Evidence-Based Practices in Nursing

Article excerpt

The evidence base in gerontological nursing has made important strides in the past 25 years and has had a far-reaching impact on the quality of care for older adults.

Evidence-based nursing arguably began in the century with the founder of modern nursing, Florence Nightingale. Raised in an upperclass atmosphere of independent scholarship (albeit undertaken almost exclusively by gentlemen), and motivated by a desire to improve health, Nightingale initiated and carried out a program analyzing hospital data before both her training as a nurse and eventual assignment to the Crimea. Her scientific skills became more widely known through her development of statistical methods and her collection and analysis of soldier morbidity and mortality data during the Crimean War (McDonald, 2001). Her research resulted in remarkable changes in military medicine, including characterizing the sick and/or wounded soldier as having the right to adequate food, suitable quarters, and appropriate treatment. Her work resulted in a dramatic reduction in the mortality rate in the British military.

Nightingale went on to employ research knowledge to make significant changes in public health, such as testing the public water supply, improving sanitation, and preventing starvation (Palmer, 1977). Nonetheless, Nightingale is not best remembered for her extraordinary accomplishments as a statistician and researcher, but as the Lady with the Lamp, providing loving care to distressed soldiers.

After Nightingale, nursing research efforts to improve practice were often small, separate, and unfocused. This lasted until the 1970s, when the profession began to advocate for advanced graduate and doctoral education for nurses and for the development of a scientific base for nursing practice. As a result, efforts to generate the evidence base for nursing practice intensified and expanded dramatically worldwide. An increasing number of nursing studies began to focus on clinical problems and produced findings that have a direct impact on nursing practice and patient outcomes (Burns and Grove, 2007).

The first major nursing evidence-based practice project (EBP) began through the Western Interstate Commission for Higher Education (Krueger, 1978), with the goal of using research in the clinical setting. In the late 1970s, the CURN Project (Conduct and Utilization of Research in Nursing) identifed 10 areas of nursing research that had adequate evidence to use in practice (for example, structured pre-operative teaching, prevention of pressure ulcers) (Horsley, Crane, and Bingle, 1978). In 1986, the body of nursing science knowledge had matured to the point that the National Center for Nursing Research was added to the National Institutes of Health. This Center became the National Institute of Nursing Research (NINR) in 1994. Nursing's first EBP journal, Evidence Based Nursing, was published in 1998, and a second journal dedicated to EBP, Worldviews on Evidence-Based Nursing, was launched in 2004.

Nursing research encompasses a wide scope of scientific inquiry, including clinical research, health systems and outcomes research, and nursing education research. Nurse researchers study how to assist individuals and groups as they respond to health and illness experiences (for example, reducing side effects of illness and treatment) and address social and behavioral aspects of illness and quality of life. Much nursing research is seeking to understand the relationships among biological, behavioral, psychological, and sociological factors. The scope of clinical research ranges from acute to chronic care experiences across the entire life span; health promotion and preventive care to end-of-life care; and care for individuals, families, and communities in diverse settings (American Association of Colleges of Nursing, 2006). The inclusion of nursing science as a sanctioned field for doctoral study in the National Academy of Sciences in 2005 heralded the recognition of the scientific contributions of the discipline. …