Abstract
Knowledge and use of evidence-based practice are essential to ensure best practices and safe patient outcomes. Staff development specialists must be leaders in this initiative to support clinical nurses toward improved practice outcomes. This article describes the background for understanding the historical evolution from research utilization to evidence-based practice, defines some key concepts related to evidence-based practice, and suggests essential components for building evidence-based practice programs in healthcare institutions.
The current healthcare environment is increasingly focused on patient safety since the Institute of Medicine published two significant reports spotlighting how safety is compromised in health care institutions. The two publications, To Err is Human(Kohn, Corrigan, & Donaldson, 2000) and Crossing the Quality Chasm (Committee on Quality of Healthcare in America, 2001), call upon healthcare professionals to improve patient interventions and outcomes for safer, quality care. Berwick's (2002) analysis of these reports provides further insights about the gaps in current care and what represents best practices in quality patient care. Increasingly, the practice of nursing is coming under the spotlight, since 59% of nurses work in acute-care facilities and hold accountability for the 24-hour management of patient-care delivery (Steinbrook, 2002). Traditionally, practicing nurses have examined care outcomes in relation to a specific patient on a shift or by an encounter of care. The nursing profession is now also being held accountable for patient population outcomes that are sensitive to nursing interventions, such as skin integrity and patient falls. The American Nurses Association'sNursing Report Card (1995), and its evolution into the National Database of Nursing Quality Indicator Project (Dunton, 2002), is an example of a national effort to benchmark using nursing outcomes across institutions. The literature increasingly reflects studies documenting outcomes of nursing care across institutions, such as the article by Rudy, Lucke, Whitman, and Davidson (2001) describing the benchmarking of central line infections, part of a multihospital study of 10 patient outcomes.
Measuring nursing outcomes requires nurses to use current and valid research in practice to ensure the care interventions measured reflect best practices. Nurses may not realize the urgent need for evidence upon which to base practice, since many nurses may not be aware of changing professional expectations. Often nurses do not have the skills necessary to review the evidence and lack knowledge to evaluate the strength of the evidence. Staff development specialists can play a critical role in establishing a culture of inquiry at their institutions by developing staff evidence-based practice knowledge and skills through programs and activities. Learning about evidence-based practice and generating programs to address knowledge deficits are steps toward advancing the profession in all practice settings. Research and evidence-based practice should not be viewed as an "add on" to staff development programs, but rather as one of the essential foundations for creating a learning environment.