Evidence-Based Practice in Nursing Essay

The entire medical professional body is always working on ensuring that there is saving of human life and improving it to make it at least better. Professional nurses, for instance, are some of the key pillars in this sector that play vital roles in saving lives and improving the health status of their patients. In this regard, the use of evidence-based practices by the nurses has often yielded positive results as they use such practices to ensure that they improve the lives of the patients they serve. This paper analyses two articles that entails the use of qualitative studies in the medical profession in the quest to help improve the performance of the nurses.Evidence-Based Practice in Nursing Essay

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Qualitative Studies
The article entitled Increasing cultural awareness: qualitative study of nurses’ perceptions about cultural competence training. BMC nursing by (Kaihlanen, Hietapakka & Heponiemi, 2019) addresses the issues on cultural differences that nurses face in the process of discharging their duties. Nurses are usually tasked with duties of handling patients from different backgrounds and for them to be successful in discharging of their duties they must be able to understand the cultural background of their patients, their values and practices so that they can be an effective creation of a good environment to discharge their duties. This source emphasizes the importance of cultural competence, the nurses must relate well with their patients to ensure that there is the quality provision of the medical services as expected of them.
The authors used a qualitative type of study in which they employed the use of ethnography study to collect professional views and perceptions about cultural differences among their patients. The study thus entails analysis of the perceptions that these professionals have on people from different cultural groups. The training which was conducted at one of the primary healthcare units in Finland divided the understanding of the cultural differences into three. This was done to ensure that the training was perfectly done and each of the targeted groups is effectively impacted. The perceptions were also divided into three distinct categories in which qualitative analysis of the data was done to help in improving the current practices among the nurses in the provision of their services.
Additionally, the authors established a trustworthy environment among the professionals and the patients that receive their services through the creation of a communication network. The emphasis on cultural competence and awareness was based on the need to make nurses understand their culture and thus ease to discharge of their duties. Besides, the authors also emphasized on the future e-training of the nurses to improve on their transparency and service delivery when in line of duty, this is because of the need to ensure that there is quality service provision to the patients.Evidence-Based Practice in Nursing Essay
On the other hand, the study was done by Cohen & Gooberman-Hill, (2019) in their article entitled, Staff experiences of enhanced recovery after surgery: systematic review of qualitative studies emphasized on the analysis of the staff experience on the management of the enhanced recovery after surgery (ERAS). ERAS is a critical time for any patient that requires professional service care for effective service delivery for the patients. Eight studies were conducted in this analysis in which 6 nations participated in the study with four surgical specialized groups taking part in the study to ensure that the results collected reflected the exact picture of what takes place in the management of the ERAS cases. These studies focused on the health professional experiences on issues related to ERAS that take place before, after, and during the process.
In their studies, Cohen & Gooberman-Hill, (2019) emphasized on five main themes of study aimed at improving service delivery to the ERAS patients. These were improving communication and collaboration among nurses and the patients, the issue of resistance to change among professionals was also highlighted and the need to ensure that the changes are made effective despite the resistance. Highlighting of the roles and significance of the protocols in the process of discharging services to the patients; finally knowledge and the expectations of the patients from the nurses and entire medical team are also some crucial factors that any medical officer should always consider when discharging duties to ensure that they don’t breach the trust and expectations that patients have over them.Evidence-Based Practice in Nursing Essay
Additionally, the study done in this case used ethnography type of qualitative study in which there was an effective analysis of the professionals on their understanding and experience on ERAS cases. Albeit the study not including numerous study nations and specialists, it was at least able to engage six nations in which various surgical specialists were involved in the study. The collected results were at least able to reflect the desired goals and a clear picture of the professional perceptions and understanding of the matter. This was aimed at creating trustworthiness, and conformability of how the professionals and the ERAS patients have always related and how the medical professionals discharge their duties in this line to ensure that these patients have an appropriate healing session.
The authors also indicated that the study was also transferable through their ability to engage various nations in their study. The study involved different professionals from 6 different nations who came into a common concision on the matter. This is an indicator that the study was successful and transferable. Therefore, despite the process being complex and challenging its worth it to be implemented in the quest to manage ERAS cases and ensure that these patients get quality service care.
