Evidence-based Practice and Pharmacotherapeutics: Implications For Nurses
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Note: The content below is an excerpt from an article written exclusively for the 12th edition of Davis's Drug Guide for Nurses. To access the full article, visit DavisPlus, F.A. Davis's online center for student and instructor ancillaries, at http://davisplus.fadavis.com.
The purpose of evidence-based practice is to improve the outcomes of treatment for patients. How pharmacologic agents affect patients is often the subject of research; such research is required by the Food and Drug Administration (FDA) before and after drug approval. Any medication can be the subject of an evidence-based clinical review article. But what does "evidence-based" mean and how does it relate to nursing?
According to Ingersoll, "Evidence-based nursing practice is the conscientious, explicit, and judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups of patients and in consideration of individual needs and preferences" (2000, p. 152). Still subject to debate are questions about the sufficiency and quality of evidence. For example, what kind of evidence is needed? How much evidence is necessary to support, modify, or change clinical practice? And, were the studies reviewed of "good" quality and are their results valid?
In general, clinicians use hierarchy of evidence schemas to rank types of research reports from the most valuable and scientifically rigorous to the least useful. The hierarchy makes clear that some level of evidence about the effect of a particular treatment or condition exists, even if the evidence is considered weak. illustrates a hierarchy of evidence pyramid with widely accepted rankings: the most scientifically rigorous at the top, the least scientifically rigorous at the bottom. Practitioners and clinicians should look for the highest level of available evidence to answer their clinical questions. However, it is important that clinicians also apply the second fundamental principle of EBP, which is that evidence alone is not sufficient to make clinical decisions. Decision makers must always trade off the benefits and risks, and the costs associated with alternative treatment options, and by doing so, consider the patients' values and preferences.