Evidence-based practice is good for nursing


Nursing professionals and midwives make up the bulk of the healthcare workers in hospitals and play a central role in healthcare. The quality of health care can be increased when nursing professionals routinely use the best available evidence. Since many of the factors that are perceived by nursing professionals as obstacles to the use of evidence-based practice (EBP) are at the organizational level, it makes sense to develop models for changing healthcare organizations and to improve their effectiveness assess so that the use of EBP can be successfully promoted by healthcare professionals.

We define organizational infrastructures as "the underlying basis or elementary framework with which clinical care is offered and supported". These include, for example, organizational strategies, stations that focus on the development of nursing, and other organizational forms of development such as organizations that develop and implement evidence-based nursing procedures, standards or guidelines for clinical practice.

We searched the literature for meaningful evaluations of the day-to-day effectiveness of organizational interventions that address the promotion of EBP in nursing. We included a study from the United States that examined a hospital and did not report the number of nurses. The study assessed the effects of a standardized, evidence-based nursing procedure on improved nursing care for those at risk of developing a nursing-related pressure ulcer (healthcare-acquired pressure ulcer: HAPU), measured by the frequency of nursing-related pressure ulcers. If a patient had a point value of 18 or less on the Braden scale on admission to the hospital, the nursing staff were allowed to start the pressure ulcer prophylaxis measures without a doctor's order. The Braden scale is used to assess the risk of whether the affected person will develop a pressure ulcer. An adult with 18 points or less is considered to be at high risk of pressure ulcers.

Renewed analyzes of the data on nursing-related pressure ulcers in interrupted time series showed a trend that the rates did not change before and after the intervention (pressure ulcer prophylaxis). Assuming that this trend is true, there is no evidence for the effectiveness of the intervention three months after it started (mean rate per quarter 0.7%, 95% confidence interval (CI) 1.7-3.3; p = 0.457). Due to the low percentages related to the cases after the intervention, it was not statistically possible to derive effects over a period of more than three months.

Given the importance of organizational changes to promote EBP in nursing, it is surprising that eight years after the publication of the previous Cochrane Review without relevant studies, there is still a lack of studies with adequately evaluated interventions in the organizational infrastructure. If health lawmakers and organizations are concerned to successfully promote evidence-based nursing at the organizational level, they must ensure that well-designed studies are funded and conducted to generate evidence that can guide the process.