Findings from a recently reported study on evidence-based practice (EBP) in nursing revealed both encouraging as well as concerning findings. The vast majority (90%) of the more than 500 registered nurses (RNs) who participated in the study reported using EBP. However, a substantial proportion (69%) of RNs also indicated they have only a low to moderate level of understanding of EBP.
Earlier this year, Sigma Theta Tau International (STTI), the Honor Society of Nursing, conducted an online, electronic survey of active RNs in the United States,1 issuing invitations via e-mail to nurses whose e-mail addresses were obtained from a trio of nurse marketing lists. A total of 565 nurses agreed to participate, affording a 95% confidence level in the representativeness of findings. A brief profile of respondents to the survey is provided in the TableT1.
STTI2 defines EBP as “an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities who are served.” The value of EBP lies in its ability to not only minimize the translation time required for implementation of research findings into nursing practice, but to help approximate the edges that lie among and between ritualistic practices, habitual approaches, personal preferences, anecdotal experiences, empirical data, and unequivocal statistical significance to support current nursing practice. Ideally, EBP provides critical care nurses with the best available evidence to support nursing care of acute and critically ill patients and their families.
Use of Evidence-Based Practice
The STTI survey results suggest that EBP is gaining not only recognition but also expanding application in nursing:
90% of respondents reported that they need to access and apply EBP at least occasionally (1 to 2 times per month);
64% of RNs related that their needs for evidence upon which to plan nursing care arise either weekly (34%) or multiple times each week (30%); and
73% of RNs perceived that an adequate amount of information related to EBP was both available and accessible to them. Sixty percent of participants rated these resources as “adequate” and another 13% rated them as “more than adequate.” Perceived adequacy of information was especially true among respondents who had entered nursing within the previous 5 years—more than 82% of these nurses identified EBP resources as “more than adequate.”
Understanding of Evidence-Based Practice
The STTI survey results also provide some preliminary indications that nurses’ familiarity and application of EBP principles are gaining some foothold:
31% of RNs characterized themselves as having a high level of familiarity with EBP and 45% described their familiarity as moderate;
45% of participants reported that they had a high level of comfort with the entire EBP process and another 48% identified a moderate level of comfort with this process. Although “comfort” cannot be equated with competency, it likely reflects some degree of both understanding and integration of EBP precepts on a personal level; and
Aspects of the EBP process in which respondents identified the highest comfort levels was in “Searching for research/evidence.”
Continuing Development in Evidence-Based Practice
Even as a preliminary snapshot of the extent to which EBP is making a meaningful presence in nursing, findings from the STTI survey highlight a number of issues that need to be addressed to maintain expansion of EBP, including the following:
24% of RNs characterized themselves as having a low level of familiarity with EBP;
10% of RNs rated their comfort level with the EBP process as low;
RNs identified appraisal and analysis of research evidence as the step in the EBP process that currently poses the greatest challenge;
66% of RNs identified the single largest obstacle in locating EBP information was not having the time at work to search for or to analyze research evidence; the second largest obstacle (identified by 45% of RNs) was that evidence was often written in a manner that made it difficult to analyze or appraise;
more than 1 in 4 (27%) RNs perceived the availability and accessibility of EBP resources to be inadequate; and
in terms of nurses’ perceived needs for evidence upon which to base their practice, it is particularly disconcerting that 8% of RNs described their need for this type of information as occurring only “seldom” (less than once per month) and another 2% as “never.”
Much needs to be done to supply critical care nurses with a comprehensive, ongoing, and readily accessible spectrum of information needed to provide optimal care to patients placed in their care. At the very least, we can assist in providing staff with background information and instructions related to the EBP process; in identifying currently available EBP resources such as those listed at STTI’s Web site (www.nursingknowledge.org, www.nursingsociety.org/education/ceonline.html), in the Worldviews on Evidence-Based Nursing journal (www.nursingsociety.org/worldviews), and throughout the Internet; and by designating opportunities for nurses to discuss, locate, analyze, and act upon evidence already available. Unless we take the initiative to instigate such measures, those 8% of nurses who seldom recognize a need to make these efforts may find themselves gradually conjoined to the 2% who never do.