At the core of evidence based practice, there exists a reflection of an ideological stance that at times seems to be in direct tussle with the hierarchical status driven stereotypic association of medical practice. Unlike evidence based practice, the latter is buttressed and defined by the allocation of scarce health care resources. Evidence based practice transcends that way of thinking and defines quality of medical care not only as a function of resource allocation but also an adherence to a set of critical features.
Moreover, evidence based practice is at the core of medical practice and nurses being the largest component of medical professionals have been at the forefront in critically acclaiming and identify, evaluate and apply best practices in patient care. Critical Features The concept of evidence based practice in nursing or medicine encompasses a set of five critical components. First, evidence based medicine lays emphasis on professional responsibility of the nurse to utilize their judgment, personal experience and a host of other relevant external clinical evidence in the making of decisions.
This ensures that the decision is not only scientifically and clinically supported but that such decisions are ideally made to the best interest of the patient under the care of a professional nurse. The integration of evidence derived from research, professionally acquired clinical expertise and decision making with reference to the needs and perspectives of the patients remains a dominant pillar in evidence based practice (Craig et al 2002; Rubefield et al 2006). Second, the concept of evidence based practice explicitly refers to the care offered to individual patient.
This feature ensures that care espouses the primacy of the patient nurse relationship over that of other parties such as the patient’s family members, the local community or even the health institution offering the health services. Such a feature is supportive of very crucial ethical considerations enshrined in the nursing code of ethics (Trinder et al 2000). Third, the concept proposes that in cases of decision making such decisions as regards clinical practice should be explicit, transparent and open for external examination.
Such a feature ensures that decisions are not arbitrarily made without taking into account important facets of the decision making process. Additionally, the feature promotes accountability, transparency and integrity in clinical practice as well as bestowing honor and respect for inalienable rights of human beings even in cases where the patients is partially or fully incapacitated and therefore unable to individually make decisions concerning their health and consequent mode or quality of health care (DiCenso et al 2005; Trinder et al 2000; Gambrill, 2006a;Tanner et al 2004).
Fourth, the integration of information technology as an irrepressible component of evidence based practice promotes the use of current best clinical evidence. Since clinical based practice is definitive of incomplete evidence that is subject to revision, several sources and forms of evidence have to be collected and collated with the benefit of a hierarchy or evidence to ensure that decisions made are in line with current and progressive evidence disseminated by research and enshrined into clinical practice.
This kind of analysis takes us to the fifth feature which creates the need of evaluation that is not only systematic but also objective. Such evaluation places the physician in a reflective and active role where the physicians own skills and judgment are put to test. This eventually progresses to an active role where a decision is made with relation to the patient’s clinical condition(Trinder et al 2000). Challenges and Limitations facing the Implementation of Evidence-based Practice in Nursing
At the heart of every opportunity and urgency to modernize health care services is a deep commitment to improve quality and promote person centered health care provision through the adoption of evidence based practices. In line with the 21st century vision, nurses are required to be leaders in the acquisition of valuable scientific and clinical evidence and consequently adopt such evidence into everyday health care provision. However, challenges are rife because the implementation of evidence based practice is quite a complex issue.
One major challenge is that standardization of the practice so as to improve on reproducibility. The crux in relation to standardization is the variability of the nature what is right or wrong to do. While there is adequate proof that the everyday experiences in medical practice, reflection, inquisition of variabilities in the medical sphere and objective evaluation of research evidence possess a wealth of possibility in improving health care provision, such proof cannot be extrapolated for each and every nurse practitioner(Gambrill 2006b).