How APRNs Can Lead the Charge in Evidence-Based Practice in Modern Healthcare

EVIDENCE-BASED PRACTICE AND THE APRN

Generating Evidence: Historical Perspective

Although the meaning of the term “evidence” may appear straightforward, a deeper exploration of its historical roots in healthcare is necessary. According to the Oxford English Dictionary Online (2020), evidence is defined as an object or document that serves as proof. The objects or documents considered valid as evidence vary across disciplines. For historians, original documents or artifacts serve as evidence, while lawyers rely on a complex system codified with federal, state, or other rules of evidence.

Within the context of Evidence-Based Practice (EBP), evidence is restricted to research findings that evaluate the efficacy and safety of an intervention or the predictive power of a diagnostic procedure. The quest for evidence can be traced back over 2000 years, with definitions of what constitutes sufficient evidence evolving over time.

The Role of Randomized Controlled Trials (RCTs)

Despite the numerous study designs used to evaluate the effectiveness of various interventions and diagnostic procedures, the randomized controlled trial (RCT) remains the gold standard for generating evidence. The RCT is based on three critical elements:

1. Manipulation of an experimental intervention.
2. Comparison of the group receiving the experimental intervention to a control group receiving a placebo, sham device, or standard intervention.
3. Random allocation of subjects to an intervention or control group.

Random allocation, a practice advocated since the early 1930s, is essential in an RCT as it effectively spreads potentially confounding factors evenly among treatment and control groups. The trial comparing streptomycin with standard care (bed rest) is often cited as the world’s first large-scale RCT, with randomization achieved using a closed envelope system and blinding subjects to their treatment group.

Defining Current Best Evidence

Building on this historical foundation and guided by Archibald Cochrane’s pioneering efforts, current best evidence is defined as findings from studies evaluating the efficacy and safety of an intervention or the predictive accuracy of an assessment. These studies must:

• Directly evaluate the effect of an intervention.
• Compare the intervention with a placebo, standard care, or a sham device.
• Document adverse side effects associated with the intervention.

The studies must be conducted on human subjects and measure the most direct outcome of treatment. For instance, a study assessing the efficacy of a topical wound therapy should measure wound closure rather than interim outcomes based on convenience.

Criteria for Evidence-Based Interventions

What criteria must be fulfilled to deem an intervention as “evidence-based”? Regulatory groups such as the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have established specific criteria. To receive an indication for clinical use, the FDA requires results from two well-designed RCTs with consistent outcomes, both of which must compare the agent with a placebo- or sham-based control group.

While these groups provide well-defined criteria for labeling an intervention as evidence-based, achieving this level of evidence is labor-intensive and costly. The impact on APRN practice is significant; for example, a study of primary care practice found that only 18% of recommendations are based on high-level patient-oriented evidence, while half rely on expert opinion or rationale-based decisions.

The Impact of Evidence-Based Practice on APRN Roles

Evidence-Based Practice (EBP) plays a crucial role in the daily activities of Advanced Practice Registered Nurses (APRNs). EBP ensures that APRNs base their clinical decisions on the best available evidence, improving patient outcomes and enhancing the quality of care provided. By staying informed about the latest research and incorporating it into practice, APRNs can lead the way in implementing cutting-edge interventions.

Strategies for Integrating EBP in APRN Practice

For APRNs, integrating EBP into practice requires a systematic approach:

1. Continual Education: APRNs should pursue ongoing education to stay current with the latest research and clinical guidelines.
2. Collaboration: Working closely with multidisciplinary teams allows APRNs to share insights and apply evidence-based interventions more effectively.
3. Critical Appraisal: APRNs must develop skills in critically appraising research studies to determine their validity and applicability to clinical practice.
4. Patient-Centered Care: Incorporating patient preferences and values into decision-making ensures that care is tailored to individual needs, supported by the best evidence.

Challenges and Solutions in EBP Implementation

While EBP offers numerous benefits, APRNs may face challenges in its implementation, including:

• Limited Time: The fast-paced nature of healthcare can make it difficult for APRNs to stay updated on the latest research.
• Access to Resources: Not all healthcare settings provide equal access to research databases and journals.
• Resistance to Change: Some healthcare professionals may resist adopting new practices based on the latest evidence.

To overcome these challenges, APRNs can:

• Advocate for Access: Push for better access to research resources in their workplace.
• Schedule Time for Research: Allocate specific times for reviewing the latest literature and integrating findings into practice.
• Educate Peers: Share knowledge and encourage colleagues to embrace EBP through workshops and presentations.

FAQs About Evidence-Based Practice and the APRN

Q: What is the primary goal of Evidence-Based Practice for APRNs?
A: The primary goal is to improve patient outcomes by making informed clinical decisions based on the best available evidence.

Q: How can APRNs stay updated on the latest evidence?
A: APRNs can stay updated by attending professional conferences, subscribing to relevant journals, participating in online forums, and engaging in continuous education.

Q: What are the key components of an RCT, and why is it considered the gold standard?
A: The key components are manipulation of an intervention, comparison to a control group, and random allocation of subjects. RCTs are considered the gold standard because they minimize bias and confounding factors, providing the most reliable evidence.

Q: How does EBP benefit patient care?
A: EBP ensures that patients receive the most effective treatments, leading to better health outcomes, reduced risks, and more efficient use of healthcare resources.

Q: What are common barriers to implementing EBP, and how can they be addressed?
A: Common barriers include limited time, access to resources, and resistance to change. These can be addressed by advocating for better access, scheduling time for research, and educating peers on the benefits of EBP.

Incorporating Evidence-Based Practice is vital for APRNs seeking to provide the highest quality of care. By understanding the historical context, mastering RCTs, and overcoming challenges in implementation, APRNs can ensure their practice remains at the forefront of healthcare innovation.