Michelle Troseth, Chief Professional Practice Officer, Elsevier Clinical Solutions

Not many could argue against the idea that adopting evidence-based practice (EBP), based on the most current and credible clinical research, improves the quality of care delivered. However not everyone knows how to apply it.

Nurses play a vital role in shaping the patient healthcare experience, with many patients placing trust in their nurses to ensure they’re receiving the best and most up to date care available. With Australia’s move towards a more digitised healthcare system, nurses are now faced with a new range of technological tools and informatics to support their daily practices and help inform their clinical decisions. It’s unquestionable – Australia needs the support and engagement of its nurses in order to make the idea of EBP a national reality.

The call for improved evidence-based quality in the Australian healthcare system underscores the need for a realignment of care, to make it more effective, safe and efficient. But, as we think about how to apply EBP at the point-of-care, we must consider how evidence-based content is incorporated into the workflow with different technological tools. Both workflow and technology are critical elements to apply EBP. We must also think about fostering a culture that welcomes enquiry and new knowledge.

Why adopt EBP?
Looking back to the mid-1990s, nurses realised that to achieve better patient outcomes, new knowledge must be transformed into clinically-useful forms that are effectively implemented across the entire care team, and measured in terms of meaningful impact on performance and health outcomes. With that, the goal of EBP was to take current knowledge and connect it to standardise care to improve care processes and, ultimately, patient outcomes. Without EBP, nurses and other healthcare providers are at risk of significant variances in care.

From a holistic perspective, EBP can be defined as looking at the literature of the top currently available clinical research, as well as the clinical expertise within a specialty area, and connecting it to clinical experience. In addition, EBP considers patient values (or preferences) within a situation. These three components must work together.

Ultimately, for nurses to apply EBP effectively, they need:

• The necessary tools
• The right culture to embrace it
• The engagement skills to bring patient values into the care process

Closing the gap between patient’ expectations and reality
Patients expect to receive evidence-based care at the point-of-care. The reality I suspect, is that this is not currently happening across all Australian hospitals. So with this in mind, as nurse leaders we need to ask ourselves why and how we can make EBP a reality so that a level of safe, quality care is delivered to patients across the care continuum.

How the Australian healthcare system can expand its focus on EBP:

• Make EBP an interprofessional priority and lead with nurses. Nurses represent the largest single health profession in Australia. If we start with nurses, we can make a tremendous impact. This means pushing nurses to practice at the top of their license and embrace EBP. Ultimately, this is not just a nursing solution; it’s an interprofessional team concept.
• Employ models and frameworks. These are critical to EBP. Having a model and/or framework that hospitals can embrace to either implement or align with their organisational practice models makes a significant difference. Models and/or frameworks make transparent that this a way to apply EBP. Too often, EBP is thought of as a theoretical concept that is difficult to embrace, and that’s just not the case. Employing models and/or frameworks also engages clinicians and clinical scholars who are experts in their respective fields.
• Cultivate the right culture. If organisational culture simply accepts things the way they are and doesn’t question why, practice will never advance. Leaders that truly embrace cultures of EBP encourage their healthcare providers to ask why something is always done one particular way or another. Also, enquiry can bring about positive change. If a culture of enquiry does not exist in which people who don’t understand ask questions, practice will not change.

What’s Next for EBP?
Looking ahead, there are three ways EBP can be supported and emerge as a standard component of healthcare delivery in Australia:

1. Make the evidence more evident in the workflow. This involves transitioning from documents that are static, to information that is actionable and evident to healthcare providers.
2. Facilitate integration with Electronic Health Record (EHR) vendors. EBP must be integrated into health information technology in a way that makes it usable to nurses and clinicians in their day-to-day practice.
3. Continue to advance an interprofessional approach. Physicians who have primarily relied on clinical trials in the past are viewing evidence-based methodologies as additional options to arriving at quality-focused, value-based care. Along with nurses and other allied health professionals, they are beginning to adopt inter-professional EBP as a cornerstone to greatly improve the momentum of this movement.

With the right tools, culture and patient engagement skills to help bring true patient value to the care process, EBP can continue to progress and become a reality for nurses and healthcare providers Australia wide.