Sometimes the scientific evidence is clear….but no one wants to change what they are doing.
Change is hard if providers, media, or members of the public are in love with keeping things the way they are, or have a vested interest in the status quo, or perhaps just don’t like change…or the evidence. (Maybe we’re all a little guilty of this.)
Check out this free, full-text editorial available through PubMed: http://www.o-wm.com/content/when-science-meets-sacred-cows (Source: 2010 OWM).
Critical Thinking: What sacred cows should be put out to pasture in your or others’ practice? What about using the Trendeleberg position to treat hypotension, checking foley balloons before insertion, other? List a few areas where your organization HAS changed practice based on evidence. What were the barriers & facilitators?
Want to know the value of evidence in practice? You might ask King Charles II (or at least his physicians who survived him). Check out what happens when much of the evidence for practice was based on tradition & experts: https://www.youtube.com/watch?v=OeA_OKqqBJ4 (5:27).
Everyone agrees…..patients deserve the best care we can give now, even though we won’t know everything about anything until we know everything about everything (RCH personal communication)
Critical thinking: What is one practice that you learned in nursing school, that has already changed? Why did it change?
For some evidence that you can probably put to use right away to give patient-centered, family-centered care, check out this user friendly summary from UCSD! https://www.youtube.com/watch?v=Q_hs-uNBdPQ (4:48)
Remember back when you asked your mom why you should make your bed, set the table, or do some other then-distasteful task? Maybe you said, “Do I have to?”
Remember her answer? Sometimes it was just: “Because I said so!” Was that enough evidence to support your practice of setting the table or making your bed? You bet! After all she was THE expert on such things.
Likewise…is expert opinion good evidence for your practice? Yes, it is. EXPERT OPINION of individuals or committees is the 7th level of evidence for nursing practice (Melnyk & Fineout-Overholt, 2005), and should be considered.
Of course the first question that you must ask is: “Is the person/committee (who is telling you how to prevent falls, promote safety, teach patients, and so on and on) an actual EXPERT on that topic?” The answer is a matter of judgment. If the person/committee has special education, credentials, or experience or is a recognized authority on the topic about which they are giving advice, then you could reasonably conclude yes, they are experts. In that case the advice should be considered evidence for practice. (Caution: Your judgment of their expertise matters!–don’t just follow along. Don’t forget that person who is expert in one area may not be an expert in another.)
The 2nd question that you must ask is; “Does any research or stronger level of evidence exist on the topic?”
- If it does NOT exist, then you should use that expert opinion in combination with scientific principles, anecdotal case reports, and theory. Or you might create some new research yourself. (Source=Iowa EBP Model)
- If it DOES EXIST, then you should pay most attention to the stronger evidence and interpret the weaker evidence of expert opinion in that light.
Critical thinking: Try your new knowledge in this example. Many educators and professionals who run journal clubs consider journal clubs effective based on feedback from participants. At least in 2008, 80% of experimental studies suggested that journal clubs helped with learning and being able to critically review a research article. However, no research is available on whether the learning from journal clubs actually translates into practice (Deenadayalan et al., 2008). You are considering a journal club. What would you decide to do and why?
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