What is Evidence-Based Practice?
It is conducting your nursing actions in accordance with the latest nursing research. It starts with asking “Why?” we practice the way we do. Then you consult the latest research on the topic and either confirm you’re practicing accordingly or find out that you should make changes. That could be a simple change or require a change to the policy and procedure manual, staff training etc.
“Why do we keep patients NPO (nothing by mouth) during their stay in the ED?” Nurses trying to keep their patients comfortable have to deny their patients food…why? Waiting in the emergency department can take many hours. Traditionally, the thought was to keep ED patients NPO in case they ended up needing a procedure with a risk of aspiration. Patients come into the ED soon after eating and they get the treatment they need no matter when their last meal was. Why are all patients kept NPO?
To be proactive and truly practice EBP, you would look into the most current research to see if this practice of NPO is warranted or should be changed to match the current research. This is just what Traci Denton, RN, BA, CCRN did at Vanderbilt University Medial Center. She looked up the research and presented it to her supervisor. Now, not all patients entering the ED are denied food and drink during the many hours they may spend in the ED. See the details of Traci’s Evidence-based Practice project on Vanderbilt University’s web site.
What is Nursing Research?
It is the search for knowledge to ultimately better serve our patients. It starts with a question of “What if…?” A researcher will then devise a way to systematically study and collect data to understand or discover a real or perceived issue, as in Qualitative studies or, compare two or more strategies to see if there is a significant difference, as in Quantitative studies. A goal of research is to be published so that the entire nursing community can benefit from the new knowledge.
What if elderly female patients felt more comfortable talking with their doctors about bladder issues? Here is a question that may be answered by a Qualitative study looking at it as a possible real or perceived issue. A researcher may devise and questionnaire for patients and study the results to see if in fact it is an issue.
What if patients, with dysphagia (swallowing difficulties) eating gelatin, in the hospital, are getting more aspiration pneumonia then those not eating gelatin? A Quantitative study could keep data on all dysphagic patients who eat the gelatin vs. those who don’t and discover if there is a difference in the percentage of gelatin eaters who get aspiration pneumonia. [If the difference was significant, you could change your practice to offer dysphagic patients alternative dessert options- that would be an example or Evidence-Based Practice]
What is Quality Improvement (QI) or Continuous Quality Improvement (CQI)?
It is a thinking that most things can be improved (vs. if it ain’t broke don’t fix it). It starts with the question, “How can we make a process/performance better?” This is almost always a local casual form of researching and can result in better evidence-based practice on a local level. QI could have nothing to do with EBP and more about saving time, money or increasing patient satisfaction. It tends to focus on the process of how things are done and how they could be done better. The QI person in the institution might look at why unit 3B uses twice as many paper towels as unit 3A and do an informal type of investigation and see how they can get 3B to be more like 3A. It can be about customer satisfaction such at implementing an ADET dialogue to improve consumer ratings. Like research and EBP, QI looks for objective data to analyze and improve processes.
How can we reduce the number of nurses out with work related back injuries? The hospital would study the current process of lifting and turning patients in the hospital. They would look for alternative and better ways to do that nursing task. They may decide the staff needs more lifting belts and purchase more lifting belts for the unit. QI should also include an evaluation.
It’s not just the job of the designated “QI” person to come up with processes that need improvement. You, as a professional nurse, should be on the lookout for areas that need improvement. You could be the one to bring up the number of staff out for back pain. Don’t just present the problem, present a solution. Look at nursing research and find an article showing no evidence that lifting belts reduce the rate of back injuries. Search and find other articles that show reduced back injury success with lift teams, mandatory two person transfers and mechanical lifting devices. Compare the evidence and use it to form a campaign to institute the best evidence-based practice to your workplace.
I hope this helps explain the differences between Evidenced-Based Practice, Research and Quality Improvement. Please note that all the examples listed above are hypothetical and intended for learning examples only with the exception of Traci Denton’s work.