Exam 20: Evidence-Based Practice

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In the early published definitions of EBM, the areas of foci included identifying, critically appraising, and summarizing best current evidence. However, it became clear that evidence alone was not sufficient to make clinical decisions, so in 2000 the Evidence-Based Medicine Working Group presented the second fundamental principle of EBM. This principle specified that clinical decisions, recommendations, and practice guidelines must not only focus on the best available evidence, but they also must include the values and preferences of the informed patient.

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Student responses will vary according to the shared decision making area chosen, the decision aid chosen, and the plan written to incorporate it into the practice setting.

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Three categories of barriers to using evidence in clinical practice include limitations in EBP systems, human factors, and lack of support for clinicians who use EBP. Limitations in EBP systems may result from an overwhelming amount of evidence and sometimes contradictory findings in the research. Human factors that create barriers include lack of knowledge about EBP and skills needed to conduct EBP, nurses' negative attitudes toward research and evidence-based care, nurses' perception that research is only for medicine and is a cookbook approach, and patient expectations. Another barrier to EBP involves lack of organizational systems or infrastructure to support clinicians using EBP. Causes for barriers in this category include lack of authority for clinicians to make changes in practice, peer emphasis on practicing the way they always have practiced, lack of time during the workday, lack of administrative support or incentives, and conflicting priorities between unit work and research.