Evidence-Based Practice (EBP) consists of three components: 1. "External evidence from research, evidence-based theories, opinion leaders, and expert panels; 2. Clinical expertise such as internal evidence generated from outcomes management or quality improvement projects, a thorough patient assessment and evaluation, and use of available resources; and 3. Patient preferences and values" (Melnyk & Fineout-Overholt, 2015, p. 4). This is a fairly standard definition of EBP.
Anecdotal experience is not included in this definition. I think that is significant. I think it's part of professional judgment, but not EBP. It has a place in professional health care, but it's not what we're talking about. If I relied on anecdotal experience to guide my practice, I would still be tearing the tips off my gloves when I start an IV, fanning a recently cleaned IV site to hasten the drying time, and swabbing the male end of a primary tubing line with alcohol if it accidentally touched the ground. I was taught all of these things early on because I'd believe anyone who had been a nurse longer than me. If my 15 years in nursing has taught me anything, it is to be skeptical when someone shows me a new technique, deferring instead to the "data." My ears turn off when I hear a nurse say to me, "What I like to do is..," or "The way I was taught was..."
To me experience is only significant if it is tempered with evidence, either external or internal, in light of the patient needs. The reason why many of us want to follow in Lynn's footsteps is because she tempers experience with evidence. That is the root of EBP. EBP is what allows us nurses to enter into intelligent, collegial discussions with other members of the multidisciplinary team. EBP makes us professionals. Calling into question someone's experience and authority on a subject because they have chosen to contribute their knowledge to education is insulting and unprofessional. None of us would have jobs without our educators.
Melnyk, B. M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed.). Philadephia, PA: Wolters Kluwer.
Thank you! You listed a great reference for EBP. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Once again...your missing the bigger picture. The problem with what you just wrote is in the very first sentence. What I have been discussing here (heatedly, I admit) is not that EBP is useless. It's your term "experts". I'll ask you a very simple question?...How is one deemed an "expert"......obviously it has little to do with clinical experience so what is the academia's definition. In my small, small, mind...I don't know but if you say expert?.....you better be able to back that up.
Let me give you an example. To this day it still goes on , by the way. Nurses saying " I can't get this IV , I'm gonna have to get the Doctor to get it"....if you tell me I have never heard that before then your not being truthful...so why are "Doctors" the experts?
Why would we even begin to think that a Doctor has a better chance at that IV then a nurse?..EBP?. I read a study recently and YES I read more than you think....That was on the "bundle "practice. It may have been the study to prove that bundles reduce infection?...not sure...but the point is in that study the author points out how when bundles are used CLBSI's dropped considerably...OK...bundles work. However, reading that study closely it says PICC insertions were not included in the study, however, the authors feel PICC's would still benefit from the bundle...EBP!!...how many organizations ran out and made PICC teams use a bundle sheet now before insertion....ahh...all of them. But clinical experience, yes I said it, CLINICAL experience tellsl you...we have been doing the bundle steps since we started MST... the reason PICC lines were not included is because PICC's don't get infected from insertion. With the advent of dedicated PICC teams it pretty much ELIMINATED PICC insertion related infections. But, I'm sure alot of really smart nurses with 100 letters behind their name didn't know that to be true so just took the study at face value. So, now nurses are getting yelled at for not including the bundle sheet on every insertion...when we CREATED the bundle steps that they so cherish. But if you were an "expert" you would already know that. The reason I am so good at what I do....is not because I proclaim to be....it's practice. Practice, practice,practice. drilled into me since I was a kid. You want to be great at Vascular Access then damn it...PUT IN THE WORK...practice practice practice. I could have chosen throughout my career to go the route of research and management, but in my head I wanted to be the best...the only way I knew how to do that was PRACTICE...and my letters stopped at BSN VA-BC. Sorry.
Jack
Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice. Do you guys actually read the references you quote on this site." Critical appraisal of evidence is the hallmark of EBP. The meaning of EVIDENCE is fully appreciated within the context of BEST PRACTICES which incliudes the following (Stevens 2002)":
Research Evidence
Clinical knowledge gained from the individual practitioner's experience ******
Patient and practitioners preference*********
Basic principles from logic and theory*********
That's called Qualitative and quantitative evidence.
Your refeence is extremely old. When writing standards, guidelines, position papers, manuscripts for publications, etc, the general rule is the reference should be less than 5 years. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861