Evidence-Based Decision Making:
What Guides Our Practice?
Nursing Management in the
Health Care Environment
N5311
Research-Based
&
Evidence-Based
Jeannette Crenshaw,
DNP, MSN, RN, LCCE, IBCLC, NEA-BC
Who was our
first nurse
researcher?
In dwelling upon the vital importance of
sound observation, it must never be lost sight
of what observation is for. It is not for the
sake of piling up miscellaneous information
or curious facts, but for the sake of saving life
and increasing health and comfort.
—Florence Nightingale, 1860, p. 125
http://books.nap.edu/openbook.php?record_id=4986&page=103
Causes of Mortality
Major Causes of
Mortality in
Crimean War?
Infection
Exposure
Malnutrition
Dehydration
Not war wounds!
Crimean War Years
Hospital ward:
– Vermin-infested
– Network of cesspools
– Sewer lines blocked
– Stench trapped by closed windows
– Water supply visibly contaminated with
organic matter
– Disease rampant (e.g., (cholera, typhus,
typhoid)
Crimean War Years
Hospital ward
–Primitive
–Unsanitary food preparation
–No laundry facilities
–No clean clothes, bed sheets or
linens
Mortality Rate of Injured Soldiers Following
Implementation of Aggressive Sanitary &
Environmental Reforms
Florence Nightingale
implemented aggressive sanitary &
environmental reforms
Results
Flo’s research triggered
widespread reforms in both
military & civilian health care
What is
Research-Based
Practice?
Research-Based Practice
Research-Based
Practice
Practice is based on
strong research studies
A
Clinical Definition5
“Using the best research
about the effects of specific
procedures, drugs, tests, and
treatments to help guide
decision making.”
Childbirth Connection. 2000). Your Guide to Safe &
Effective Care During Labor & Birth
Nursing Research
“...the systematic inquiry specifically
designed to develop, refine, and
extend nursing knowledge?
?nurse researchers examine
problems of specific concern to
nurses and the patient, families, and
communities they serve.”
Commitment
to Research
Buyea, S. C. & Slattery, M. J. (2006). Evidence-based
practice in nursing: A guide to successful
implementation. Marblehead, MA: HCPro, Inc.
An Obligation!
No other profession has
such potential to do good
through research.
Therefore, nursing research is
not an option but an obligation.
—Ida Martinson, 1976
What is
Evidence-Based Practice?
(EBP)
Evidence-Based Practice
Broader, newer term which includes the
integration of research & other evidence,
such as:
– Quality & process improvement data
– Practice guidelines
– Expert opinion
– Patient & family preferences and
values
– Physiologic principles
– Case studies
Evidence-Based Practice
Problem solving approach to the
delivery of care that integrates
–The best evidence from welldesigned studies
–A clinician’s expertise
–Patient preferences and values
Evidence-Based
Practice
“?an integration of best evidence
available, nursing expertise, and
the values and preferences of
the individuals, families, and
communities served.”
Sigma Theta Tau International’s
Position Statement on Evidence-Based Nursing
Evidence-Based Practice
De-emphasizes
–Tradition & rituals
–Isolated & unsystematic
clinical experiences
–Ungrounded “authority”
opinions
Melnyk, B. M. & Fineout-Overholt, E. (2005). Evidencebased practice in nursing & healthcare: A guide to best
practice. Philadelphia: Lippincott Williams & Wilkins.
Sacred
Cow
Evidence-Based Management?
Evidence-Based
Management
Using the best evidence in
leadership and management to
make organizational decisions
Marshall, D. (2008). JONA, 38(5),205207.
Evidence-Based Management
“For the most part, leaders
who have staunchly
advocated best evidence
application in patient care
have been less aggressive in
applying the same logic to
management decisions and
organizational improvement.”
Marshall, D. (2008). JONA, 38(5), 205-207.
Evidence-Based Management
Evidence-Based Management
“The use of proven,
workable methods to inform
leaders’ strategic
decisions.”
Just as clinicians use evidence
to inform their practice and
ensure better patient outcomes,
managers should use evidence
to inform their management
practices.
Pfeffer, J. & Sutton, R. (2006). EvidenceBased Management. Harvard Business
Review, 84(1), 62-64
Evidence-Based Management
Leaders must
– Abandon obsolete traditions
–Require proven results before
implementing programs
–Foster a spirit of experimentation
in all employees
Pfeffer, J. & Sutton, R. (2006). Evidence-Based
Management. Harvard Business Review, 84(1), 62-64
Pfeffer, J. & Sutton, R. (2006). Evidence-Based
Management. Harvard Business Review,
84(1), 62-64.
Evidence-Based Practice
Evidence-based clinical practice
Evidence-based education
Evidence-based management
Evidence-based decision
making
Underpinning Philosophy?
A Problem Solving
Approach
To improve quality and safety while
decreasing medical error & healthcare
costs5.
Clinical Practice, Education,
Decision-Making, Administration
Research & Best Evidence
Research shows that using EBP
improves outcomes compared
with use of “routine” practices