Category Archives: Evidence based nursing

Nightingale: Avante garde in meaningful data

In honor of Nurse Week, I offer this tribute to the avante garde research work of Florence Nightingale in the Crimea that saved lives and set a precedent worth following.

Nightingale was a “passionate statistician” knowing that outcome data are convincing when one wants to change the world.  She did not merely collect the data, but also documented it in a way that revealed its critical meaning for care.

As noted by John H. Lienhard (1998-2002): Nightingale coxcombchart“Once you see Nightingale’s graph, the terrible picture is clear. The Russians were a minor enemy. The real enemies were cholera, typhus, and dysentery. Once the military looked at that eloquent graph, the modern army hospital system was inevitable.  You and I are shown graphs every day. Some are honest; many are misleading….So you and I could use a Florence Nightingale today, as we drown in more undifferentiated data than anyone could’ve imagined during the Crimean War.” (Source: Leinhard, 1998-2002)

As McDonald (2001) writes in the BMJ free, full-text,  Nightingale was “a systemic thinker and a “passionate statistician.”  She insisted on improving care by making policy & care decisions based on “the best available government statistics and expertise, and the collection of new material where the existing stock was inadequate.”(p.68)

Moreover, her display of the data brought its message home through visual clarity!

Thus while Nightingale adhered to some well-accepted, but mistaken, scientific theories of the time (e.g., miasma) her work was superb and scientific in the best sense of the word.   We could all learn from Florence.

CRITICAL THINKING:   What issue in your own practice could be solved by more data?  How could you collect that data?   If you have data already, how can you display it so that it it meaningful to others and “brings the point home”?






Quasi- wha??

Two basic kinds of research design exist:  

  1. Experimental design in which
    • the researcher manipulates some variable,randomized
    • the participants are randomly assigned to groups, &
    • one group is a control group that gets a placebo or some inert treatment so that outcomes in that group can be compared to the group(s) that did get the treatment.
  2. Non-experimental design in which the researcher doesn’t manipulate anything, but just observes & records what is going on.   Some of these are descriptive, correlational, case, or cohort study designs for example.

One particularly interesting “experimental” design is one in which 1 or 2 of the experimental design ideal requirements as listed above are missing.  These are called quasi-experimental designs.

thinking3In a quasi experimental design

  • The researcher manipulates some variable, but….
  • Either the participants are NOT randomly assigned to groups
  • &/OR there is no control group.

A quasi-experimental design is not as strong as a true experiment in showing that the manipulated variable X causes changes in the outcome variable Y.  For example, a true experimental study with manipulation, randomization, and a control group would create much stronger evidence that hospital therapy dogs really reduced patient pain and anxiety.  We would not be as confident in the results of a quasi-experimental design examining the exact same thing.  In the next blog, we’ll examine why.

For more info:  Check out earlier blog:    “What is an RCT anyway?” at

Critical thinking:  Go to PubMed & use search terms “experiment AND nurse” (without the quotation marks).  Open an interesting abstract and look for the 3 elements of a classic experimental design. Now look for “quasi experiment AND nurse” (without the quotation marks.)  See what element is missing!

Bake it into your project cake!

In the last post we compared stronger direct measures of outcomes with weaker indirect
measuremeasures of project outcomes.

So…what direct measures are you “baking into your project cake”? What do you hope will be your project outcome & what measurement will show that you achieved it? –pain scores? weight? skin integrity? patient reports of a sound night’s sleep?  Share your story.  Help others learn.

Or if you just stuck with HCAHPS (or other) as outcome measure, explain why that was the best choice for your project.  (Maybe in your case it was a direct measure!)

Happy measuring!

For More Info on direct vs. indirect measures & Critical thinking: Check out t Direct speaking about INdirect outcomes: HCAHPS as a measurementquestion

Your chance to shine!

Join the Honor Society of Nursing, Sigma Theta Tau International and more than 2,000 of your peers in Indianapolis, Indiana, USA, 28 October – 1 November 2017, for the 44th Biennial Convention. Experience STTI’s largest event, which features more than 800 oral and poster presentations, networking opportunities, and more.

Call for Abstracts
Opportunities are now available to submit abstracts for the 44th Biennial Convention.
Submission Deadline: 9 November 2016.

For more information:

“Two roads diverged in a yellow wood, and sorry I could not travel both and be one traveler, long I stood and looked down one as far as I could…” R.Frost

Below is my adaptation of one of the clearest representations that I have ever seen of when the roads diverge into quality improvement, evidence-based practice, & research.  Well done, Dr. E.Schenk PhD MHI, RN-BC!qi-ebp-research-flow-chart

!!Here they come to save the day!! Toolbox to move from paper to practice

toolsOk, so you found some GREAT, new & improved clinical guidelines that exactly fit the problem that you are trying to solve on your unit.   Now What???   How do you get from the guidelines from paper to practice?  & How do you know that the guidelines are any good any way?   Where are the tools for all this?MightyMouse

Like the old cartoon Mighty Mouse, here comes the Registered Nurses Association of Ontario to save the day!  (cue the music)   You can download a FREE toolkit.  Yes, that’s right.  FREE.

It comes complete with examples & step-by-step instructions.  Check it out!   And if I haven’t been persuasive enough, here’s the table of contents!   This is waaay cooool.  Don’t miss it.

For more info here’s the site to download

RNAO toolkit download

ZIKA: Evidence-based clinical guidelines to prevent sexual transmission

As  you probably know Zika is already causing problems in an area outside of Miami, FL. CDC has taken the unusual step of issuing a travel warning there. 16743-close-up-of-a-mosquito-feeding-on-blood-pv

Accurate clinician and patient information in the U.S. will become more critical, and your advice to others could save lives as the disease spreads.

imagesCALQ0QK9Some of the best evidence on what to teach is from CDC.  These experts have reviewed the best available literature and developed these clear  evidence-based clinical guidelines to
prevent sexual transmission of Zika
.  Such evidence-based guidelines are considered very STRONG evidence--some of the strongest out there!! (For more see: “I like my “I like my coffee (and my evidence) strong!”)

Note that I point out, as do they, that these guidelines are based on the best available evidence which continues to evolve.  (It wasn’t that long ago when experts denied that Zika could be sexually transmitted.  Now we know better.)

what so what what nextScientific evidence is not static. It is dynamic and ever evolving.  This is not a problem with science, but is part of its very nature–that of discovery.

Why this matters: Clinicians should continue to educate all patients about ZIKV sexual transmission risk, to conduct testing for all persons with possible sexual exposure, and to report all cases of ZIKV to local health authorities” (CDC, 2016).

Critical thinking: How might you use this information at work or with the broader public?question

For more information: Check out CDC Zika Virus webpage