Finally, I think that these studies will be applicable in my population because it entailed research from various quarters. The authors have also indicated that their articles are trustworthy making it possible to be acceptable in my population. Therefore, these studies would be easily accepted by the nurses.Evidence-Based Practice in Nursing Essay

Grading quality of evidence and strength of
recommendations
Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Working Group
Clinical guidelines are only as good as the evidence and judgments they are based on. The GRADE
approach aims to make it easier for users to assess the judgments behind recommendations
Healthcare workers using clinical practice guidelines
and other recommendations need to know how much
confidence they can place in the recommendations.
Systematic and explicit methods of making judgments
can reduce errors and improve communication. We
have developed a system for grading the quality of evidence and the strength of recommendations that can
be applied across a wide range of interventions and
contexts. In this article we present a summary of our
approach from the perspective of users of guidelines.
What makes a good guideline?
Judgments about evidence and recommendations are
complex. Consider, for example, the choice between
selective serotonin reuptake inhibitors and tricyclic
antidepressants for the treatment of moderate depression. Clinicians must decide which outcomes to
consider, which evidence to include for each outcome,
how to assess the quality of that evidence, and how to
determine if selective serotonin reuptake inhibitors do
more good than harm compared with tricyclics.
Because resources are always limited and money that is
spent on serotonin reuptake inhibitors cannot be used
elsewhere, they may also need to decide whether any
incremental health benefits are worth the additional
costs.Evidence-Based Practice in Nursing Essay
It is not practical for individual clinicians and
patients to make unaided judgments for each clinical
decision. Clinicians and patients commonly use clinical
practice guidelines as a source of support. Users of
guidelines need to know how much confidence they
can place in the evidence and recommendations. We
describe the factors on which our confidence should
be based and a systematic approach for making the
complex judgments that go into clinical practice
guidelines, either implicitly or explicitly. To achieve
simplicity in our presentation we do not discuss all the
nuances, some of which are discussed in the longer
version of this article on bmj.com.
The GRADE Working Group began as an informal
collaboration of people with an interest in tackling the
shortcomings of present grading systems. Table 1 summarises these shortcomings and the ways in which we
have overcome them. The GRADE system enables
more consistent judgments, and communication of
such judgments can support better-informed choices
in health care. Box 1 shows the steps in developing and
implementing guidelines from prioritising problems
through evaluating their implementation. We focus
here on grading the quality of evidence and strength of
recommendations.Evidence-Based Practice in Nursing Essay
Definitions
We have used the following definitions: the quality of
evidence indicates the extent to which we can be confident that an estimate of effect is correct; the strength of
a recommendation indicates the extent to which we
can be confident that adherence to the recommendation will do more good than harm.
The steps in our approach are to make sequential
judgments about:
x The quality of evidence across studies for each
important outcome
x Which outcomes are critical to a decision
x The overall quality of evidence across these critical
outcomes
x The balance between benefits and harms
x The strength of recommendations
All of these judgments depend on having a clearly
defined question and considering all of the outcomes
that are likely to be important to those affected. The
question should identify which options are being comThis is an abridged version; the full version is on bmj.com
Correspondence to:
Andrew D Oxman,
Informed Choice
Research
Department,
Norwegian Health
Services, PO Box
7004, St Olavs plass,
0130 Oslo, Norway
[email protected]
BMJ 2004;328:1490–4
1490 BMJ VOLUME 328 19 JUNE 2004 bmj.com
pared (for example, selective serotonin reuptake
inhibitors and tricyclic antidepressants), for whom
(moderately depressed adult patients), and in what setting (primary care in England).Evidence-Based Practice in Nursing Essay
Quality of evidence
Judgments about quality of evidence should be guided
by a systematic review of available evidence. Reviewers
should consider four key elements: study design, study
quality, consistency, and directness (box 2). Study
design refers to the basic study design, which we have
broadly categorised as observational studies and
randomised trials. Study quality refers to the detailed
study methods and execution. Consistency refers to the
similarity of estimates of effect across studies.
