INTRODUCTION:

The patients who receive research-based nursing care make "sizeable gains" in behavioral knowledge, and physiological and psychosocial outcomes compared with those receiving routine nursing care¹. We expect nurses to care with their hearts and minds to provide comfort to the patient and we also expect them to be critical thinkers, good communicators and abreast of all the important research findings. The National center for Nursing Research at the National Institute of Health and the American Nurses association cabinet on nursing research have promoted and provided guidance by focusing research on nursing practice and nursing education^{2, 3}.

What is Evidence-based nursing practice?

The practice of nursing in which the nurse makes clinical decisions on the basis of the best available current research evidence, his or her own clinical expertise, and the needs and preferences of the patient⁴.

It is the application of valid, relevant, and research-based information in nurse decision-making. Used effectively, evidence-based nursing methods can be used to dramatically enhance patient care and improve outcomes⁵.

Importance of evidence based nursing

1. EBP supports and informs clinical, administrative, and educational decision-making.

2. Combining research, organizational experience (including quality improvement data and financial data), clinical expertise, expert opinion, and patient preferences ensures clinical decisions based on all available evidence.

3. EBP ensures efficacy (the ability to reach a desired result), efficiency (the achievement of a desired result with a minimum of expense, time, and effort), and effectiveness (the ability to produce the desired result).

4. EBP weighs risk, benefit, and cost against a backdrop of patient preferences. This decision making encourages health-care providers to question practice and determine which interventions work and which do not.

5. EBP ensures that nurses use evidence to promote optimal outcomes or equivalent care at lower cost or in less time and that health-care provider promote patient satisfaction and higher health-related quality of life.

Sources of Evidenced-Based Nursing:

Trial And Error:-

Here nurses frequently try a variety of approaches to solve the problems. After some time they settle on one approach that is more often than not effective. This approach reduced critical thinking and wasted time.

Personal Experiences:-

Making decisions based on their personal experience and it frequently influenced by Tradition, Authority and Trial and Error.

Intuition:-

It is defined as “Quick perception of truth without conscious attention or reasoning”. In rare occasions a “Gut feeling” may be reliable.

Barrowed Evidence:-

It can be useful because it fills gaps that exist in nursing science. Provides a basis on which to build new evidence, and can be a stronger type of evidence than sources that are not based on theory and science. It is important for nurses to consider its fit with the nursing phenomenon.

Tradition:-

It has long been accepted basis for information. Nurses can be so entrenched in practice traditions that they fail to ask questions that could lead to changes based in evidence. Consistent use of tradition as a basis for practice limits effective problem solving and fails to consider individual needs

Authority:-

There are various sources of authority such as books, articles, web pages and individuals and groups. These are perceived as being meaning full sources of reliable information, Yet in reality, The information provided may be based in personal experience or tradition rather than scientific evidence.

Scientific Research:-

It is considered the best source of evidence. There are many different research methods that can be used to describe and explain to nursing care⁷.

Best Resources for Evidence Base Nursing education and practice:-

1. Printed Resources such as Encyclopedia, Hard books, Guides and care plan modules.

2. Electronic Resources such as Professional journals, Popular magazine News papers Industry bulletins

3. Subject -Specific Databases:-

(a) TRIP-database	http:/www.tripdatabase.com.	It support of EBP and simplify the nurses to accesses the web
(b) EMBASE	http:/info.embase.com	It Provides comprehensive online access to recent literature
(c) CINAHL	http:/www.apa.org/psyin/o	It covers the area of nursing and allied health
(d) PSYCINFO	http://www.apa.org/ psyinfo	It is an International coverage of nursing, education and other areas
(e) MEDLINE via Pubmed	http://www.ncbi.nim.nih.govt	Providing coverage of Medline and other medical sciences literature
(f) Evidence-Based Nursing/ EB online	http://ebn.bmjjournals.com	Help practicing nurses keep up with the manner. Based literature in a manageable⁸.

Models of Evidence-based Practice:-

The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) depicts three essential cornerstones that form the foundation for professional nursing. These cornerstones are practice, education, and research.

Practice is the basic component of all nursing activity (Porter-O’Grady, 1984). Nursing practice is the means by which a patient receives nursing care. It is an integral component of health-care organizations.

