| Best Practices
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
HCGNE Activities 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. |