Directness refers to the extent to which the people,
interventions, and outcome measures are similar to
those of interest. Another type of indirect evidence
arises when there are no direct comparisons of
interventions and investigators must make comparisons across studies.
The quality of evidence for each main outcome can
be determined after considering each of these four elements. Our approach initially categorises evidence
based on study design into randomised trials and
observational studies (box 2). We then suggest considering whether the studies have serious limitations,
important inconsistencies in the results, or whether
uncertainty about the directness of the evidence is warranted.
Additional considerations that can lower the
quality of evidence include imprecise or sparse data
and a high risk of reporting bias. Additional considerations that can raise the quality of evidence include a
very strong association (for example, a 50-fold risk of
poisoning fatalities with tricyclic antidepressants; see
table 2) or strong association (for example, a threefold
increased risk of head injuries among cyclists who do
not use helmets compared with those who do1
) and
evidence of a dose-response gradient. Box 3 gives our
suggested definitions for grading the quality of the evidence.
The same rules should be applied to judgments
about the quality of evidence for harms and benefits.
Important plausible harms can and should be included
in evidence summaries by considering the indirect evidence that makes them plausible. For example, if there
is concern about anxiety in relation to screening for
melanoma and no direct evidence is found, it may be
appropriate to consider evidence from studies of other
types of screening.Evidence-Based Practice in Nursing Essay
Judgments about the quality of evidence for important outcomes across studies can and should be made
in the context of systematic reviews, such as Cochrane
reviews. Judgments about the overall quality of
evidence, trade-offs, and recommendations typically
require information beyond the results of a review.
Other systems have commonly based judgments of
the overall quality of evidence on the quality of
evidence for the benefits of interventions. When the
risk of an adverse effect is critical for a judgment, and
evidence regarding that risk is weaker than evidence of
benefit, ignoring uncertainty about the risk of harm is
problematic. We suggest that the lowest quality of
evidence for any of the outcomes that are critical to
making a decision should provide the basis for rating
overall quality of evidence.
Recommendations
Does the intervention do more good than harm?
Recommendations involve a trade-off between benefits
and harms. Making that trade-off inevitably involves
placing, implicitly or explicitly, a relative value on each
outcome. We suggest making explicit judgments about
the balance between the main health benefits and
harms before considering costs. Does the intervention
do more good than harm?
Recommendations must apply to specific settings
and particular groups of patients whenever the
benefits and harms differ across settings or patient
groups. For instance, consider whether you should recommend that patients with atrial fibrillation receive
warfarin to reduce their risk of stroke, despite the
increase in bleeding risk that will result. Recommendations, or their strength, are likely to differ in settings
where regular monitoring of the intensity of antiBox 1: Evidence-Based Practice in Nursing Essay Sequential process for developing
guidelines

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First steps
1. Establishing the process—For example, prioritising
problems, selecting a panel, declaring conflicts of
interest, and agreeing on group processes
Preparatory steps
2. Systematic review—The first step is to identify and
critically appraise or prepare systematic reviews of the
best available evidence for all important outcomes
3. Prepare evidence profile for important outcomes—Profiles
are needed for each subpopulation or risk group,
based on the results of systematic review, and should
include a quality assessment and a summary of
findings
Grading quality of evidence and strength of
recommendations
4. Quality of evidence for each outcome—Judged on
information summarised in the evidence profile and
based on the criteria in table 2
5. Relative importance of outcomes—Only important
outcomes should be included in evidence profiles. The
included outcomes should be classified as critical or
important (but not critical) to a decision
6. Overall quality of evidence—The overall quality of
evidence should be judged across outcomes based on
the lowest quality of evidence for any of the critical
outcomes.
