What is Evidence Based Practice?

Peer Response:
Length: A minimum of 150 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
Peer Post:
Evidence based practice (EBP) is defined as “A practice that involves making clinical decisions based on an integration of the best available evidence, most often from disciplined research, with clinical expertise and patient preferences” (Polit & Beck, 2018, p.403). In simpler terms, it may also be defined as being the best relevant practice possible supported by science. In fact, EBP has evolved and broadened over the years. EBP was founded by Dr. Archie Cochrane. According to the Cochrane Collaboration (as cited by Melynk &Fineout-Overholt, 2019, p.12), a proponent of randomized control trials (RCTs), Dr. Cochrane pushed forward the notion of reviewing research evidence. Sackett et al. (as defined by Melnyk & Fineout-Overholt, 2019) defined EBP as “The conscientious use of current best evidence in making decisions about patient care” (p.8). Since then the concept of EBP has expanded. Today EBP is composed of both external (research) and internal (own clinical experience) evidence in a systematic approach to conduct a problem-solving method (Melnyk & Fineout-Overholt, 2019, p.8). EBP not only composes the best practice for the patient/family’s best interest but does so by also considering cost efficiency and quality. Now, systematic reviews are widely available. These systematic reviews are not only available for clinicians, but also for policy makers, patients, and advocates of care. The methodology of EBP can be defined in subsequent steps. It begins with a question/practice that needs answering/changed on the field of work. This question is then researched to gain evidence and additional information on the topic chosen. The evidence acquired is then appraised as usable information and finally the evidence is applied in practice with recording and evaluation of the practice change and patient evaluation/outcomes.
Barriers are numerous regarding EBP. Some of these obstacles fall on the health professionals themselves. These include the lack of knowledge and skills regarding EBP, animosity towards change by staff and organizations, and misperceptions towards EBP. Additional impediments to EBP also include the lack of consequences for not having EBP, lack of autonomy by a provider, and lack of time/resources.
An example of a clinical question I have can be summed down to obesity. Working in a busy rural Emergency room I see firsthand the number of obese patients in my community including their comorbidities. More so over the amount of childhood obesity in my community. Obesity is a global problem; however I am amazed at the high prevalence of obesity where I live. One of the probable answers to this question is of course the predominant Hispanic culture in my community. There must be more than just culture influence contributing to childhood obesity. For example, Ayala et al. (2015) cited that among fifth, seventh, and nineth graders the rates of obesity in my county were greater than all of California (47% vs 38%). What specific areas contribute to the high obesity rates among children? How can the advanced practice nurse help the patient and family members contribute to a healthy body mass index (BMI).
In additional question I have has came up during the covid-19 pandemic. Due to the pandemic and its sequelae, patients who are intubated remain so for weeks even months at end. This increases their change of super infections causing bacterial pneumonia on top of the viral pneumonia suffered. Clinical question would be as follows: Can the use of oral disinfectant (mouth wash, chlorhexidine) before intubate and progressively during treatment help minimize occurrence of bacterial pneumonias.

Resources
Ayala, G. X., Ibarra, L., Binggeli-Vallarta, A., Moody, J., McKenzie, T. L., Angulo, J., Hoyt, H., Chuang, E., Ganiats, T. G., Gahagan, S., Ji, M., Zive, M., Schmied, E., Arredondo, E. M., & Elder, J. P. (2015). Our Choice/Nuestra Opción: The Imperial County, California, Childhood Obesity Research Demonstration Study (CA-CORD). Childhood Obesity, 11(1), 37-47. http://dx.doi.org/10.1089/chi.2014.0080
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: a guide to best practice (4th ed.). Wolters Kluwer.

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Polit, D. F., & Beck, C. T. (2018). Essentials of nursing research: appraising evidence for nursing practice. Wolters Kluwer Health /Lippincott Williams & Wilkins.

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