‘Be the change agent’: Evidence-based practice can be achieved with 5 key steps
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ORLANDO, Fla. — Evidence-based medical practices can be fostered through a five-step process that begins with asking the right questions, according to a presenter at the 2024 Rheumatology Nurses Society annual conference.
“When you’re with a patient next time, ask yourself, ‘Is what I’m doing the best for my patient?’” William G. Zic, MSN, assistant professor of nursing at Dominican University, in Illinois, told attendees. “Check your organizational mission, check policies, check procedures, look at departmental goals, look at your department’s values. Do they support evidence-based practice?
“Well, if they don’t, talk with your leaders, your managers, to see if you can be the change agent,” he added. “Create something new. Move forward with evidence-based practice process.”
According to Zic, once a problem has been identified, developing an evidence-based solution boils down to five key words — “asking” specific questions, “acquiring” evidence based on the questions, “appraising” the evidence for quality, “applying” that evidence and, finally, “assessing” the outcomes of that implementation.
“Understanding these steps, I believe, is the key,” he said, noting they derive from work by Lisa Hopp, PhD, RN, FAAN, and Leslie Rittenmeyer, PsyD, RN, CNE.
Research questions should be made specific using the PICOT process, which identifies a “problem” and specifies an “intervention,” the “comparison” being made, the “outcome” being measured and the span of “time” being analyzed, Zic said.
“The way you state your question, or the problem that you identify, is going to frame what you’re doing,” he said. “The PICOT is the foundation, the blueprint, for your next steps.”
Next, clinicians should gather research that has been conducted on the question, preferably from the last 3 to 5 years, Zic said. He recommended first searching free databases, such as the Directory of Open Access Journals and Google Scholar, before turning to paid resources. Libraries, he added, should not be overlooked as quiet spaces to work and gain access to journals and databases.
“Find your librarian,” Zic said. “They’re going to help you come up with resources on database use, etc. They’re part of your team.”
The gathered evidence should also be evaluated for its reliability. Zic described a “pyramid” of evidence strength, in decreasing order, consisting of systematic reviews, randomized controlled trials, cohort studies, case-control studies, case series and case reports, and at the bottom, editorials and expert opinion.
Once the evidence is gathered and appraised, it should be applied with a patient-centered approach, Zic said, encouraging “respect for your patient’s values, their ideas and thoughts.”
Finally, the progress of the research and its overall effects on the practice should be assessed, according to Zic.
“What adjustments do you need to make?” he said. “Are you within budget? How is quality being affected? Are your patients satisfied or dissatisfied? Are you keeping up with staff training needs?”
Once these steps have been completed, the results should be shared with colleagues and the wider medical community. Possible methods include journal publications, podium speeches and the use of social media, Zic said.
“Despite the use of increased evidence in our current practice, much more research is definitely needed to better understand how to put this evidence into action more reliably and more quickly,” he added. “Let us get this information out.”
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Zic WG. From Rheumatology Research to Bedside Practice. Presented at: Rheumatology Nurses Society annual conference; July 17-20, 2024, in Orlando, Florida (hybrid meeting).
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