7. Balance of benefits and harms—The balance of benefits
and harms should be classified as net benefits,
trade-offs, uncertain trade-offs, or no net benefits
based on the important health benefits and harms
8. Balance of net benefits and costs—Are incremental
health benefits worth the costs? Because resources are
always limited, it is important to consider costs
(resource utilisation) when making a recommendation
9. Strength of recommendation—Recommendations
should be formulated to reflect their strength—that is,
the extent to which one can be confident that
adherence will do more good than harm
Subsequent steps Evidence-Based Practice in Nursing Essay
10. Implementation and evaluation—For example, using
effective implementation strategies that address
barriers to change, evaluation of implementation, and
keeping up to date
Education and debate
BMJ VOLUME 328 19 JUNE 2004 bmj.com 1491
coagulation is available and settings where it is not.
Furthermore, recommendations (or their strength) are
likely to differ in patients at low risk of stroke (those
under 65 without any comorbidity) and patients at
higher risk (such as older patients with heart failure)
because of differences in the absolute reduction in risk.
Recommendations must therefore be specific to a
patient group and a practice setting.
Those making a recommendation should consider
four main factors:
x The trade-offs, taking into account the estimated
size of the effect for the main outcomes, the confidence
limits around those estimates, and the relative value
placed on each outcome
x The quality of the evidence
x Translation of the evidence into practice in a specific
setting, taking into consideration important factors
that could be expected to modify the size of the
expected effects, such as proximity to a hospital or
availability of necessary expertise
x Uncertainty about baseline risk for the population
of interest.Evidence-Based Practice in Nursing Essay
If there is uncertainty about translating the
evidence into practice in a specific setting, or
uncertainty about baseline risk, this may lower our
confidence in a recommendation. For example, if an
intervention has serious adverse effects as well as
important benefits, a recommendation is likely to be
much less certain when the baseline risk of the population of interest is uncertain than when it is known.
Table 1 Comparison of GRADE and other systems
Factor Other systems GRADE Advantages of GRADE system*
Definitions Implicit definitions of quality (level) of evidence and
strength of recommendation
Explicit definitions Makes clear what grades indicate and what should
be considered in making these judgments
Judgments Implicit judgments regarding which outcomes are
important, quality of evidence for each important
outcome, overall quality of evidence, balance
between benefits and harms, and value of
incremental benefits
Sequential, explicit judgments Clarifies each of these judgments and reduces risks
of introducing errors or bias that can arise when
they are made implicitly Evidence-Based Practice in Nursing Essay
Key components of quality of
evidence
Not considered for each important outcome.
Judgments about quality of evidence are often
based on study design alone
Systematic and explicit consideration of study
design, study quality, consistency, and directness
of evidence in judgments about quality of evidence
Ensures these factors are considered appropriately
Other factors that can affect
quality of evidence
Not explicitly taken into account Explicit consideration of imprecise or sparse data,
reporting bias, strength of association, evidence of
a dose-response gradient, and plausible
confounding
Ensures consideration of other factors
Overall quality of evidence Implicitly based on the quality of evidence for
benefits
Based on the lowest quality of evidence for any of
the outcomes that are critical to making a decision
Reduces likelihood of mislabelling overall quality of
evidence when evidence for a critical outcome is
lacking
Relative importance of
outcomes
Considered implicitly Explicit judgments about which outcomes are
critical, which ones are important but not critical,
and which ones are unimportant and can be
ignored
Ensures appropriate consideration of each outcome
when grading overall quality of evidence and
strength of recommendations
Balance between health
benefits and harms
Not explicitly considered Explicit consideration of trade-offs between
important benefits and harms, the quality of
evidence for these, translation of evidence into
specific circumstances, and certainty of baseline
risks
Clarifies and improves transparency of judgments
on harms and benefits
Whether incremental health
benefits are worth the costs
Not explicitly considered Explicit consideration after first considering whether
there are net health benefits
Ensures that judgments about value of net health
benefits are transparent
Summaries of evidence and
findings Evidence-Based Practice in Nursing Essay
Inconsistent presentation Consistent GRADE evidence profiles, including
quality assessment and summary of findings
Ensures that all panel members base their
judgments on same information and that this
information is available to others
Extent of use Seldom used by more than one organisation and
little, if any empirical evaluation
International collaboration across wide range of
organisations in development and evaluation
Builds on previous experience to achieve a system
that is more sensible, reliable, and widely applicable
*Most other approaches do not include any of these advantages, although some may incorporate some of these advantages.
