To meet the needs of the modern healthcare system, the Institute of Medicine (IOM), now the National Academy of Medicine, published a set of five core competencies required of each health professional. This is not an exhaustive list but represents those competencies common among a variety of health professionals and those most important to advancing healthcare. These competencies included providing patient-centered care, working in interdisciplinary teams, applying quality improvement, utilizing informatics, and employing evidence-based practice (IOM, 2003). As a core competency, evidence-based practice (EBP) represents a significant skill for nurses and other healthcare providers who have considerable influence on healthcare decisions and improving the quality and safety of care. EBP allows clinicians and interprofessional teams to keep up with the rapidly changing environment.
The world is experiencing an information and technology explosion, and healthcare is no exception. Unfortunately, in healthcare, the growth of knowledge outpaces the application to practice. The process of incorporating new knowledge into clinical practice is often considerably delayed. Curry (2018) reports that it may take up to 15 years to approve new drugs. The average time for the uptake of research into actual practice is 17 years (Hanney et al., 2015). New knowledge has grown exponentially. Early in the 20th century, many healthcare professionals had but a few, hard-to-access journals available to them. Today, MEDLINE indexes 5,600 journals (National Library of Medicine, 2020), with more than 26 million references. The Cumulative Index to Nursing and Allied Health Literature (CINAHL) indexes more than 5,500 journals and includes more than 3.4 million records (EBSCO Publishing, 2020). Accessibility of information on the web also has increased consumer expectation of participating in treatment decisions. Patients with chronic health problems have accumulated considerable expertise in self-management, increasing the pressure for providers to be up to date with the best evidence for care.
Despite this knowledge explosion, healthcare clinicians can experience a decline in knowledge of best care practices that relates to the amount of information available and the limited time to digest it when no longer in a school or training environment. Estabrooks (1998) reported that knowledge of best care practices negatively correlated with year of graduation—that is, knowledge of best care practices declined as the number of years since graduation increased. EBP is one of the best strategies to enable healthcare providers to stay abreast of new practices and technology amid this continuing information explosion.
The objectives for this chapter are to:
Describe the evolution of EBP in healthcare
Discuss EBP in relation to outcomes and accountability
Highlight the healthcare clinician’s role in EBP
EBP is a problem-solving approach to clinical decision-making within a healthcare organization. EBP integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP uses a deliberate approach to consider ...