Choosing the Best Evidence to Guide Clinical Practice: Application of AACN Levels of Evidence

Abstract

T he idea of sharing clinical experiences to improve patient care is not new to nurses. Florence Nightingale published her observations on cleanliness, nutrition, and fresh air in Notes on Nursing 1 in 1860. Her work was the start of evidence-based nursing practice. More than 150 years and thousands of research studies later, the use of evidence to guide nursing practice is the expected standard of practice for both individual nurses and health care organizations. Scope and Standards of Practice 2 and Code of Ethics 3 of the American Nurses Association both call for nurses to incorporate research evidence into clinical practice. Schools of nursing have added content on evidence-based practice to their curricula. 4 Despite these efforts, barriers inhibit implementation of changes based on published evidence into bedside patient care. Overall, the barriers involve the characteristics of the nursing profession, organizational dynamics, and the nature of the research.5,6 Studies 7,8 have consistently indicated that a nurse's inability to both determine what evidence is ready for implementation into practice and then successfully develop processes to sustain an evidence-based practice change is a barrier. Evidence-Based Practice Evidence-based nursing care is informed by research findings, clinical expertise, and patients' values, and its use can improve patients' outcomes. Use of research evidence in clinical practice is an expected standard of practice for nurses and health care organizations, but numerous barriers exist that create a gap between new knowledge and implementation of that knowledge to improve patient care. To help close that gap, the American Association of Critical-Care Nurses has developed many resources for clinicians, including practice alerts and a hierarchal rating system for levels of evidence. Using the levels of evidence, nurses can determine the strength of research studies, assess the findings, and evaluate the evidence for potential implementation into best practice. Evidence-based nursing care is a lifelong approach to clinical decision making and excellence in practice. (Critical Care Nurse. 2014;34[2]:58-68) 58 Choosing the Best

Methods Used by Critical Care Nurses to Verify Feeding Tube Placement in Clinical Practice

“…[11][12][13][14] Clinical practice guidelines such as the AACN practice alerts contain recommendations for practice that are evidence-based. 15 Guidelines synthesize available evidence to assist clinicians in translating research findings into clinical practice. 16 AACN's practice alert on verification of feeding tube placement was originally published in 2005, revised in 2009, and is available on the AACN website (www.aacn.org).…”

Learning through research: from teaching science to the sphere of nursing care

“…24 Hence, simplifying the challenges posed to teaching through research based on whether it is a public or private school, disregarding the context, will possibly neglect the phenomenon itself, which, in principle, is a complex problem that also affects public universities. 6 Taking these challenges as priorities for the development of human capital, starting with undergraduate sphere, implies promoting the quality of different factors that influence nursing work, especially one's critical-reflective ability to make sciencebased decisions; [25][26][27] competencies to require research that solve work process related problems or that reorient work processes; 2 the ability to understand the nursing process as a problem-solving scientific method; the initiative to train nurses to adhere to the health systems and care delivery.…”

“…Source: Current database of Directory of Research Groups, National Council for Scientific and Technological Development -CNPq, Brazil (2015).…”

Maintaining Your Momentum: Moving Evidence Into Practice

“…4 Nurses need to evaluate the strength of evidence as far as the risk or benefit of the evidence that is guiding practice interventions. 17,18 Several tools exist to help clinicians critically evaluate and determine the strength of evidence (ie, the level of evidence). The levels of evidence defined by the AACN provide criteria for evaluating the strength of the evidence used to guide practice.…”

“…Essential elements of EBP include the integration of best research and other forms of evidence to guide practice, viewing clinical expertise as a component in care effectiveness, and considering patients' preferences, values, and engagement in care decisions as essential to providing optimal evidence-based care to patients and their families. 2,[12][13][14][15][16][17][18] Embracing EBP as a practice standard requires critical care nurses to be active consumers of current evidence, critically applying evidencebased interventions in practice and retiring traditional ways of providing care.…”