Box 2: Criteria for assigning grade of evidence
Type of evidence
Randomised trial = high
Observational study = low
Any other evidence = very low
Decrease grade if:
• Serious ( − 1) or very serious ( − 2) limitation to study
quality
• Important inconsistency ( − 1)
• Some ( − 1) or major ( − 2) uncertainty about
directness
• Imprecise or sparse data ( − 1)
• High probability of reporting bias ( − 1)
Increase grade if:
• Strong evidence of association—significant relative
risk of > 2 ( < 0.5) based on consistent evidence from
two or more observational studies, with no plausible
confounders (+1)
• Very strong evidence of association—significant
relative risk of > 5 ( < 0.2) based on direct evidence
with no major threats to validity (+2)
• Evidence of a dose response gradient (+1)
• All plausible confounders would have reduced the
effect (+1)
Box 3: Definitions of grades of evidence
High = Further research is unlikely to change our
confidence in the estimate of effect.
Moderate = Further research is likely to have an
important impact on our confidence in the estimate of
effect and may change the estimate.
Low = Further research is very likely to have an
important impact on our confidence in the estimate of
effect and is likely to change the estimate.
Very low = Any estimate of effect is very uncertain.
Education and debate
1492 BMJ VOLUME 328 19 JUNE 2004 bmj.com
We suggest using the following categories for
recommendations:
“Do it” or “don’t do it”—indicating a judgment that
most well informed people would make;
“Probably do it” or “probably don’t do it”—indicating a
judgment that a majority of well informed people
would make but a substantial minority would not.
A recommendation to use or withhold an intervention does not mean that all patients should be treated Evidence-Based Practice in Nursing Essay
identically. Nor does it mean that clinicians should not
involve patients in the decision, or explain the merits of
the alternatives. However, because most well informed
patients will make the same choice, the explanation of
the relative merits of the alternatives may be relatively
brief. A recommendation is intended to facilitate an
appropriate decision for an individual patient or a
population. It should therefore reflect what people
would likely choose, based on the evidence and their
own values or preferences in relation to the expected
outcomes. A recommendation to probably do something indicates a need for clinicians to consider
patients’ values and preferences more carefully when
offering them the intervention.
In some instances it may not be appropriate to
make a recommendation because of unclear trade-offs
or lack of agreement. When this is due to a lack of good
quality evidence, specific research should be recommended that would provide the evidence that is
needed to inform a recommendation.
Are the incremental health benefits worth the
costs?
Because spending money on one intervention means
less money to spend on another, recommendations
implicitly (if not explicitly) rely on judgments about the
value of the incremental health benefits in relation to
the incremental costs. Costs—the monetary value of
resources used—are important considerations in making recommendations, but they are context specific,
change over time, and their magnitude may be difficult
to estimate. While recognising the difficulty of accurate
estimating costs, we suggest that the incremental costs
of healthcare alternatives should be considered explicitly alongside the expected health benefits and harms.
