REPORT: October/November 2005

Research News You Can Use: Base Your Practice on Evidence

Are we ready for evidence-based practice?

by Cindy Gurney, PhD, RN, Research Specialist; Foundation of New York State Nurses

We know that we should use research in our practice. We’ve heard that evidence-based practice is a “systematic approach to problem solving” based on the best [research] evidence, our expertise, and our patients’ preferences. Jumping the hurdle from talking about it to doing it can be hard, especially obtaining and assessing the evidence.

Diane Pravikoff, Annelle Tanner, and Susan Pierce (2005), recently reported the results of their study of nurses’ perceptions of their ability to obtain evidence and their access to tools to do so. They also studied the barriers nurses face to using research and other evidence in practice. They cited the work of King and Carroll (1994), who noted that a visible computer terminal at the nursing unit, a “technology champion,” and rewards for using it, contributed to online literature search behaviors. All this may be nice, but 70% of today’s nurses graduated from nursing school before 1990 — an indication that the major portion of our workforce entered nursing before the use of electronic databases became popular (Spratley et al. 2001).

Librarians can help in the search for the latest information, but often they’re not available. Our best resources as nurses may be our own ability to search print and electronic media. When sophisticated libraries are not available, the Internet may be our most potent tool for searching the literature. Are we ready?

Pravikoff, Tanner, and Pierce conducted a survey of working clinical nurses for this project. Respondents resembled nurses in general. Most commonly, they were 40-49 year old women working in a hospital. They held a diploma or associate degree in nursing and last had been enrolled in a degree-granting program in 1984 or earlier. While they reported confidence in use of a computer, they were less confident about using bibliographic databases. Only 19% could confidently search CINAHL (a nursing literature database) and 36% were comfortable with MEDLINE. Seventy-seven percent had never received instruction in the use of electronic literature databases.

Access to literature search capability is as important as skill in using the databases. Only 19% of respondents reported access to journals on their nursing units, while 26% reported access to electronic databases on the unit and 49% had access to the Internet. At home, 98% had access to the Internet but only 18% had access to CINAHL and 40% to MEDLINE. Nearly half of respondents with Internet access at work (46%) reported that their online resources were inadequate.

Nurses also reported barriers to research in practice. Acknowledging that time and resources were probably the biggest issues, researchers asked what other barriers existed in addition to time. The top five of these individual and institutional barriers are reported in order of importance in the boxes accompanying this column.

We need to recognize our shared responsibility for overcoming these personal and institutional barriers to using evidence in practice. As individuals, we have training needs and should embrace the mindset that says the traditional way of business may be obsolete. We have a personal responsibility to deliver patient care that will do no harm.

Our leaders, nurse managers, nurse executives, and healthcare institution executives have a responsibility to ensure that we are equipped to provide patient care that is the result of the best evidence, our professional expertise and patient preference. There is so much here for all of us to do. Let’s get underway!

References

King, B.A., & Carroll P. (1994). Nurses as end-user searchers of the literature on CD-ROM. Journal of Nursing Staff Development, 10(6): 319-22.

Pravikoff, Diane S. (2005). Readiness of U.S. Nurses for Evidence-Based Practice. American Journal of Nursing, 105 (9): 40-51.

Spratley E., et al. (2001). The registered nurse population March 2000: findings from the National Sample Survey of Registered Nurses. Rockville, MD: U.S. Department of Health and Human Services.