REPORT: July/August 2006

Research News You Can Use: Base Your Practice on Evidence

Evidence-based practice and standards of care: how do they relate?

by Amy Wysoker, PhD, RN, APRN, BC; associate professor, C.W. Post Campus, Long Island University; Council on Nursing Research, Medical Legal Nurse Consultant

Previous issues of this column have provided information on evidence-based nursing practice. As defined by DiCenso, Guyatt and Ciliska (2005, p. 555) evidence-based practice is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”

It is important for nurses to be aware of the relationship between evidence-based practice and standards of care. Standards of care are “the skills and learning commonly possessed by members of a profession” (Kelly & Joel, 1995, p.498). The courts in King v. State of Louisiana (1999) expanded further on the definition stating “legal duty of care or standards of care means a nurse must have and use the knowledge and skill ordinarily possessed and used by nurses actively practicing in the nurse’s specialty area.”

Professional and specialty organizations, state boards of nursing, federal organizations and regulatory bodies both at the federal and state levels formulate standards of care. Standards of care are continually updated and revised as societal changes occur (Wysoker, 2001). In order for nurses to meet standards of care, they must be involved in evidence-based nursing practice. Without practicing evidence-based nursing, it is questionable if nurses can meet the definition of standard of care.

The American Nurses Association (ANA, 2004) Scope & Standards of Practice delineates six standards of practice and nine standards of professional performance. Each standard provides measurement criteria to guide nurses. The following example indicates the connection between evidence-based nursing practice and standards of care. Standard of practice number 4 is planning. One measurement criteria for planning requires that it “integrates current trends and research affecting care in the planning process (p.24).” Evidence-based practice is the means to meet this criterion.

Another example in the Scope & Standards of Practice document is standard number eight of professional performance — education (ANA, 2004). Two measurement criteria for this standard require that nurses seek “experiences and formal and independent learning activities to maintain and develop clinical and professional skills and knowledge” (p. 35) and acquire “knowledge and skills appropriate to the specialty area, practice setting, role, or situation” (p. 35). In order for nurses to meet this professional performance standard, evidence-based nursing practice must be incorporated into their practice. Without doing so nurses cannot live up to the requirements set forth in the education standard.

In addition to the ANA’s Scope and Standards of Practice document, which pertains to registered nurses, the organization also publishes documents in collaboration with specialty organizations. The Scope and Standards of Psychiatric-Mental Health Nursing Practice is an example of one such document (ANA, 2000). Standard four, planning, states: “The psychiatric-mental health nurse develops a plan of care that is negotiated among the patient, nurse, family, and health care team and prescribes evidence-based interventions to attain expected outcomes” (p. 32). One measurement criteria to meet this standard “specifies evidence-based interventions that reflect current best practices and research” (ANA, 2000, p.32). In this example, psychiatric nurses need to utilize evidence-based psychiatric nursing practice to meet this standard.

The Code of Ethics for Nurses with Interpretative Statements (ANA, 2001) describes ethical standards nurses must familiarize themselves with and practice. Section 5.2 speaks toward professional growth and maintenance of competence. “Continual professional growth, particularly in knowledge and skill, requires a commitment to lifelong learning. Such learning includes, but is not limited to, continuing education, networking with professional colleagues, self-study, professional reading, certification, and seeking advanced degrees. Nurses are required to have knowledge relevant to the current scope and standards of nursing practice, changing issues, concerns, controversies, and ethics” (ANA, 2001, p.18). This description is not only a standard of care; it is what evidence-based practice is all about.

How do nurses meet these standards of care? Evidence-based practice is the only way. Evidence-based practice is not really a new thing; it is how nurses meet standards of care and practice competently.

Standard of care resources

• American Nurses Association - www.nursingworld.org
• National Council of State Boards of Nursing - www.ncsbn.org
• New York State Board of Nursing - www.nysed.gov
• Joint Commission on the Accreditation of Healthcare Organizations - www.jcaho.org
• Centers for Medicare and Medicaid Services (CMC) - www.access.gpo.gov

References

American Nurses Association. (2004). Nursing: Scope and standards of practice. Washington, D.C. Author.

American Nurses Association (2001). Code of ethics for nurses with interpretive statements. Washington, D.C. Author.

American Nurses Association (2000). Scope and standards of psychiatric-mental health nursing practice. Washington, D.C. . Author.

Kelly, L., & Joel, L. (1995). Dimensions of professional nursing. New York: McGraw-Hill.
King v. Louisiana, 728 So.2d 1027 (La. Ct. App., 1999)

Wysoker, A. (October, 2001). Standards of care. J Am Psychiatric Nurses Assoc. 7, 166-168.

This column is available for reprint in other publications. Copyright law protects the content, so permission must be obtained from NYSNA before reprinting. Contact the NYSNA Communications Department at 800-724-NYRN (6976), ext. 275, or communications@nysna.org.