When relevant and available, disaggregated costs
(differences in use of resources) should be presented in
evidence profiles along with important outcomes. The
Table 2 Quality assessment of trials comparing selective serotonin reuptake inhibitors (SSRIs) with tricyclic antidepressants for treatment of moderate
depression in primary care2 Evidence-Based Practice in Nursing Essay

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No of studies
Quality assessment Summary of findings
Design Quality Consistency Directness
Other
modifying
factors*
No of patients Effect
SSRIs Tricyclics
Relative
(95% CI) Absolute Quality Importance
Depression severity (measured with Hamilton depression rating scale after 4 to 12 weeks)
Citalopram (8) Randomised
controlled trials
No serious
limitations
No important
inconsistency
Some
uncertainty
about
directness
(outcome
measure)†
None 5044 4510 WMD
0.034
(−0.007 to
0.075)
No
difference
Moderate
Critical
Fluoxetine (38)
Fluvoxamine (25)
Nefazodone (2)
Paroxetine (18)
Sertraline (4)
Venlafaxine (4)
Transient side effects resulting in discontinuation of treatment
Citalopram (8) Randomised
controlled trials
No serious
limitations
No important
inconsistency
Direct None 1948/703
2 (28%)
2072/6334
(33%)
RRR 13%
(5% to
20%)
5/100 High
Critical
Fluoxetine (50)
Fluvoxamine (27)
Nefazodone (4)
Paroxetine (23)
Sertraline (6)
Venlafaxine (5)
Poisoning fatalities§
UK Office for
National
Statistics (1)
Observational
data
Serious
limitation‡
Only one study Direct Very strong
association
1/100 000/
year of
treatment
58/100 000/
year of
treatment
RRR 98%
(97% to
99%)§
6/10 000 Moderate Critical
WMD = weighted mean difference, RRR = relative risk reduction.
*Imprecise or sparse data, a strong or very strong association, high risk of reporting bias, evidence of a dose-response gradient, effect of plausible residual confounding.
†There was uncertainty about the directness of the outcome measure because of the short duration of the trials.
‡It is possible that people at lower risk were more likely to have been given SSRIs and it is uncertain if changing antidepressant would have deterred suicide attempts.
§There is uncertainty about the baseline risk for poisoning fatalities.Evidence-Based Practice in Nursing Essay
Summary points
Organisations have used various systems to grade
the quality of evidence and strength of
recommendations
Differences and shortcomings in these grading
systems can be confusing and impede effective
communication
A systematic and explicit approach to making
judgments about the quality of evidence and the
strength of recommendations is presented
The approach takes into account study design,
study quality, consistency, and directness in
judging the quality of evidence for each
important outcome
The balance between benefits and harms, quality
of evidence, applicability, and the certainty of the
baseline risk are all considered in judgments
about the strength of recommendations
Education and debate
BMJ VOLUME 328 19 JUNE 2004 bmj.com 1493
quality of the evidence for differences in use of
resources should be graded by using the approach
outlined above for other important outcomes.
How it works in practice
Table 2 shows an example of the system applied to evidence from a systematic review comparing selective
serotonin reuptake inhibitors with tricyclic antidepressants conducted in 1997.2 After discussion, we agreed
that there was moderate quality evidence for the
relative effects of both types of drugs on severity of
depression and poisoning fatalities and high quality
evidence for transient side effects. We then reached
agreement that the overall quality of evidence was
moderate and that there were net benefits in favour of
serotonin reuptake inhibitors (no difference in severity
of depression, fewer transient side effects, and fewer
poisoning fatalities). Although we agreed that there
seemed to be net benefits, we concluded with a recommendation to “probably” use serotonin reuptake
inhibitors because of uncertainty about the quality of
the evidence. We had no evidence on relative costs in
this exercise. Had we considered costs, this recommendation might have changed.Evidence-Based Practice in Nursing Essay
Conclusions
We have attempted to find a balance between simplicity and clarity in our system for grading the quality of
evidence and strength of recommendations. Regardless of how simple or complex a system is, judgments
are always required. Our system provides a framework
for structured reflection and can help to ensure that
appropriate judgments are made, but it does not
remove the need for judgment.
Contributors and sources: see bmj.com
Competing interests: Most of the members of the GRADE
Working Group have a vested interest in another system of
grading the quality of evidence and the strength of recommendations.
1 Thompson DC, Rivara FP, Thompson R. Helmets for preventing head
and facial injuries in bicyclists. Cochrane Database Syst Rev
2000;(2):CD001855.
2 North of England Evidence Based Guideline Development Project.
Evidence based clinical practice guideline: the choice of antidepressants for
depression in primary care. Newcastle upon Tyne: Centre for Health Services Research, 1997.
(Accepted 5 March 2004)
Medical researchers’ ancillary clinical care responsibilities
Leah Belsky, Henry S Richardson
Investigation of participants in clinical trials may identify conditions unrelated to the study.
