about e2p

You are committed to providing the best care to residents. You want to improve their quality of life. Think back to how you learned to turn a resident. Did you learn this skill by reading a text book, watching a video, observing someone doing it, or through trial and error? You have probably used all of these learning techniques and sources of information. Have you ever thought that there must be a best practice for turning a resident?  How do you know that the way you are doing it is the best way? You probably ask yourself this type of question all the time. What is the best way to decrease Mr. Smith's pain when giving him a bath?  What can you do to best prevent Mrs. Tate from falling when she goes to the bathroom?  How can you best relieve the pressure on Miss White’s heel so she does not get another sore?

The best care is that which is evidence-based. We call this type of care evidence-based practice (EBP). As research related to the clinical questions we ask comes to light, advanced practice providers must be able to review this evidence and determine how it applies to important questions, practices, and policies. Those who provide care must take this evidence and individualize it for residents. Some EBP may apply to all residents in long-term care. Some must be customized for each resident. Part of what makes a practice an EBP is that it is acceptable and effective for a specific resident. 

Evidence-based practice (EBP) is unique because it includes the preferences and values of the patient and family in the process. While the clinician may utilize the best evidence available, application and outcomes will differ based upon the patients' values, preferences, concerns, and/or expectations.

where to find best evidence

In the age of technological explosion, it is sometimes difficult for nurses to know what is the best evidence. Sources of best evidence can be extrapolated from research and non-research foundations (Goode, 2000). Research evidence can include:

• Meta-analyses

• Integrated research reviews

• Experimental studies

• Observational studies

• Correlational studies

Non-research evidence can entail:

• Quality improvement and risk data

• International, National, and local standards

• Infection control data

• Patient preferences

• Clinical expertise

• Benchmarking

• Cost effectiveness analysis

• Pathology

• Retrospective or concurrent chart reviews

the evidence-source equation

Clinician Experience + Patient Preferences + Scientific Findings = Evidence-Based Guidelines

Combining the strongest evidence from all three sources for a specific health problem improves the care of current and future patients who share that problem.

• Clinician Experience: A clinician who makes trustworthy observations, carefully analyzes care situations, knows individual patients' preferences, applies pertinent learnings from previous clinical situations to the current one, and has relevant knowledge can offer insights that improve patient care (Wakefield et al., 1998).
• Patient Preferences: When clinicians solicit and respect the treatment-related desires of patients, the most appropriate health care decisions can be made. Patient preferences are influenced by values, beliefs, culture, and previous personal or family experiences.
• Scientific Findings: Rigorous, credible, clinically relevant research that, when applied to a specific health situation, contributes to improved care.
• Evidence-Based Practice (EBP) represents a broader concept. When clinicians use the EBP approach, they go beyond the expertise of clinicians and researchers, and consider the patient's preferences and values to guide patient care.