Using Evidence to Address Clinical Problems
Pamela M. Ironside
PhD, RN, FAAN
Indiana University School of Nursing
New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN
- Differentiate clinical opinion from research and evidence summaries
- Explain the role of evidence in determining best clinical practice
- Identify gaps between local and best practice
- Discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preferences
- Participate effectively in appropriate data collection and other research activities
- Consult with clinical experts before deciding to deviate from evidence-based protocols.
- Appreciate strengths and weaknesses of scientific bases for practice
- Acknowledge own limitations in knowledge and clinical expertise before determining when to deviate from evidence-based best practices
- When you think about the patients for whom you have been providing care this semester, what could possibly be wrong with the best evidence available to date?
- In what specific situation would you NOT use this evidence when planning care for this patient? Why?
- With whom would you consult (if anyone) in making this determination?
- Are there data sources that we have not yet explored that could be helpful in considering [this problem] or planning ways to alleviate it?
- What questions do you have (about this problem or nursing practice related to care of patients experiencing the problem) that aren’t being addressed by current researchers?
This exercise can be used for discussion or as a group project that is marked pass/fail. An important aspect of discussion is to engage students in thinking about the practical use of evidence in its most inclusive sense (i.e.: students immersed in exploring various data sources may inadvertently discount other valuable sources such as patient/family values and/or clinical expertise). As well, exploring what’s missing is a great time to talk about the importance of ongoing research and what to do when decisions must be made for which there is little, no, or conflicting evidence. Differentiating between valid and invalid reasons and the importance of backup from clinical experts can also help students explore the limits and boundaries of their current knowledge and experience.
Alternatively, you may ask each student to write and submit a one page summary of their findings which you can mark using a rubric consistent with those used at your school. (ie: A – work is clear, complete and concise, demonstrates excellent command and critical use of resources related to [the problem]. B – work is clear and concise, reflects consistent and appropriate use of resources related to [the problem]. C – work is incomplete and reflects non-critical or superficial use of resources). The questions at the end, however, should be for discussion only.