Researchers need guidance on whether they have a duty to treat such conditions
Researchers testing a new treatment for tuberculosis
in a developing country discover some patients have
HIV infection. Do they have a responsibility to provide
antiretroviral drugs? In general, when do researchers
have a responsibility to provide clinical care to participants that is not stipulated in the trial’s protocol? This
question arises regularly, especially in developing
countries, yet (with rare exceptions1
) existing literature Evidence-Based Practice in Nursing Essay
and guidelines on research ethics do not consider
ancillary clinical care. We propose an ethical
framework that will help delineate researchers’
responsibilities.
What is ancillary care?
Ancillary care is that which is not required to make a
study scientifically valid, to ensure a trial’s safety, or to
redress research injuries. Thus, stabilising patients to
enrol them in a research protocol, monitoring drug
interactions, or treating adverse reactions to experimental drugs are not ancillary care. By contrast, following up on diagnoses found by protocol tests or treating
ailments that are unrelated to the study’s aims would be
ancillary care.
Two extreme views
When asked how much ancillary care they should provide to participants, the first reaction of many clinical
researchers, especially those working in developing
countries, is that they must provide whatever ancillary
care their participants need. From an ethical
perspective, this response makes sense. Research
participants in trials in the developing world are
typically desperately poor and ill, and everyone
arguably has a duty to rescue those in need, at least
when they can do so at minimal cost to themselves.2 3
Yet this response fails to acknowledge that the goal of
research is to generate knowledge not care for
patients.4 5 When researchers consider that offering
ancillary care this broadly may drain limited human
and financial resources and confound study results,
they tend to retreat from this position.
Some researchers veer to the opposite extreme.
“We may be doctors,” they note, “but these are our
research participants, not our patients, so we owe
them nothing beyond what is needed to complete the
study safely and successfully—that is, we owe them no
ancillary care.” But this extreme position is ethically
questionable. Consider the case of researchers
studying a rare disease. It is ethically unacceptable to
say to a participant, “We are going to monitor the toxicity and effectiveness of this experimental drug, and
we will make sure it does not kill you, but we are not
going to provide any palliative care for your
condition.” Closely monitoring a participant’s disease
without being willing to treat it in any way amounts to
treating him or her as a mere means to the end of
research Evidence-Based Practice in Nursing Essay

Evidenced Based Practice (EBP) is essential to enable all nurses to provide the most current up to date practises for their patients. This process involves research, systematic review of current practises, critical thinking skills, evaluation and application to the clinical setting. In addition to this, the nurse must take into account the patients’ preferences. For nurses to have professional autonomy they must be able to justify their actions and demonstrate an understanding of why they perform the tasks they do. This defines them as unique professionals judged by their knowledge and not simply by their hands on skills. As stated by McSherry, Simmons & Pearce (2002); “Nurses are responsible for the care they provide for their patient.…show more content…
(Polit & Beck, 2010). As nursing is person-centred and relies on a multidisciplinary team approach it has to take into account the care setting, patient predilections, clinical judgement and best available evidence. (Holland & Rees, 2010). The key steps involved in evidence based practice come from a thirst for knowledge that once ignited makes the next step to asking a well worded clinical question easier. A well formulated question improves patient outcomes and supports the implementation of change. One such method looks at foreground and background questions. A background question is usually a basic knowledge question and is usually answered by a textbook. Foreground questions are usually specific and once answered can help in clinical changes. An acronym useful for formulating a well worded question is PICOT. ( Stillwell, Fineout-Overholt, Melnyk, Williamson, 2010). “PICOT is an acronym for the elements of the clinical question: patient population (P), intervention or issue of interest (I), comparison intervention or issue of interest (C), outcome(s) of interest (O), time it takes for the intervention to achieve the outcome(s) (T).” (Stillwell et al., 2010, p. 59). When a question has been identified the best study design can be chosen. For a prognosis question, a good quality cohort study would be used. For a non-compliance question, a qualitative study would be appropriate and for the effectiveness of treatment a systematic Evidence-Based Practice in Nursing Essay