1. Palatnik, AnneMarie MSN, RN, APN-BC

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What drives your practice: tradition or evidence? How many times have you been in a situation where you've asked, "Why do we do handle this situation in this way?" and the answer has been, "Because that's the way we've always done it." How many times, when caring for patients, have you stopped to ask "Why am I doing what I'm doing? Why am I giving this medication, doing this procedure in this way, performing this intervention?"

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In the same regard, how many times have you heard that evidence must drive our practice? Evidence-based practice enables nurses to provide the highest quality care to our patients and enhances patient outcomes. Evidence-based practice (sometimes referred to as evidence-based clinical decision making) includes more than just a systematic review of randomized clinical trials. Evidence-based practice also encompasses opinions from experts, patient assessments, availability of healthcare resources, and patient preferences.


According to Melnyk and Fineout-Overholt, evidence-based practice has five critical steps:


1. Ask a significant clinical question.


2. Collect the best evidence, including clinical studies, meta-analyses, and clinical practice guidelines.


3. Critically review the evidence for validity, reliability, and applicability.


4. Integrate appropriate evidence with your clinical expertise and the patients' preferences and values to make a practice decision or practice change.


5. Evaluate the practice decision or change that resulted from implementing the evidence into practice.



Systematic reviews of clinical studies (meta-analyses) and evidence-based clinical practice guidelines are considered the strongest level of evidence on which to base practice decisions. Practice guidelines are derived from expert panel reviews of all of the available evidence. These expert panels then make recommendations and grade them.


One of the things that the expert panels look at when reviewing clinical trials is the P (probability) value derived from any particular trial. The P value tells us how likely it is that the study's desired outcome was the result of chance; the smaller the P value, the less likely that the result is due to chance. A P value of 0.05 is considered statistically significant for research purposes; a P value of < 0.001 is considered extremely significant.


In "Understanding P values" in this issue, DaiWai Olson and Bradley Kolls offer a down-to-earth explanation of P values and what they mean.


Until the next time, be healthy, be happy, be great advocates for your patients, and challenge practices that lack supporting evidence.


AnneMarie Palatnik, MSN, RN, APN-BC

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Director of Clinical Learning Center for Learning Virtua Health Mount Laurel, N.J.




Melnyk B, Fineout-Overholt E. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.