In nursing, it is important to practice evidence-based decision-making. “Evidence-based practice is using the best available evidence, a clinician’s expertise, and a patient’s values and preferences in making healthcare decisions. The Prevention and Chronic Care Program works to expand the available evidence base for evidence-based practice and to ensure clinicians have the tools to put this knowledge base into practice.” The Agency for Healthcare Research and Quality outlines what it is and why.
How you make decisions is critical to patient care and protection for yourself as a nurse. You want to make informed, rational decisions designed to provide the best possible outcome for the patient while respecting their values and beliefs, bolstered by the most recent research.
It is important to take the information you have learned from other cases and patients and apply it to current patients. Not only will it allow you to treat the patient faster and more accurately, but it will also allow you to do your job more efficiently and learn the signs to recognize to prioritize care.
There are three main components to evidence-based decision-making. USA.edu outlines them as follows:
- Best external evidence: Evaluate and implement the most current, clinically relevant, scientifically sound research.
- Individual clinical expertise: Draw on your personal experience of what has worked and not worked in your clinical practice.
- Patient values and expectations: Consider and value the preferences of your patients.
All these steps go into rounding out your skills as a nurse. All three must be taken into consideration for each patient. No two patients are the same, even if their symptoms are. These patients may have different values or belief systems, which will alter the treatment plans and options.
External evidence can help determine what has happened in other cases, not just those you have seen. This is important for learning about new treatment methods or even dosing instructions. You don’t want to fall behind in case there is something that may work better or faster than what you know.
Finally, trust your own experiences. It may come down to something you have seen before that there is no new guideline for, but you may be able to treat the patient effectively based on your experience. Combining all your skills and knowledge is important to make the best patient care decisions.
After considering the evidence, there are steps to process the information, including:
- Analyzing information within the context of normal and abnormal ranges.
- Separating relevant and irrelevant data while finding information gaps.
- Focusing on relationships between symptoms and cues.
- Determining potential causes of health problems.
- Comparing similar situations between current and past patients.
- Predicting possible outcomes and complications of treatment.
Remember that different diagnoses can have similar presentations at first. Monitoring test results and separating information will allow you to focus on the relationships between the two to help make a diagnosis. Then, using your experiences and research, you can make an informed, evidence-based decision using real-time data and information combined with historical records of your patient and others.
These skills are invaluable in the medical field. One of the most valuable is understanding what is relevant and what is irrelevant within patient histories to determine what is a symptom and what is not. In doing so, you can decide if there are any information gaps or something a patient did not mention, believing it to be irrelevant.
This ensures you have all the information before deciding on patient care. Gaps often exist, and it is important to identify them so you are using all the evidence possible. At the same time, it is also important not to make assumptions; taking the facts and compiling them is the path to evidence-based decision-making.
Once you have all the information, you can make a diagnosis. Then, you can set goals and take action. Make your treatment plan for the patient and consult with them before implementing it.
Additionally, applying clinical reasoning to your critical thinking will help you reflect on your decisions. It is important to go back and consider the actions you have already taken and if other options are available. This is especially relevant to long-term patients, such as those a family nurse practitioner may see.
Clinical reasoning is applying your evidence-based decision-making after a treatment plan has been made, whether because the patient has completed it or because they are not improving at the rate you believe they should. It ensures you use the right cues, evidence, research, action, and reasoning to help the patient and determine gaps in care or information.
If there was, you could apply this information to the next patient to ensure you fill evidence gaps in the future. Not only will this help you as a nurse or nurse practitioner, but it will also help ensure your patients receive the right care at the right time.
Nursing
While evidence-based decision-making is important in all areas of your career in nursing, it is especially pertinent to nurse practitioners. Nurse practitioners in many states make the same decisions regarding patient care as primary care physicians, while in others, they must have a physician sign-off. All decisions must be made using all the information available.
When using evidence-based decision-making skills, the nurse practitioner will follow the steps above to make care choices regarding treatment.
This supports consistent treatment decisions across patients. While no two patients are the same, it does provide a starting point for treatment. Once that is determined, along with the patient’s medical history and input, you can develop treatment options to fit the patient best.
Nurse practitioners play a highly in-demand role. Learning and utilizing evidence-based decision-making can increase your skills to make you an effective nurse practitioner. You can also help prevent any need for additional support by ensuring your decisions are informed, and no negligence has occurred.
Government support
There are government agencies in the United States that serve to support evidence-based decisions. One such agency is the US Preventative Services Task Force (USPSTF), a group of volunteer experts that “make recommendations about clinical preventive services such as screening tests, counseling services, and preventive medicCongress authorizes AHRQCongress to provide scientific, technical, administrative, and dissemination support to the USPSTF.”
In addition to making recommendations, the task force coordinates how evidence research is handled. They have guidelines in 1998 and 2004 outlining these processes and how reporting should be taken. The task force studies this information before making decisions.
This collaboration of experts across many fields uses the latest evidence to make patient care recommendations. While this is a physician’s role, nurses must know the latest treatment recommendations to provide proper care. This also applies heavily to nurse practitioners in all states, regardless of their level of supervised decision-making to make the right choices.
