Evidence -Informed or -Based?

How nurses make decisions for car plans comes down to how and where they acquire their knowledge. With overwhelming supply of information provided online with new research, cutting edge treatments, and resources readily available, nurses must be careful on how they base these clinical decisions.

With the plethora of knowledge that nurses receive from textbooks, clinical trials, and doctor's orders, it is easy to overlook how the individual patient fits in to the care.

Older systems of health care  focused on biomedical models that looked solely at the disease and pathology of the patient. But now is the time for transition. Nurses need to shift their focus from how to cure and care, to the perspective of the client and how the patient feels about their care and treatment (Lamoure, J. 2011).

Often used interchangeably are the terms, evidence-based and evidence-informed practice. However, these concepts are synonymous.

 Evidence-based practice and medicine refers to making choices based on what research and practice says to be the best choice. This involves applying an intervention based on experience that it works. While effective, this practice often leads to a "one size fits all" plan of care for those with the same diagnosis. The intervention seems rigid and involves little consideration of external factors such as the patient's beliefs, values and preferences. This gives the patient the appearance that nurses were just going through the motions to treat the illness rather than care for the patient.

Furthermore, evidence-based practice was deemed less effective due to several barriers it posed to nurses including, time constraints to research, limited access to scholarly literature and medical advancements, and workplaces that did not have up-to-date technologies.

To avoid overlooking these important aspects of care and to ultimately enhance the client's well-being, the phenomena of evidence-informed practice was adopted. This approach is dynamic and considers both the quantitative (research information) and qualitative (client's well-being) data. When a nurse considers and understands a broader spectrum of information, she/he is able to tailor balanced care for the client (Lamoure, J. 2011).

By focusing on evidence-informed decisions, client-centred care is ensured and other consideration can be included into care such as spirituality, home care and alternate medication.

This information is also relevant when considering the information available online. Nurses need to sift through the many different opinions and perspectives offered. To analyze information and come to balanced conclusions, nurses must consider:

Applying evidence-informed practice to technologies and resources requires nurses to look at various sources instead of using the same database over and over. As well, it calls nurses to analyze the sources and research available online to distinguish whether the information is current, relevant, and easily understood.

Consider how many people obtain their information first hand in today's society. The first step often involves using an online search engine. But when nurses uses these databases to acquire their knowledge and reference, they need to be aware of how these search engines display their information.

Most search tools tailor the given results based on previous searches. Based on what websites you have visited before, and resources commonly use, web searches narrow down the margin and prioritize their results. If you and a friend searched the same topic into the same search engine your results would be different and in a different order. These companies do this in best interest of the user to make it easy to navigate and have a smaller range to choose from, but it significantly influences the knowledge we use (ComputerWeekly.com, 2009).

This video explains how these searches adapts the results we see:

Many people are likely to choose the first link or website offered, but how reliable is this? If our search engines are shaping the results to best suit us, how are we as nurses supposed to use this for our unique patients? This is hardly evidence-informed practice.

To incorporate evidence-informed decisions into the expanding world of technology, nurses need to exercise their media literacy skills, and go beyond the first page. This again draws to mind the balance:

• Clinical expertise
• Resources
• Research evidence
• Patient preferences.

Technology is becoming increasingly intelligent but nurses often forget about the power of their own experience and expertise. As nurses we do a majority of the assessment and spend a great amount of time with the patient. This gives nurses a special insight into the individual experience of the client, what works well, and how to improve in a similar situations. We are constantly reflecting back on our clinical knowledge without realizing the power it holds. Our internal databases influence and shape our care for each patient based on their needs. By using Tanner's nursing process, we can effectively reflect on these experiences to best chose a plan of care (Brown, et al. 2006).

To obtain concrete research evidence and reliable resources, nurses must seek other portals besides Google and Yahoo, and examine nursing-based databases found in library websites. Additionally, nurses can visit the College of Nurses websites, and nationally recognized associations. It is important to consider what these standards recognize as best practice, and apply the appropriate intervention. Although the patient may not chose what the research deems to be the best intervention, it is essential that nurses still understand and know what process works best. As well, this allows for better health teaching, to help the patient understand why the research and medicine favour a certain treatment (CNA, 2010).

Finally is understand how technology can be incorporated to understand patient preferences. Not only does patient preference refer to client comfort and physical care, but also spiritual and mental support. As outlined by the nursing theorist Watson, patient care is holistic and therefore I must adopt a holistic lens as I search for knowledge (Brown, et al. 2006). Nurses must consider the lens of the client and their family. Putting yourself in their place involves empathic communication and ultimately respecting their choices.

As nurses, we often want to fix and heal, doing whatever we can to keep the patient alive, but this is not always in the best interest of the client. As well, this involves respecting information that the patient provides and their perspective of illness. Providing patients with choice allows them to feel in control and at the centre of the care team, which is the core principle of why evidence-informed practice is greater than evidence-based.


References
Brown, D. McWilliam, C., Ward-Griffin, C. (2006) Client-centred empowering partnering in nursing. Journal of Advanced Nursing, 53(2), 160-168. Doi: 10.1111/j1365-2648.2006.03711.x

Canadian Nurses Association. (2010). Evidence-informed decision making and nursing practice. Retrieved from http://www.cnaaiic.ca/~/media/cna/page%20content/pdf%20en/2013/07/26/10/52/ps113_evidence_informed_2010_e.pdf

ComputerWeekly.com (2009). Google tailors search results based on user behaviour. Retrieved from http://www.computerweekly.com/news/1280091581/Google-tailors-search-results-based-on-user-behaviour

The Cochrane Collaboration. (2013). Evidence-based health care and systemic reviews. Retrieved from http://www.cochrane.org/about-us/evidence-based-health-care

Deutschewelleenglish. (2012). Simple search engines like Google and Bing, shift. Retrieved from http://www.youtube.com/watch?v=WwIoTW3DRfM

Lamoure, J. (2011). The collaborative patient/person-centric care model (CPCCM): Introducing a new paradigm in patient care involving an evidence-informed approach. Academic.edu Research. Retrieved from http://www.academia.edu/455869/The_Collaborative_Patient_Person-