Summary of the 6th Annual Evidence-Based Practice Conference at UCLA

Victoria Morrison, RN, BSN, Nurse Research Assistant at St. Joseph Hospital in Orange, Calfiornia, recently attended the 6th Annual Evidence-Based Practice Conference at UCLA. Here is her summary :

On April 26, 2007, I went to the 6th Annual Evidence-Based Practice Conference at UCLA, “Empowering Patients and Nurses As Partners in Evidence-Based Care.” I thought I would share some of the keynote speaker’s ideas on evidence-based practice. The keynote speaker, Bernadette Mazurek Melnyk, PhD, RN, CPNP/NPP, FAAN, FNAP, is the Dean and Distinguished Foundation Professor in Nursing at Arizona State University. She kindly emailed me and gave me permission to use excerpts from her lecture to put on our blog.

According to Dr. Melnyk, evidence-based practice (EBP) is a problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician’s expertise as well as patient preferences and values. The aim of EBP is to make decisions about types of care . Resources available also must be considered in decision-making.
As nurses, we must accelerate EBP because despite an aggressive research movement, the majority of findings from research often are not integrated into practice. Dr. Melnyk poignantly noted that it takes approximately 17 years to make a change, so we as health providers need to get a move on to make things happen. Often practices within nursing are routed in tradition and are often outdated; they do not lead to the best patient outcomes. Even traditional continuing education conferences do not significantly improve clinical performance and as nurses we need to improve clinical outcomes and performance. Also EBP must be implemented to advance our profession and enhance life-long learning and keep our practices up to date. In the future, it is quite possible that 3rd party payers will only provide reimbursement for healthcare practices that are supported with evidence. Therefore we need to be practicing EBP.

EBP affects patient’s physiological, psychosocial, and functional status. As pointed out by Melnyk, EBP improves outcomes and outcomes reflect IMPACT! This then leads to a positive effect on the health system.

A study by Pravikoff, Tanner, and Pierce (2005) looked at registered nurses in the U.S. The researchers found that 34.5% of the sample only needed information infrequently, almost half were not familiar with the term “evidence-based practice,” and more than half believed that their colleagues use research findings in their practice. This study also showed that most nurses do not search information resources to gather practice information and only 27% had any instruction in using electronic databases.

Barriers to evidence-based practice in the Pravikoff et al. study included “lack of value for research.” Organizational barriers for using information in practice included “presence of other goals with a higher priority.” Researchers concluded that “RNs in the United States aren’t ready for evidence-based practice because of the gaps in their information literacy and computer skills, their limited access to high quality information resources, and above all, the attitudes toward research” (Pravikoff et al., 2005 p. 50).

Knowing this information, how do we get EBP into practice? This is the burning question when there are such visible barriers. According to Melnyk, we must become key facilitators of EBP or champions. This roles involves obtaining knowledge and skills of EBP, understanding that EBP improves care and outcomes, believing in the ability to implement EBP, developing mentor(s)/teachers who are skilled in EBP, and gaining administrational/organizational support. In making patient care decisions, we must use our clinical judgment and expertise, access up-to-date evidence, and consider patient’s preferences and values to make a decision.

Dr. Melnyk lists five steps as the process of EBP:
1. Ask the burning clinical question in PICO format
Patient population
Intervention of interest
Comparison intervention or group
Outcome
2. Collect the best evidence. Search first for systematic reviews (e.g., the Cochrane Database of Systematic Reviews) and evidence-based clinical practice guidelines (http://www.guideline.gov/).
3. Critically appraise the evidence.
4. Integrate evidence, clinical expertise, and patient factors/preferences to implement a decision.
5. Evaluate the outcome.

So remember, evidence-based practice improves outcomes for patients, and nursing is all about the patients! This conference again renewed my own enthusiasm for EBP. I would again like to thank Bernadette Melnyk and Arizona State University for sharing her power-point presentation.

References
Melnyk, B. (April 2007). Empowering patients and nurses as partners in evidence-based practice. Power-point presentation given at UCLA Conference.

Pravikoff, D., Tanner, A., & Pierce, S. (2005). Readiness of U.S. nurses for evidence-based practice. American Journal of Nursing, 105(9), 40-50.