ASU College of Nursing Leads Effort to Improve Patient Care
2-Nov-2005 2:40 PM EST
Newswise — The field of healthcare is evolving at a rapid pace, with new research studies, drugs and technologies being constantly announced.
What's the best treatment for attention deficit disorder, does fish oil help prevent heart disease, is tamoxifen the drug of choice for preventing certain types of breast cancer?
With demanding patient workloads, how do healthcare professionals answer these questions and keep up with the latest developments in their field as they work to deliver the best care to their patients?
Arizona State University's College of Nursing is tackling this challenge head on with its Center for the Advancement of Evidence-Based Practice (CAEP).
Evidence-based practice (EBP) is an approach to patient care that incorporates the use of best evidence from well-designed studies, a clinician's expertise, and patient values and preferences, according to CAEP Director Ellen Fineout-Overholt, ASU associate professor of nursing.
The center's efforts spearheaded the formation of the- Arizona Consortium for Evidence Based Practice, a group that unites interdisciplinary healthcare professionals throughout the state to advance the principles and practices of EBP. It is the first statewide effort of its kind in the nation.
"Clinicians never stop asking 'why?' a patient is exhibiting certain signs and symptoms and whether the current care practices are the right ones," Fineout-Overholt says. "Our center is helping transform healthcare from the inside out by providing nurses and other healthcare providers with the tools and skills necessary to find and evaluate the latest evidence in their field, synthesize that information and incorporate it into their decision making and practice."
When evidence based practice is implemented, patient outcomes are at least 28 percent better, says Bernadette Melnyk, Foundation Professor in Nursing and dean of ASU's College of Nursing.
Melnyk and Fineout-Overholt are the co-editors of a recently published book, Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice, the first book on evidence-based practice written by nurses in the U.S.
Melnyk says that EBP comprises five steps. The first is to ask the clinical question.
"For example: 'In adults, is cognitive behavior therapy or yoga more effective in reducing depressive symptoms?'" she says. "The next steps are to search for the best evidence to answer the question, and then to critically appraise the evidence found in the literature search."
Step four, implementing the evidence into decision making, involves what some may see as revolutionary in healthcare, patient preferences and values.
For example, Fineout-Overholt explains that, while the literature might recommend a specific drug for lowering blood pressure, a patient may want to first explore changes in diet and exercise. The decision of what is best for the patient should be made in collaboration with the care provider by integrating patients' preferences and values, clinicians' expertise, and research.
The final step in the EBP process is evaluating the outcome, including patients' evaluations of their experience.
"When you have more healthcare professionals who understand EBP, there is a better integration of research into clinical bedside application," says Dr.Bart Demaerschalk, MD, assistant professor of neurology at Mayo Clinic. With Dr. Dean Wingerchuk, MD, he co-directs Mayo Clinic's Evidence Based Clinical Practice, Research, Informatics, and Training (MERIT) Center. "If you learn the principles, you more readily start with the clinical problem, delve in to see what information is available, appraise it and incorporate it into daily practice," he says. "You learn how to teach yourself over your entire career."
In addition to offering classes and workshops on the basics of EBP, the Center for the Advancement of Evidence-based Practice (CAEP) at ASU offers a mentorship program that prepares staff nurse teams and advanced practice nurses to serve as leaders and mentors in changing organizational culture.
In January, the university will begin offering the nation's first EBP graduate certificate program for healthcare providers.
"It is imperative that nursing education be at the forefront of the evidence based practice movement," says Christi Brito, RN, clinical educator at the Yuma Regional Medical Center and a member of the Arizona consortium. "I believe that ASU will be considered visionary in the work that they are doing and supporting on this front,"
"We frequently hear about how the health care dollar is shrinking, yet as nurses we are challenged to deliver quality care," she continues. "Evidence based practice offers the best of both worlds -- care that is truly based on what works, and will not only save lives but dollars as well. I firmly believe that Arizona is blazing a trail that could end up as a national model."