Evidence-based Practice Centers (EPCs) were established in 1997. They generate evidence reports for the Effective Health Care (EHC) Program. Their evidence directly impacts the information used by USPSTF.
There are nine EPCs in the US between practice centers and universities. The teams at the EPCs consist of researchers and specialists trained in multiple aspects to apply research best to store evidence most effectively.
“The Regulatory Decision Pathway (RDP) was developed as a result of an expressed desire from Boards of Nursing (BONs) to have a tool for the evaluation of cases of nursing practice errors or unprofessional conduct that would promote disciplinary consistency and incorporate a systems approach,” according to the Journal of Nursing Regulation. This ensures that evidence-based decision-making is also applied to you.
If you go before the board regarding something negative, it will use the RDP to determine whether it was intentional or unintentional. Using evidence-based decision-making will separate human error from reckless behavior. This is in place to help protect you and your nursing license.
There are multiple ways that evidence-based decision-making is used to support you. You can utilize resources from agencies that have compiled them in a way that makes them easily accessible and readable.
This support can go a long way in assisting your evidence-based decision-making and treating your patients. This support ensures that you are given a fair opportunity when you must go before the board and that all evidence is considered on your behalf.
Additional support
When it comes to evidence-based decision-making, there are several ways to learn how to use best all the information provided. One is through peers who may guide you through the resources to explain where to find things.
Outside of your practice or facility, one way is through association memberships. These associations are also there as support, though not through the government, and allow you to find information, learn, and network. This networking can lead to mutually supportive relationships with peers.
These memberships, such as the one to the American Association of Nurse Practitioners, have annual dues to join and require that you be certified as a nurse practitioner. This means that you know that all research provided and peer resources will come from another nurse practitioner or other reliable source.
The value of using all the resources available to you in your evidence-based decision-making is without compare. All the resources listed are available to you, usually online, and provide you with information to guide your decisions.
Education
As with almost all skills in nursing, you can learn evidence-based decision-making through school. Many schools base their curriculum around this practical approach, so as you know the other skills needed to be successful as a nurse practitioner, you also gain this tool to help yourself.
Many nurses who wish to further their career may choose to advance into a role such as a nurse practitioner and select one of many specialties available. This education also includes clinical placements, as with other nursing degrees, before testing for licensure.
Along with support from your school, you should expect to apply your evidence-based critical thinking skills in nursing during your clinical placements; you can learn more about these programs here.
Many programs are available online to obtain an advanced nursing degree and become a nurse practitioner. These online programs allow students to be more flexible about when they attend courses instead of abiding by set times, meaning they can continue to work as they learn.
Schools such as Carson-Newman University Online support making placement arrangements for your clinical portion of education. This added support ensures that you can cool from anywhere and have a team behind you to help when it is time to apply knowledge.
When considering schools to attend, it is important that you find one that meets your needs and provides you with the most current training to prepare you for a job as a nurse practitioner. A flexible school with a good support system can mean the difference between completing your courses and not.
At Carson-Newman University Online, their goal is to help you complete the program successfully and obtain your license to practice. You can complete coursework by a deadline rather than attending classes at set times and are taught the latest information, including evidence-based decision-making skills.
Job Outlook
According to the US Bureau of Labor and Statistics: “Overall employment of nurse anesthetists, nurse midwives, and nurse practitioners is projected to grow 40 percent from 2021 to 2031, much faster than the average for all occupations.
About 30,200 openings for nurse anesthetists, nurse midwives, and nurse practitioners are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.”
This extremely positive job outlook includes increased pay from a registered nurse to a nurse practitioner. Some specialties are also in higher demand, where your skills in evidence-based decision-making can expand.
Considering the gaps in primary care in the US, family nurse practitioners are highly sought after to fill them. This gap has been expected for years, but the US is no closer to solving it.
The role of a family nurse practitioner to see and treat patients helps fill that gap and leaves job opportunities very open. When considering any job change, it is important to know the outlook of that career, and this one is sure to be needed for a long time.
Conclusion
Evidence-based decision-making is important for any decisions you make, career or otherwise. It is a critical process when your choices directly impact others, such as the patients you are treating.
You can learn evidence-based decision-making through school and your peers and continue to build on that skill as you practice your license or certification. There are also many ways to get support and access the tools and research needed to extend beyond the patient’s symptoms and into diagnosis or treatment.
Your experience also plays a vital role in evidence-based decision-making. What you have learned from other patients can help you ask the right questions to the right patients to fill in any information gaps. It can also h you to reduce errors and parse out infoirrelevantrelevant to the patient’s care or treatment.
Utilizing all the resources available at the right time will help you make the most informed decision to assist and treat your patients. It is important to recognize where and when information is useful to you and then to consider the patient’s needs.
While a patient may present to you with something you want to treat a certain way, that patient may have different beliefs or values that you will need to understand, then you need to work with them to develop a personal plan for them. This is not a bad thing, but rather another piece of experience to add to your toolkit of evidence-based decision-making skills.
Whatever role you choose, applying evidence-based decision-making to your patient care routine remains vital to the patient and your career.
