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Evidence-based practice

    Evidence based practice (EBP) is an approach to care wherein professionals use the best evidence possible ie the most appropriate information available to make clinical decisions for individual patients EBP promotes the collection interpretation and integration of valid important and applicable patient-reported clinician-observed and research-derived evidence The best available evidence moderated by patient circumstances and preferences is applied to improve the quality of clinical judgments and facilitate cost-effective care

    Best practices v. intuition

    EBP involves complex and conscientious decision-making which is based not only on the available evidence but also on patient characteristics situations and preferences It recognizes that care is individualized and ever changing and involves uncertainties and probabilities Ultimately EBP is the formalization of the care process that the best clinicians have practiced for generations – from the country “Doc” who knew his patients to the practitioner who knew his patients over decades
    Evidence-based practice (EBP) develops individualized guidelines of best practices to inform the improvement of whatever professional task is at hand Evidence-based practice is a philosophical approach that is in opposition to rules of thumb folklore and tradition Examples of a reliance on "the way it was always done" can be found in almost every profession even when those practices are contradicted by new and better information

    Research based evidence

    Evidence-based design and development decisions are made after reviewing information from repeated rigorous data gathering instead of relying on rules single observations or custom Evidence-based medicine and evidence-based nursing practice are the two largest fields employing this approach In psychiatry and community mental health evidence-based practice guides have been created by such organizations as the Substance Abuse and Mental Health Services Administration and the Robert Wood Johnson Foundation in conjunction with the National Alliance on Mental Illness
    This model of care has been studied for 30 years in universities and is gradually making its way into the public sector It effectively moves away from the old “medical model” (You have a disease take this pill) to a “evidence presented model” using the patient as the starting point in diagnosis EBPs are being employed in the fields of health care juvenile justice mental health and social services among others
    Key elements in using the best evidence to guide the practice of any professional include the development of questions using research-based evidence the level and types of evidence to be used and the assessment of effectiveness after completing the task or effort One obvious problem with EBP in any field is the use of poor quality contradictory or incomplete evidence Evidence-based practice continues to be a developing body of work for professions as diverse as education psychology economics nursing social work and architecture

    Psychology

    According to Norcross et al. (2006) "the burgeoning evidence based practice movement in mental health attempts to identity implement and disseminate treatments that have been proven demonstrably effective according to the empirical evidence" However Norcross et al. (2006) also state that perhaps it is more useful to identify what does not work They conducted a survey rating experts opinions of "not at all discredited" to "certainly discredited" for a range of treatments Examples of almost certainly discredited psychotherapies included: angel therapy the use of pyramid structures orgone therapy crystal healingand past lives therapy One limitation of this poll was that the experts selected were slanted towards Cognitive behavior therapies and they did not have adequate knowledge of integrative and eclectic psychotheuptic methods It was recommended that future polls take this into consideration though the researchers concluded that the study does identify the dark side or "quack factor" of modern mental health practiceNorcross JC, GarofaloA KoocherG (2006) Discredited Psychological Treatments and Tests; A Delphi Poll Professional Psychology; Research and Practice vol37 No 5. 515-522

    Nursing

    Though a real fad in nursing some take the view that EBP is not applicable to nursing Nursing practice can be based on research of course That's not the same thing as EBP however We mix up terms a lot in nursing or have problems with definitions Nursing's clinical practice is mostly based on the medical model (Mason Leavitt & Chaffee 2002) EBP is just one more example of staying with the medical model not nursing EBP is credited to Cochrane a British epidemiologist who pushed medicine into evidence-based practice (French 2002)
    How much actual research do we do in nursing? Nursing uses multiple parameters to care for patients that are not research- or evidence-based We need to come to a more exact understanding of what EBP means to nursing as opposed to medicine because medicine uses scientific research findings as their evidence-based practice (Dale 2005) Significant disagreement exists within nursing as to how to even define evidence-based practice
    References
    Dale A. (2005) Evidenced-based practice: Compatability with nursing Nursing Standard 19(40) 48-54
    French P. (2002) What is the evidence on evidence-based nursing? An epistemiological concern Journal of Advanced Nursing 37(3) 250-257
    Mason D. J., Leavitt J. K., & Chaffee M. W. (2002) Policy and politics in nursing and health care (4th ed) St Louis MO: Saunders/Elsevier

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