Evidence-based practice

Sandeep Moola*

* Research Fellow & Innovations Officer - The Joanna Briggs Institute - The University of Adelaide

Abstract: Evidence-based practice (EBP) has seen tremendous growth in recent years. EBP provides an opportunity for clinicians and healthcare professionals to provide the best treatment possible based on the best available evidence, which will in turn result in better patient outcomes. The Joanna Briggs Institute’s (JBI) approach to evidence-based healthcare provides a better understanding of the role that evidence plays in clinical practice with a central focus on the effectiveness, meaningfulness, appropriateness and feasibility of health practices and delivery methods.

Keywords: evidence-based practice; nursing; evidence-based healthcare; joanna briggs institute

Evidence-based practice (EBP) has seen tremendous growth in recent years. The concept of EBP emerged from evidence-based medicine and it currently encompasses all healthcare disciplines and professions. EBP is a cyclical process of identifying clinical problems, followed by rigorous question development, searching for evidence, critical appraisal and synthesis of findings to make informed decisions in your clinical practice. Health care delivery settings and health professionals then have a chance to utilise and evaluate the impact of the evidence on health outcomes, health systems and professional practice. EBP is changing the way you as health professionals practice.

So, why EBP? EBP provides an opportunity for clinicians and healthcare professionals to provide the best treatment possible based on the best available evidence, which will in turn result in better patient outcomes. Pearson et al (2005) state that evidence-based practice is clinical decision-making that considers the best available evidence; the context in which the care is delivered; client preference; and the professional judgment of the health professional.¹

The Joanna Briggs Institute’s (JBI) approach to evidence-based healthcare provides a better understanding of the role that evidence plays in clinical practice with a central focus on the effectiveness, meaningfulness, appropriateness and feasibility of health practices and delivery methods.¹ JBI’s model of evidence-based healthcare provides a very good understanding of different processes involved from evidence generation to evidence utilisation (from bench- to bed-side), possible through various tools. JBI has developed specific tools and resources for each of these processes.

JBI essentially regards evidence-based healthcare as a cyclical process, wherein global health care needs are identified by those working in and using health services. These needs are then addressed through evidence generation. Since there is an enormous amount of research available, which is of variable quality, it is essential that this research evidence is assessed in a systematic way and collated (evidence synthesis) for the purposes of dissemination in appropriate and relevant formats for health professionals and patients (evidence transfer). However, it is also important that the evidence that is synthesised and disseminated is supported by programs to assist in their implementation (evidence utilisation).

What do you do if your practice is not evidence-based? Have you at any point of time in your practice asked yourself, does this particular intervention or drug work or is effective than the other intervention or drug? Understand what you are doing and what you are trying to achieve in relation to a particular patient! You wish you could improve or change practice but have difficulty in focusing or defining what you intend to achieve. Clinically relevant questions serve to focus your activity and are informed by context.

The best approach to answer your questions is conduct a systematic review of the literature, but then it not always possible or practical in many situations as you may lack adequate access to resources or do not have enough time because of your clinical workload. What do you do then? You search for evidence that will inform your practice. You can find articles in databases, journals, websites, libraries, and papers. Now that we know where and how to find evidence, how do we identify good quality information from the sheer volume of material published annually. There are over 30,000 journals published annually and more than 15 million papers cited alone in MEDLINE. The best approach to search for evidence or articles is to use PICO (Participant, Intervention, Comparison & Outcome) format from your clinical question, which then can be used to identify key words for your search.

Now, we come to the essential part of EBP process, which is critical appraisal. What is the difference between appraising an article and simply reading it? Appraisal is a technique that enables you to exclude papers of inadequate quality and to extract the good ones and evaluate them. Always appraise before using information to inform practice. Also acknowledge that there may be disagreements between the appraisers and if in doubt seek assistance!

JBI has free access to many web-based resources, but some information for members only. Bear in mind that EBP should not blindly driven by best available external evidence; in fact, EBP is a balance of externally available evidence, patients’ preferences and needs and clinical judgement or expertise. Health professionals here at JBI design and produce outputs for health professionals like you and in addition want to ensure that you have easy access to high quality information to inform your clinical decisions. This is the key to our success!

Reference

1. Pearson A, Wiechula R, Court A and Lockwood C. The JBI model of evidence-based healthcare. Int J Evide Based Healthc. 2005; 3:207-215.