The Future of Nursing: Why the Use of Evidence as a Guide to Practice is Non-Negotiable

USE OF EVIDENCE AS A GUIDE TO PRACTICE

Research and Theory-Based Practice: A Synergistic Approach

In the ever-evolving field of nursing, the importance of using evidence as a guide to practice cannot be overstated. Evidence-based practice (EBP) has become a cornerstone in healthcare, ensuring that clinical decisions are made based on the best available research. However, it is crucial to recognize that theory also plays a significant role in guiding practice, complementing the use of evidence.

The relationship between research and theory in nursing practice is often misunderstood. While research provides the data needed to inform practice, theory organizes and synthesizes this data in a way that makes it practical and applicable. According to Younas and Quennell (2019), nursing theories have been utilized across both Eastern and Western healthcare settings to guide practice, demonstrating their universal applicability.

The Role of Middle-Range Theories in Guiding Practice

Middle-range theories have gained prominence in nursing due to their specific focus and practical applicability. Unlike broad nursing theories, middle-range theories address particular patient experiences or clinical problems, making them highly relevant for everyday practice. For example, a middle-range theory might focus on managing chronic pain or adapting to a chronic illness like diabetes, providing a structured approach to these specific issues.

Smith and Liehr (2018) have identified several middle-range theories that have the potential to significantly impact clinical nursing practice. These include theories related to uncertainty in illness, symptom management, and self-efficacy, among others. For Advanced Practice Registered Nurses (APRNs), these theories offer targeted strategies for addressing the unique challenges they face in their specific fields.

Integrating Research and Theory in Practice

One of the challenges in nursing is integrating research evidence with theoretical frameworks to create a comprehensive guide for practice. Historically, the focus was on using conceptual models of nursing to guide care. However, there has been a shift towards using middle-range theories that are more specific and applicable to clinical practice.

For instance, the Roy adaptation model is a broad conceptual model that has been used as the foundation for developing middle-range theories like the adaptation to diabetes mellitus theory. This theory specifically addresses how patients adapt to living with diabetes, providing a clear, evidence-based approach for nurses to follow in practice (Whittemore & Roy, 2002).

The Practicality of Theory in Evidence-Based Practice

Contrary to common perception, theory is not just an academic exercise; it is a practical tool that can make nursing practice more systematic and purposeful. By combining theory with research evidence, nurses can develop a more holistic approach to patient care. This integration allows for the application of evidence in a way that is both practical and theoretically sound, ensuring that patient care is both effective and comprehensive.

For example, the Theory of Meaning, one of the middle-range theories identified by Smith and Liehr (2018), helps nurses understand how patients derive meaning from their experiences with illness. This understanding can inform the way care is provided, ensuring that it is not only evidence-based but also aligned with the patient’s personal and cultural context.

Overcoming Barriers to the Use of Evidence as a Guide to Practice

Despite the clear benefits, there are still barriers to fully integrating evidence and theory into nursing practice. One significant barrier is the perception that theory is too abstract or complex to be useful in everyday clinical settings. However, as demonstrated by the success of middle-range theories, when theories are developed with a specific focus, they become highly relevant and practical for guiding clinical practice.

Another barrier is the lack of education and training in how to effectively use theory and evidence together. Nursing education programs must emphasize the importance of both research and theory in guiding practice, ensuring that future nurses are equipped with the tools they need to provide the best possible care.

The Future of Nursing: Embracing Theory-Based Evidence

As the field of nursing continues to evolve, the integration of theory and evidence will become increasingly important. Middle-range theories will continue to be developed, providing nurses with more specific tools to guide their practice. At the same time, the emphasis on evidence-based practice will ensure that these theories are grounded in the latest research, making them even more effective.

APRNs, in particular, will benefit from this integrated approach, as it will allow them to address the specific challenges they face in their specialized fields. By using theory-based evidence as a guide to practice, APRNs can ensure that their care is both scientifically sound and tailored to the unique needs of their patients.

Box 6.10: Middle-Range Theories

To further illustrate the practical application of middle-range theories, Box 6.10 lists several theories that are currently available to practicing nurses. These theories address a range of patient experiences and clinical problems, providing a structured approach to care that is both evidence-based and theoretically sound.

• Uncertainty in illness
• Theory of meaning
• Self-transcendence
• Symptom management
• Unpleasant symptoms
• Self-efficacy
• Story theory
• Self-reliance
• Cultural marginality
• Caregiving dynamics
• Moral reckoning

These theories offer a practical guide for nurses, helping them to navigate the complexities of patient care with a clear, evidence-based approach.

FAQs

Q: What is the importance of using evidence as a guide to practice?
A: Using evidence as a guide to practice ensures that clinical decisions are based on the best available research, leading to better patient outcomes and more effective care.

Q: How does theory complement evidence-based practice?
A: Theory organizes and synthesizes research evidence, making it more practical and applicable in clinical settings. It helps to create a more systematic and purposeful approach to patient care.

Q: What are middle-range theories, and why are they important?
A: Middle-range theories are theories that focus on specific patient experiences or clinical problems. They are important because they provide practical, evidence-based strategies that are directly applicable to everyday nursing practice.

Q: How can APRNs benefit from using theory-based evidence in practice?
A: APRNs can use theory-based evidence to address the unique challenges they face in their specialized fields, ensuring that their care is both scientifically sound and tailored to the needs of their patients.

Q: What are some examples of middle-range theories?
A: Some examples of middle-range theories include the Theory of Meaning, Symptom Management Theory, and Self-Efficacy Theory. These theories provide practical guides for specific aspects of patient care.

By embracing the use of evidence as a guide to practice, and integrating it with theory, nurses can ensure that their care is not only effective but also holistic and patient-centered. This approach will be essential as the field of nursing continues to advance, and as the demand for high-quality, evidence-based care grows.