice that allows the nurse to assess the best possible intervention to achieve the best possible outcome.  

Is evidence-based practice the same as best practice? The brief answer is no, yet many times the two terms are used interchangeably. The difference between the two lies in the availability of hard data and evidence to support EBP, as opposed to independent practices that may have yielded a certain outcome but have not been thoroughly researched, repeated or proven.  

Why do we keep talking about EBP? Why is it so important? Can I as a nurse choose to ignore EBP? The most important reason why EBP is important is that it’s the right intervention to do to achieve the best possible outcomes for our patients. All the nurses that I have met in my practice ALWAYS want to achieve the best possible outcome for patients. Where we see a difference in practice is how much variation we see in adopting EBP and how some of us simply choose to put the evidence aside and choose the best practice with which they are familiar. I completely agree that critical thinking in the moment is extremely important and should always prevail when a “in-the-moment” decision is required. That said, as a nurse, I believe that it is my responsibility to know what the EBP suggest so that I can make the best possible decision in the moment. If we do not keep up with the EBP, we are not the best possible nurses we can be for those we serve. 

Now that we understand why EBP is so important, how do I keep up with EBP? Although this is not an all-inclusive list, I would argue that you should do the following:  

  • Secure a journal subscription,  
  • Obtain a membership in a professional organization, and  
  • Attend a local journal club or unit council.  

The primary source of EBP is the scientific literature. This is why it is important to secure a nursing journal subscription. Of course, there are way too many options and I am not suggesting that you read all of the literature. That said, you can identify a journal that represents your specialty/area of practice. As an example, since most of my time is spent in executive nursing leadership, I subscribe to a journal called “Nurse Leader.” It allows me to be constantly abreast of the new evidence in this field. A few years ago, I practiced in the emergency department. During those years, I had a subscription to the Journal of Emergency Nursing. 

Many of the nursing practice specialties are represented within a professional organization. Consider identifying a professional organization that can better support your practice. That said, completing a membership form and simply being a member is not what I am referring to here. It’s important to stay engaged within that same organization. Attend the local chapter meetings, for example. If none are available, consider developing one. For example, I belong to the American Organization of Nurse Executives (AONE). I have a membership, I attend local meetings and I am actively involved in some national committees (all of this work is coordinated locally and/or via conference calls). It is possible for you to do the same. 

Lastly, consider attending local journal clubs and/or unit councils. This is a perfect way to stay engaged in your practice and to be offered opportunities to keep informed of EBP. Unit-based councils are available everywhere at Premier Health and I encourage you to seriously consider it. 

Now why is EBP important and what does it have to do with value-based purchasing? A few years ago, the Centers for Medicare and Medicaid Services (CMS) developed a new reimbursement model based on value. What this means is that it is no longer sufficient to simply provide a service (CMS, 2017). It must be a service of value; in other words, we need to show what’s in it for those we serve. When CMS made this announcement, our world changed forever. Regardless of what happens with the Affordable Care Act, I am certain of one thing. Demonstrating value for services rendered is not going away. Furthermore, the best way to demonstrate value is by embracing EBP; by definition, EBP-supported interventions offer the best possible outcomes for patients. This is why it’s so important and this is why we simply cannot ignore it. 

In summary, the most important nursing practice contribution is to obtain the best possible outcomes and to stage the best possible experience for those we serve.  We can only do so by ensuring we embrace EBP in all we do. Lastly, when we demonstrate value in what we do, we further support our organization by maximizing our reimbursement. Maximizing our reimbursement is key to maintaining a viable and thriving Premier Health and allowing us to build healthier communities for decades to come. 

Evidence-Based Practice Academy of Medical-Surgical Nurses (2016). Retrieved on March 6, 2017  

Hospital Value-Based Purchasing Center for Medicare and Medicaid Services (2017). Retrieved on March 6, 2017 

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