Education reflects the acquisition of the nursing knowledge and skills necessary to become a proficient clinician and to maintain competency.

Research provides new knowledge to the profession and enables the development of practices based on scientific evidence.

Barriers of Evidence-base Nursing Education and Practice

1. Nurse Barriers: -

Lack of

· Time, Motivation, Confidence and Research Knowledge regarding evidence-based strategies

· Awareness of Current Research

· Interest/Value for Research

· Rewards for implementing the findings into clinical practice.

· Relevance of research for practice.

· Expectations and reward systems for nurses to participate in research.

· Understanding or agreement with the conclusions of research reports.

2. Research Barriers:

Lack of:

· Relevance to Practice

· Rigorous Methodology

· Believable Findings

· Lack of collaboration between researchers and clinicians.

· Appropriate Recommendations.

3. Organizational Barrriers:

Lack of:

· Access to Journals/Research Resources

· Funding to Support New Technology

· Expectations for Research Participation

· Rewards/Positive Reinforcement Staff

· Time Allocated for Research Participation

· Staff Empowerment to Make Changes

· Support from Administrators

· Limited research presentations and publications targeted for clinicians

4. Communication Barriers:

Lack of:

· Collaboration Between Researchers and Clinicians

· Presentations to Audiences in Practice

· Publications in Clinical Journals

· Understandable Research Publications

· Availability of Consultants to Help Critique

Evidence Grading:

A1 = Evidence from well-designed meta-analysis or well done systematic review with results that consistently support a specific action (e.g., assessment, intervention, or treatment)

A2 = Evidence from one or more randomized controlled trials with consistent results.

B1 = Evidence from a high quality evidence-based practice guideline.

B2 = Evidence from one or more quasi-experimental studies with consistent results.

C1 = Evidence from observational studies with consistent results (e.g., correlational descriptive studies)

C2 = Inconsistent evident from observational studies or controlled trials.

D = Evidence from expert opinion, multiple case reports, or national consensus reports.

Recommendations for Evidence-based nursing education in future:

· Conduct collaborative research development under international leadership

· Develop Continuing education on the use of the evidence base in decision making

· Review clinical guidelines and protocols in light of the latest research evidence

· Create reward system for successful in using an evidence base decision making

· Documentation of evidence from the opinion of expert informants and dissemination of reports of expert committees

· Review the nursing curriculum at all levels

· Include evidence base for decision making in standards of clinical development process⁹.

CONCLUSION:

Evidence-based practice (EBP) positions nurses to be a significant influence on health-care decisions and a partner in improving quality of care. Beyond an expectation for professional practice, EBP provides a major opportunity for nurses to enlighten practice and add value to the patient experience. The nurse educators and nurse administrator must be involved in the policy making process for our profession in collaboration with health profession for empowerment through Evidence Based Nursing Practice. The curriculum also should be developed for interpretation for exploration.

REFERENCES:

1. Heater BS, Becker AM, Olson R. Nursing interventions and patient outcomes. A meta-analysis of studies. Nursing Research 1988; 37:303-7.

2. Kathy Mallach, Tim Porter-o’ Grady, Introduction to Evidenced based practice in Nursing and healthcare 59-60

3. Nightingale F. Notes on nursing what it is and is not. London: Churchill Livingstone, 1946. (First published in 1859)

5. Nicky Cullum is Director of the Centre for Evidence Based Nursing at the University of York, UK and formerly UK Editor of Evidence Based Nursing.

6. Thompson C, Mc. Caughan D, Cullum N, Sheldon TA, Mulhall A, Thompson DR. Research information in nurses’ clinical decision-making: what is useful? J Adv Nurs2001; 36:376–88

7. Nola A Schmidt, Evidence based-practice for nurses 6-8,96-98

8. LoBiondo-wood, G(2002)Evaluating the validity of internet resources 1,3,4,11

9. Swan.A.B Al-Gasser.N and Lang .M.N 2003 Global partnership to strengthen the evidence for nursing economics( 21,247-52)

Received on 21.01.2011 Modified on 28.01.2011

Asian J. Nur. Edu. & Research 1(1): Jan.-March 2011; Page 19-22