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Putting evidence into practice

Putting evidence into practice

Una Adderley thinks nurses need to find time to become familiar with the relevant evidence

A couple of weeks ago the new NMC Standards of Conduct, Performance and Ethics for Nurses and Midwives plopped through our letterboxes onto the mat below.

I had read the draft version during the consultation period and gone so far as to write to the NMC to express my concern that the existing reference to research had been removed. Although I received no response to my feedback, I can only presume that I was not the only one who had noticed this since the new Standards clearly state that nurses must use the best available evidence. More specifically, the Standard states that:

  • You must deliver care based on the best available evidence or best practice.
  • You must ensure any advice you give is evidence-based if you are suggesting healthcare products or services.

While I was pleased to see that this responsibility had been formalised within our professional standards, it raised several issues in my mind. There is good evidence that nurses are reluctant to seek out the original research relevant to their practice.(1) The incorporation of national guidelines (which are mainly research-based) into local guidelines and policies compensates for this reluctance to a certain extent. Unfortunately, there is also evidence that clinicians often do not deliver practice that is in line with such guidelines.(2)

I am not sure why this is. If you ask a nurse why they haven't followed guidelines, the usual answer is that they do not have time to keep up with all the latest research. Although I am only too aware of time pressures, I am not convinced that this is the real answer, particularly since practising evidence-based care should mean that care is generally more effective and thus time saving. Furthermore, although there is a steady trickle of new research, it is very unusual for a study to make a huge change to the evidence base. More often, new knowledge adds a slightly new angle or tweaks existing knowledge.

Sometimes there are very good clinical reasons why the guideline has not been followed. Guidelines are based on the results of randomised controlled trials and systematic reviews, where they exist. Although an intervention may be found to have a certain average effect in a trial population, not all patients will match the characteristics of the trial population or respond in the average way.

What worries me is when the nurse hasn't tried the evidence-based care first, since this offers the highest chance of success for most patients. Only when this fails to deliver results or when a patient's characteristics are so different from the "average" patient in whom the intervention was tested should we consider doing something different.

What the new Standards do make clear is that we have a professional responsibility to pay close attention to the evidence base. The evidence for evidence-based practice (!) suggests that nurses prefer to seek information from a trusted colleague and that specialist nurses should fulfil this role.(1) Therefore, I would suggest that our new best friends should be our local specialist nurses.

References

  1. Thompson C, McCaughan D, Cullum N, Sheldon T, Thompson D. Nurses' use of research information in clinical decision making:  A descriptive and analytical study - final report. London: NCC SDO; 2000.
  2. Sheldon T, Cullum N, Dawson D, Lankshear A, Lowson K, Watt I, et al. What's the evidence that NICE guidance has been implemented?  Results from a national evaluation using time series analysis, audit of patients' notes and interviews. BMJ 2004;329:999.

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