How APRNs Lead the Charge in Evidence-Based Practice and Quality Care

Evidence-Based Practice in Advanced Nursing: Key Concepts and Steps

Evidence-based practice (EBP) is the dominant approach for clinical decision-making in the 21st century and a core competency of advanced practice registered nurse (APRN) practice (American Association of Colleges of Nursing [AACN], 2021a). The primary purpose of this section is to review principles of EBP and how the APRN incorporates these principles into practice. It also describes the four fundamental steps of the evidence-based process and identifies resources for EBP, including individual research studies, systematic or scoping reviews, best practice statements, and clinical practice guidelines.

The Definition and Importance of Evidence-Based Practice

EBP is defined as the conscientious, explicit, and judicious use of research-based evidence when making decisions about the care of individual patients (Sackett et al., 1996). Current best evidence is drawn from research produced by nurses and others comprising the interdisciplinary team providing care to individual patients, groups of patients, or communities. Nursing research is defined as a systematic inquiry that generates new knowledge about issues of importance to the nursing profession; individual studies may focus on clinical practice, education, administration, and informatics (Polit & Beck, 2021).

The Role of APRNs in Evidence-Based Practice

For the APRN, much of this research will be generated by nurses. Nevertheless, the APRN will frequently draw upon research produced by multiple members of the interdisciplinary team delivering care in the 21st century. Further, the APRN will apply these findings to evidence-based clinical decision making as an individual provider or as a member of a team charged with constructing, revising, or applying evidence-based policies in a healthcare facility or system.

The Four Fundamental Steps of Evidence-Based Practice

1. Ask: Formulate a clear, answerable clinical question from a patient scenario.
2. Acquire: Search for the best available evidence to answer the clinical question.
3. Appraise: Critically appraise the evidence for its validity, relevance, and applicability.
4. Apply: Apply the evidence to clinical practice, integrating it with clinical expertise and patient preferences.

Resources for Evidence-Based Practice

• Individual Research Studies: These are primary sources of evidence where new data is generated and interpreted.
• Systematic or Scoping Reviews: These synthesize existing research to draw broader conclusions about the state of evidence on a particular topic.
• Best Practice Statements: These provide expert recommendations on best practices in clinical settings.
• Clinical Practice Guidelines: These are systematically developed statements that assist practitioners in making decisions about appropriate health care for specific clinical circumstances.

The Evolution of Advanced Practice Nursing and EBP

Advanced practice nursing has evolved significantly since its inception in the 20th century. Entry into APRN practice now occurs following completion of a master’s or doctoral degree. All APRNs are educated to seek out and apply current best evidence, a core component of EBP. In addition, the APRN may be involved with the generation of original research, acting as a data collector or a member of a multisite clinical trial.

The Intersection of EBP and Quality Improvement

The APRN also may participate in and lead quality improvement projects that collect and analyze data from a specific unit, facility, or multisite health system to evaluate and improve care processes in a patient care unit, facility, or health system. Quality improvement initiatives often rely on evidence-based strategies to optimize patient outcomes and operational efficiency.

Advanced Education and Research in EBP

The APRN who wishes to play a more active or lead role in generating original research may complete a doctoral program with a research focus. Most research-based doctoral programs in the United States lead to a doctor of philosophy (PhD) degree (AACN, 2021b). These programs prepare nurses for a research-intensive career; coursework leading to a PhD focuses on theory and metatheory, research methodology, and statistical analysis of findings needed to produce new knowledge for the advancement of nursing.

The Role of PhD-Prepared APRNs in EBP

Having completed a research doctorate, the PhD-prepared APRN may act as principal investigator or coinvestigator of studies with other nurse researchers. In addition, the PhD-prepared nurse may act as a member of an interdisciplinary team designing a research project, overseeing data collection, analyzing findings, and disseminating these findings via the professional literature. Many PhD-prepared nurses will function primarily in a faculty role, whereas others engage in clinical practice based on knowledge and training as an APRN.

Frequently Asked Questions (FAQ)

Q: What is Evidence-Based Practice (EBP)?
A: Evidence-Based Practice is the conscientious, explicit, and judicious use of research-based evidence when making decisions about patient care. It involves integrating clinical expertise, patient preferences, and the best available evidence.

Q: Why is EBP important in nursing?
A: EBP is crucial because it ensures that patient care is grounded in the most current and relevant evidence, leading to better patient outcomes and more efficient healthcare practices.

Q: How do APRNs contribute to EBP?
A: APRNs contribute to EBP by applying research findings in clinical decision-making, leading quality improvement projects, and generating new research as part of their advanced practice roles.

Q: What are the fundamental steps of EBP?
A: The four fundamental steps of EBP are asking a clinical question, acquiring the best evidence, appraising the evidence, and applying it in practice.

Q: What resources are essential for EBP?
A: Essential resources for EBP include individual research studies, systematic or scoping reviews, best practice statements, and clinical practice guidelines.

Q: How has advanced practice nursing evolved in relation to EBP?
A: Advanced practice nursing has evolved to integrate EBP as a core competency, with APRNs now being key players in applying and generating evidence in clinical practice.

Q: Can APRNs lead research in EBP?
A: Yes, APRNs, especially those with a PhD, can lead and conduct research that contributes to EBP, advancing the field of nursing and improving patient care.

Q: What is the role of a PhD-prepared APRN in EBP?
A: A PhD-prepared APRN may lead research projects, contribute to interdisciplinary teams, and disseminate research findings that inform evidence-based practices.

Q: What is the difference between EBP and quality improvement?
A: EBP focuses on applying the best available evidence to patient care, while quality improvement involves systematically improving processes and outcomes within healthcare settings, often using EBP strategies.

Q: How can I learn more about EBP?
A: To learn more about EBP, you can explore resources like research studies, systematic reviews, and clinical practice guidelines, or pursue advanced education in nursing that emphasizes EBP.