A Nurse’s Guide to Evidence-Based Practice in Nursing

• Understand what occurs when a curious mindset is not present in nursing practices. 
• Identify what happens in nursing care due to a lack of evidence-based practices. 
• Recognize the barriers that can impact evidence-based practices and specific questions to ask and consider while maintaining a curious mindset.

As a nurse, you complete various skills every day. If you are a seasoned nurse, these skills have become so routine you may not put extra thought into them.  

Do you ever wonder why we follow certain practices that do not seem supported by evidence while not implementing practices substantiated by much evidence? For example, at one time, nurses changed hospitalized patients’ intravenous (IV) dressings daily, even though no solid evidence supported this practice.  

When clinical trials finally explored how often to change IV dressings, results indicated that daily changes led to higher rates of phlebitis than less frequent changes. To further illustrate this point, in many hospital emergency departments across the country, children with asthma are given albuterol with a nebulizer, even though substantial evidence shows that when presented with a metered dose inhaler plus a spacer, the administration of albuterol results in children spending less time in the emergency department and experiencing fewer adverse effects.  

Nurses will even disrupt patients’ sleep, which is essential for therapeutic healing, to document blood pressure and pulse rate because it is hospital policy to take vital signs every two to four hours, even though no evidence supports that doing so improves the identification of potential complications. Medical professionals often follow outdated policies and procedures without questioning their current relevance, accuracy, or proof.  

Let’s discuss the importance of evidence-based practices and how nurses can maintain a curious mindset about their practices to achieve the highest level of patient care possible. 

Absence of a Curious Mindset in Nursing Practices 

While there is an ongoing curiosity about the best evidence to guide clinical decision-making and a culture that supports or lacks it, medical professionals are unlikely to embrace evidence-based practice. Every day, nurses perform many interventions. Some examples are: 

• Administering medications 
• Positioning 
• Suctioning 

These interventions should raise questions about the evidence supporting their use. When nurses are curious within a supportive, evidence-based culture, they can regularly ask questions about clinical practice while caring for the patient.  

A few examples of these questions are: 

• In patients with endotracheal tubes, how does using saline with suctioning compared with suctioning without saline affect oxygen saturation?  
• In patients with head injury, how does elevating the head of the bed compared with keeping a patient supine position affect intracranial pressure? 
• In post-operative surgical patients, how does the use of music, compared with the lack of music, affect the frequency of pain medication administration? 

Results Due to a Lack of Evidence-Based Practices 

Patients do not receive the highest quality of care without evidence-based practices or curiosity about why certain practices exist. A patient’s health outcomes will be seriously jeopardized, increasing healthcare costs.  

Studies have shown that when nurses and other healthcare providers engage in evidence-based practices, they experience greater autonomy and higher job satisfaction. At a time when we are facing the most severe nursing shortage in history, it is essential to empower nurses to engage in evidence-based practices and ask questions routinely.  

Evidence-based practice may lead to less nurse turnover and improve the quality of healthcare and patient outcomes. For evidence-based practices to succeed in the healthcare system, nurses must have:  

• Curiosity and consistent questioning of current clinical practices  
• Firm beliefs in the value of evidence-based practices 
• Knowledge of skills and evidence-based practices, along with the confidence to use it  
• Commitment to deliver the highest quality evidence-based care to patients and their families.  

In addition, healthcare institutions must sustain an environment that embraces evidence-based practices, including providing clinicians with the support and tools they need to engage in evidence-based care.  

Evidence-based practice is a problem-solving approach to the delivery of healthcare that includes the best evidence from studies and patient care data and combines it with patient preferences, values, and nurse expertise.  

When nurses implement evidence-based practice within a supportive environment, the highest quality of care and the best patient, provider, and system outcomes are delivered.  

Barriers to Evidence-Based Practices 

Although outcomes are better when patients receive evidence-based care, nurses and other healthcare providers often cite barriers that prevent its delivery, including: 

• Inadequate evidence-based practice knowledge and skills 
• Lack of evidence-based practice mentors to work with providers at the point of care 
• Scarce resources and support from higher administration 
• Insufficient time due to demanding patient caseloads and staffing shortages 

Once nurses gain evidence-based practice knowledge and skills, they realize it is not only possible within the context of their practice setting but that it re-establishes their passion for their roles and assists them in delivering a higher quality of care with improved patient outcomes. 

What are some questions that spark a curious mindset? 

• Who can I seek out to assist me in enhancing my evidence-based practice knowledge and skills and serve as my evidence-based practice mentor? 
• Which of my practices are currently evidence-based, and which has no evidence? 
• When is the best time to question my current clinical practices, and with whom? 
• Where can I find the best evidence to answer my clinical questions? 
• Why am I doing what I do with my patients? 
• How can I become more skilled in evidence-based practices and mentor others to implement evidence-based care? 

The Bottom Line

In conclusion, nurses and other medical professionals complete various skills daily, and it is essential to understand why we do what we do as part of the healthcare team. I like to go by the saying, “No question is a dumb question.”  

If there is a practice that you have questions about, please find a nurse mentor and ask them—understanding the entire process and the how and why will aid in achieving the best possible health outcomes for the patients. In addition, it will help keep our passion for nursing care alive and assist us in enhancing our knowledge as a professional. 

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