1. Mcilvoy, Laura
  2. Hinkle, Janice L.

Article Content

During the last few years, there has been a proliferation of literature about the concepts best practices and evidence-based practice. These terms appear to be the latest, ubiquitous buzzwords. But what is evidence-based practice, and why is it important to neuroscience nurses, particularly those who work at the bedside? By way of introduction, this article provides a description of evidence-based neuroscience nursing practice and explains why it is important to the bedside nurse.


Evidence-Based Neuroscience Nursing Practice: A Definition

A good starting place for a description of evidence-based practice is the American Association of Neuroscience Nurses' (AANN) position statement on best practices (AANN, 2005). AANN supports a definition of evidence-based neuroscience nursing practice as an integration of the best evidence available and nursing expertise with the values and preferences of the individuals, families, and communities who are served. Furthermore, AANN supports a definition of best neuroscience nursing practice as broad terminology that describes a process of infusing nursing practice with research-based knowledge. Best practices use care concepts, interventions, and techniques that are grounded in research and known to promote a higher quality of care (John A. Hartford Center of Geriatric Nursing Excellence, 2001). Best practices also is regarded as a continuum that extends from promising initiatives to the actual application of evidence-based knowledge.


So what does all this have to do with neuroscience nurses at the bedside? On a basic level, it is assumed that evidence-based neuroscience nursing is the foundation for professional practice, and as such, bedside nurses use the best evidence in their practice. It has been demonstrated that patients who receive care based on the best and latest evidence from well-designed studies have 28% better outcomes (Heater, Becker, & Olson, 1988). However, as many as 17 years can elapse between publication of evidence and its translation into practice (Balas & Boren, 2000).


Emergence of Clinical Practice Guidelines

As a means of influencing patient outcomes and introducing evidence-based medicine into bedside clinical practice, evidence-based clinical practice guidelines (CPGs) have emerged. CPGs are specific practice recommendations that are based on rigorous review and analysis of available evidence on a specific topic and a specific patient population. Evidence that supports the medicines and treatments that are most or least effective and the time frame during which these should be administered is an important component of many CPGs. This supportive evidence is a useful tool for helping to reduce practice variation, implement research findings at the bedside, and promote rapid implementation of best practice while fostering multidisciplinary teamwork. A good example is the Guidelines for the Management of Severe Traumatic Brain Injury, sponsored by the Brain Trauma Foundation (BTF). These guidelines were published in 1995 and have been updated twice since their initial publication (BTF, American Association of Neurological Surgeons, & Congress of Neurological Surgeons, 2007). Using cost-benefit analyses, it has been estimated that the routine use of these guidelines could result in a savings of $262 million in annual medical costs, $43 million in annual rehabilitation costs, and $3.84 billion in lifetime costs to society (Faul, Wald, Rutland-Brown, Sullivent, & Sattin, 2007).


During the last decade, professional specialty organizations such as AANN have brought together experts within their respective specialties to create CPGs to assist their members and the medical community by providing evidence-based care recommendations. To foster the development of high-quality, evidence-based guidelines and provide a mechanism for dissemination, the National Guideline ClearinghouseTM was placed online at, enabling more than 1,000 CPGs to be accessible to healthcare professionals, healthcare organizations, and the public. Sources of CPG databases are listed in Figure 1. Specific CPGs also can be found on specialty organizations' Web sites. AANN has recently published the Nursing Management of Adults with Severe Traumatic Brain Injury, a document of evidence-based guidelines that can be accessed online in PDF format at These guidelines are in preparation for submission to the National Guideline Clearinghouse.

Fig 1 - Click to enlarge in new window Clinical Practice Guideline Databases

Although CPGs have tremendous potential to improve patient outcomes, their success depends on proper implementation (Melnyk & Fineout-Overholt, 2005). Implementing CPGs can involve changes in physician practice; nursing practice; and systems within an organization, such as a hospital, clinic, or extended-care facility. Changes of this magnitude require a team approach and involve many levels of staff education. The CPG recommendations can be introduced as part of a clinical pathway, a protocol, an algorithm, or any combination of these. In addition, multiple publications that detail the successful implementation of guidelines in most neuroscience populations are available.


There are many nursing texts that discuss in detail what evidence-based practice is, as well as how to develop research questions from clinical problems, find the relevant evidence and critically appraise it, or generate your own evidence through research projects. Neuroscience nurses can continue to improve patient outcomes by striving to provide care based upon the best available scientific evidence, including, but not limited to, CPGs.




American Association of Neuroscience Nurses. (2005). Best Practices [Position statement]. Glenview, IL: Author. Retrieved September 19, 2008, from [Context Link]


Balas, E. A., & Boren, S. A. (2000). Managing clinical knowledge for healthcare improvements (pp. 65-70). Stuttgart, Germany: Schattauer. [Context Link]


Brain Trauma Foundation, American Association of Neurological Surgeons, & Congress of Neurological Surgeons. (2007). Guidelines for the management of severe traumatic brain injury. Journal of Neurotrauma, 24(Suppl. 1), S1-S106. [Context Link]


Faul, M., Wald, M. M., Rutland-Brown, W., Sullivent, E. E., & Sattin, R. W. (2007). Using a cost-benefit analysis to estimate outcomes of a clinical treatment guideline: Testing the Brain Trauma Foundation guidelines for the treatment of severe traumatic brain injury. Journal of Trauma, 63(6), 1271-1278. [Context Link]


Heater, B., Becker, A., & Olson, R. (1988). Nursing interventions and patient outcomes: A meta-analysis of studies. Nursing Research, 37, 303-307. [Context Link]


John A. Hartford Center of Geriatric Nursing Excellence. (2001). Best practices. Retrieved October 17, 2008, from [Context Link]


Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing and healthcare: A guide to best practices. Philadelphia: Lippincott, Williams and Wilkins. [Context Link]