|
Evidence-Based Practice
Beth
Ulrich, EdD, RN, CHE
Evidence-based
practice is becoming the standard. It seems obvious to say that we
should base our practice on a solid evidence base, but often, we have
not. Even the most basic nursing tasks are often done “because we’ve
always done it that way” not because there’s a good reason. Vital signs
are a good example. How often and when they are taken in a hospital are
usually more the result of tradition than of evidence. The same applies
to many of the things nurses do.
Nephrology Evidence-Based Practice
Nephrology
is ahead of many specialties with our use of evidence-based practice.
One of the best examples is the Kidney Disease Outcomes Quality
Initiative (K/DOQI) of the National Kidney Foundation (NKF). Another is
the work currently being done with the Fistula First project. The
commitment to evidence-based practice must, however, go beyond the
clinical aspects of care. There also must be an evidence base for care
delivery. For example, there is growing evidence that patient outcomes
in hospitals are directly related to the number of RNs who deliver the
care and the level of education of the RNs. It’s time to address this
issue in nephrology settings as well.
Additional Evidence-Based Measures
The
Institute for Healthcare Improvement (IHI) has developed a campaign to
implement changes in care proven to improve patient care and prevent
avoidable deaths (http://www.ihi.org/ihi). The goal is to save 100,000
lives by 9:00 am, June 14, 2006 – all based on the implementation of a
few evidence-based practices. Almost 3,000 hospitals nationwide are
participating in the program, which targets six interventions that have
been shown to save lives.
In
addition to applying evidence-based practices, the 100,000 Lives
Campaign aims to get rid of ambiguity and to set absolute goals (thus,
the designation of the number of lives to be saved and the specific
date and time by which that is to occur). The campaign slogan is “Some
is not a number. Soon is not a time.” When I first heard the slogan, it
made me think of how often in nursing (and elsewhere) we use those
words “some” and “soon” to avoid commitment. “I’ll check out whether my
practice is evidence-based as soon as I get a chance and have some
time.” “I’m sure we’ve made some progress. I’ll collect the data soon.”
Dorothy del Bueno, who has done much in the area of competency-based
education, once told me that we should envision frogs and toads coming
out of our mouths whenever we used the term “appropriately” because it
meant something different depending on who said it. I think we should
add the words “some” and “soon” to the frogs and toads list. Like
“appropriately,” they are words that encourage vagueness and a lack of
accountability. If you can’t define it, you can’t measure it and no one
will know it’s not completed on time or with the desired outcomes. Just
as “I’ll try” is less a commitment than “I will,” so too do words like
“some” and “soon” give us and others an escape route from
accountability.
Finding an Evidence-Based for Your Practice
One
of the features in this issue of Nephrology Nursing Journal is on
creating externships and internships to educate individuals about
nephrology nursing. When people, like externs and interns, who do not
already practice in our specialty come into a nephrology setting, they
routinely ask a lot of “Why?” questions. “Why do you do the
procedure that way?” “Why does the patient have to do this or not do
that?” “Why can’t we?” “Why must we?” An interesting exercise is to
pretend you’re the new person and to ask yourself why you do things the
way you do them in a normal day at work. If you don’t have an
evidence-based reason, it’s time to investigate whether how you do what
you do is the best way.
Beth Ulrich, EdD, RN, CHE
Editor
E-mail: BethUlrich@aol.com
|
