Applying Evidence-Based Approach in an Adult ICU to reduce Evidence-Based Practice in Nursing

 

Introduction
An increasingly growing body of research studies confirms that patient outcomes improve significantly when nurses and clinicians provide services in an evidence-based system. According to Fineout-Overholt, Melnyk and Schultz (2015), evidence-based practice is a problem-solving approach to healthcare that seeks to incorporate the use of the current best practice from current research, patient preferences and values and the clinician’s expertise. Research has confirmed that evidence-based practice (EBP), once adopted and used in clinical care, improves patient outcomes, improves patient safety, reduce costs and reduce variations in the clinical outcomes.

Due to dramatic changes in healthcare and the increasing need for integrated delivery systems, practitioners’ efforts to access new information have been intensified, with the aim being to access the most relevant information about the efficient approaches that improve patient outcomes. In this type of healthcare environment, nurses and other practitioners cannot solely rely on their experiences, opinion-based processes or pathophysiologic rationale. Instead, they must learn to obtain information from literature search, critical appraisal of research evidence and findings and synthesizing empirical evidence. They must learn and appreciate to carry out research and obtain information that should then be transferred to their practice to improve outcomes, reduce costs and enhance patient safety and confidence. The practitioners must also obtain critical thinking skills as well as evidence-based methods that are needed to make effective decisions, which then maximize the quality of care while also reducing cost of care services.
Nevertheless, integrating evidence from research into practice has proved difficult, especially when nurses are left to obtain such information and apply them on their own. Fortunately, in the past three decades, the number of research on EBP and its application in healthcare has increased tremendously, resulting into the development of various strategies and approaches for adopting and implementing EBP. In particular, various models have been developed to enhance the development, adoption and implementation of EBP in healthcare, thus improving patient outcomes. The models have greatly improved the understanding of various aspects of EBP and how it should be integrated into healthcare. They act as frameworks that guide the design as well as the implementation of those approaches that are designed to strengthen decision making based on evidence.

Currently, about forty seven prominent EBP models exist in literature and the majority have been applied in practice. Noteworthy, despite their different nature and approaches, the forty seven models can be grouped into three areas based on their themes. First, there are those that focuses on EBP, knowledge transformation processes and research utilization. Second, there are those models that focus on strategic organization change theory, seeking to promote the adoption of new knowledge. The third group is based on the theme of knowledge exchange as well as synthesis for application in practice.
Translation science involves two aspects. First, it involves the process of applying new knowledge or discoveries obtained from research in the laboratory and/or preclinical science to develop new trials and studies in healthcare. The second area is related to research for enhancing the use of best practices in healthcare (AHRQ, 2008).

Outcomes research involves, also known as the patient-centered outcomes research (PCOR) is research on the outcomes of an intervention with an aim of helping people make informed decisions about their health. It is also aimed at improving healthcare delivery as well as outcomes while also producing and promoting high integrity EBP information from research guidelines (AHRQ, 2008).

Improvement science is a generally new field that involves generating evidence about the adoption and use of EBP and provision of research evidence to guide the healthcare decisions for EBP as the best practice in the medical field (Berwick, 2008).
Research utilization is a component of the Healthcare Evidence Generation model that relates to the implementation of knowledge or evidence into practice as demonstrated by practice as well as the system change. Three elements are identified. First, it involves the evaluation of the impact of utilization of evidence on the healthcare system. Second, it should involve the process of care as well as the observed outcomes. Finally, it involves practice change.

Among the most recent and highly applied model is the ACE Star Model, which focuses on knowledge transformation. The CE Star Model is the exemplar of this synthesis paper, which seeks to develop an implementation plan in an adult ICU with patients who have some form of catheters. The aim is to use the EBP model to reduce the incidents of bloodstream infections among the patients admitted in the ICU with some form of catheters.