Evidence-Based Practice
Reproduced with permission from Roy Brown, Research and Education Librarian, Assistant Professor at Tompkins-McCaw Library, Virginia Commonwealth Library
What is Evidence-Based Practice?
David Sackett, a pioneer of Evidence-Based Practice, has written the most oft-quoted definition:
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Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
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The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
- By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice.
- Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care.
- By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens.
- External clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer.
Bryan Haynes has a more practical interpretation:
- Clinical decisions must include consideration of, firstly, the patient's clinical and physical circumstances to establish what is wrong and what treatment options are available.
- Secondly, the latter need to be tempered by research evidence concerning the efficacy, effectiveness, and efficiency of the options.
- Thirdly, given the likely consequences associated with each option, the clinician must consider the patient's preferences and likely actions (in terms of what interventions she or he is ready and able to accept).
- Finally, clinical expertise is needed to bring these considerations together and recommend the treatment that the patient is agreeable to accepting."
Evidence-Based Nursing Practice for Nurses
- Uses clinical expertise to devise a care plan to meld best evidence practice with individual patients or populations or communities.
- It's premise is that custom alone may not provide the best care.
- That a spirit of inquiry is needed to consider new and better ways to provide care.
- That there is evidence to be found to help us to integrate our clinical judgment, and our knowledge of the patient (s) to provide this care.
- That evidence based practice is constantly being reexamined as our clinical experience and patient population expands.