Evidence-Based Practice: An Art or Science?

microbiology

Evidence-based practice. EBP. If you’re pursuing or have completed a nursing degree, you’ve likely heard this term before. You’ve probably learned the definition and regurgitated it on a test. Maybe it’s showed up in one of your papers, or maybe you’ve written a whole paper about it.

But what is it? What is EBP? I’ll regurgitate the definition once, but then I want to really, really talk about it. In my own words. And I want to hear your own words. Let’s discuss EBP…

In a 1996 article, Dr. David Sackett and his co-authors, Rosenberg, Gray, Haynes, and Richardson, define EBP as:

“the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient.”

Now my words: Evidence-based practice. Practice that’s based on evidence. If the way we care for patients is only based on evidence, what else factors in? Ever watch a movie in which the words “based on a true story” float in front of the opening scene? How often is that film an exact reenactment of the real-life version? I think it’s safe to say never. Writers and producers have to factor in other considerations. The audience. Costs. Resources. Perspectives of the writers.

In healthcare, clinical evidence does not provide a fail-safe prescription for treating all patients. As Sackett et al. describe, the evidence must be integrated with clinical expertise – the perspectives of healthcare professionals. Patient values, costs, and resources matter too.

But how do we really make clinical decisions? It’s nice to think of our practice as an imaginary Venn diagram integrating evidence, clinical expertise, and patient preferences. But how do we weigh each of these? Which takes priority?

For one thing, we can appraise the strength of the evidence. Sackett et al. discuss that the best evidence comes from “systematic research”. But that’s only one piece of the puzzle – or one translucent overlapping bubble (my Venn diagram visual).

Providers: What if a patient’s values conflict with the best evidence to treat their disease? What if both you and your patient agree on an evidence-based plan, yet the medication or treatment is too expensive? What if the most affordable option for your patient carries significant risks?

Nurses: What if your hospital lacks the resources for evidence-based staffing ratios? What if your patient with limited mobility asks to be turned less frequently so they “can get some rest”? What if your colleagues are not ready to make an evidence-based practice change?

Nursing is both an art and a science. At first glance, one might think EBP falls into the science side. I mean, evidence… that’s science right? But practice based on evidence is an art, because it’s in our skillful balancing act that the best clinical decisions are made.

What are your thoughts on EBP and how to approach some of the challenges presented here?

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