A primary mission of the Hartford Center of Geriatric Nursing Excellence is to promote “best practices” among nurses and others who provide day-to-day care to older adults. In this context, “best practice” means the use of care concepts, interventions and techniques that are grounded in research and known to promote higher quality of care and living for older people. A variety of short papers, summaries, training products, and links to other sites are provided to promote knowledge and skill development among nurses and others who seek to provide high quality care to older people.
What is Best Practice in Nursing?
Use of the phrase “best practice in nursing” has become increasingly popular over the last few years. At the same time, a clear and consistently used definition of what “best practice” really constitutes remains unavailable to many practicing nurses.
In many cases, “best practice” refers to nursing practices that are based on the “best evidence” available from nursing research. The goal of “best practices” is to apply the most recent, relevant, and helpful nursing interventions, based on research, in real-life practice. Although other terms for infusing day-to-day nursing practice with research-based interventions have been used in the past (e.g., research utilization, research-based practice), the phrase “best practices in nursing” is the most popular today.
The concept “best practice in nursing” is an important one. New knowledge based on nursing and related interdisciplinary research is rapidly expanding. Provision of high quality care depends on translating research-based knowledge into real-life nursing practice. Regrettably, methods used by many nurses in the past, such as attending conferences, networking with colleagues, and reading professional journals, can barely keep pace with the array of potentially valuable practice-related reports released.
Evidence-Based Practice in Nursing
Although ‘best practice” and “evidence-based practice” are sometimes used interchangeably, the two are different in some important respects. In simple terms, best practice is a generic or general phrase for a process of infusing nursing practice with research-based knowledge. Evidence-based practice (EBP), on the other hand, emerges from evidence-based medicine (EBM), which Sackett et al. (1996) defined as
Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
The words “systematic research” are key to the distinguishing between evidence-based and best practice. Systematic research implies a number of things. First, it connotes use of research that is rigorous and well designed. Systematic research also suggests use of findings that have been supported in a series of studies. Although nurses have long valued reviews of nursing research, like those provided in the Annals of Nursing Research, the methods of EBP add additional requirements.
Systematic reviews are distinct from traditional literature reviews in some important ways. Systematic reviews are more comprehensive in scope, use pre-set criteria to grade the quality of research reviewed, and, for the most part, use randomized clinical trials as the gold standard by which evidence is judged. The process of grading research using preset criteria means that all evidence from research is not considered of equal value, and some may not be admissible at all. Decisions are guided by the hierarchy used by the organization or person to evaluate the evidence.
Agency for Healthcare Research and Quality (AHRQ)
The hierarchy for levels of evidence set forth by the Agency for Healthcare Research and Quality (AHRQ), formerly known as the Agency for Health Care Policy and Research (AHCPR), is often used in nursing. Those criteria include, from most valued to least valued.
I. A. Meta-analysis of randomized controlled trials
I. B. One randomized controlled trial
II. A. One well-designed controlled study without randomization
II. B. One well-designed quasi-experimental study
III. Well-designed nonexperimental studies (e.g., comparative, correlational, other descriptive studies)
IV. Expert committee reports, expert opinions, consensus statements, expert judgment
The Hartford Center for Geriatric Nursing Excellence supports and extends ongoing evidence-based and best practice activities of the College of Nursing. A wide variety of related research programs are under way at the College and in collaboration with University of Iowa Health Care. For additional information, visit the following sites.
Best Practice Papers
As highlighted in “Hartford Center Initiatives” HCGNE Faculty and Scholars have diverse research interests and projects. Short papers prepared by faculty and scholars are provided here, with references, to provide easy access to updates on topics of interest to those providing care to older adults.