A New Take on Evidence-Based Practice

Among physicians, there’s an old joke that half of everything we know about medical practice is wrong, but, unfortunately, we don’t know which half that is. Consumers are often unsettled to find that medical science does not progress in a linear fashion—particularly when they have already undergone a procedure or taken a medication that then falls out of favor. A new book is calling attention to this phenomenon of medical tests and therapies that have been discontinued after they were found to be either ineffective or harmful. It is titled Ending Medical Reversal: Improving Outcomes, Saving Lives and is authored by two doctors, Vinayak K. Prasad, MD, MPH, and Adam S. Cifu, MD. They use the term “medical reversal” to describe any sudden flip-flop in standards of care, and they provide examples of nearly 150 disproved medical therapies in the book’s appendix. Examples include the medication Vioxx, vertebroplasty for back pain caused by compression fractures, and coronary stents for stable angina. And of course, there’s the ongoing debate over whether certain cancer screening procedures cause as much harm as good.

When we look at the evolution of nursing practice, we can also find instances of reversals. Clearly, nursing has moved forward and changed in many ways. We have more autonomy than ever before, in terms of nurse-directed interventions. We use technology in ways we couldn’t have imagined 50 years ago. We have more education, more specific training, and more opportunities to specialize. And along with our changing roles, we’ve seen changing standards of nursing care, as evidence-based practice takes precedence over “the way we’ve always done things.” Examples of nursing reversals include:

  • Using indwelling urinary catheters to manage incontinence. This is now known to put patients at risk of infection, increase the length of hospitalization, and raise costs significantly. Many hospitals are moving toward nurse-directed catheter removal, and giving nurses the responsibility of monitoring and managing catheters according to infection control guidelines.
  • Restraining patients to prevent falls. There are new concerns about ethics and providing a higher quality of life for all patients, including the elderly, the disabled, and those with dementia. There is also newer research that exposes the hazards associated with restraints (bed rails, belts, vests, specialized chairs, etc.) Currently, restraints are considered a form of medical treatment and can only be ordered by a physician for a specific medical reason.
  • Treating pressure ulcers after they occur, rather than taking steps to prevent them. Newer tools like the Braden Scale focus on assessing patients for risk of pressure ulcers and taking steps to prevent them from forming. We recognize now that bedsores are neither innocuous nor inevitable, and that they contribute significantly to patient misery as well as raise the cost of hospitalization.
  • Flushing a central line or “locking” an open IV with heparin. Research indicates that a saline flush or lock is just as effective as heparin in keeping a line open, and can prevent serious complications associated with heparin in some patients.
  • Administering aspirin to control fever in pediatric patients. At one time, this was a standard nursing intervention. We now know that aspirin greatly increases the risk of Reye’s syndrome in the pediatric population.

Examples like these demonstrate the benefits of evidence-based nursing practice (EBNP). The movement toward EBNP is intended to standardize nursing practice with actual research-based science and reduce illogical variations in care, which can lead to unpredictable outcomes. EBNP can support nursing decisions and help nurses avoid ineffective, inappropriate, and harmful interventions, as well as those that are unnecessarily costly. At its highest level, EBNP includes a focus on identifying knowledge gaps in current nursing practice and systematically closing those gaps.

As a nurse, you should continually ask the question, What is the evidence that this intervention is the best possible practice? And when clinical questions come up, you should know where to find the answers. Unfortunately, a 2005 study that assessed the readiness of nurses for evidence-based practice found that most nurses relied on what they’d learned in nursing school, and rarely used reference materials to check for more timely or accurate information. It’s eye-opening, isn’t it? And a little bit frightening to realize how some nurses are using unproven or outdated information, when they could be advancing the practice and science of nursing.

So what’s the answer? In order to help develop evidence-based practices, nurses have to understand the concept of research and know how to find and evaluate existing research studies—no easy feat sometimes. Fortunately, these skills are taught in modern nursing curriculums, like American Sentinel’s online RN to BSN program. A nurse who understands EBNP is a confident professional, able to communicate well with a multi-disciplinary care team and advocate effectively for patients.