2nd November 2015

Here is the fourth in a series of Voices blogs from some of our Associate members who were able to join online with the 6th International Conference on Community Health Nursing Research (ICCHNR) which took place in Seoul in South Korea between 19-21 August.

The iHV was delighted to be able to support 5 health visitors to join the online streaming of the conference proceedings. We then asked them to write up a synopsis of one of the presentations that interested them to share with all our followers.

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Ruth Newson – Synopsis of Exploring the evolution of evidence in community health nursing

Speaker: Eun-Ok Im, PhD, MPH, RN, CNS, FAAN Professor.  University of Pennsylvania.

Background: Nursing practice has been based on patient outcomes in recent years.  Evidence-based nursing has been emphasised to improve outcomes in nursing practice and Community health nursing.   Community health nurses are interested in health promotion and disease prevention which requires best evidence.

The purpose of the presentation: to present a review of evidence-based nursing, to explore the evolution of evidence in community health nursing and to provide directions for evidence-based practice.

Definition of evidence-based practice by the Agency for Healthcare and Quality:

Applying the best available research results when making decisions about healthcare.  Using research evidence, clinical expertise and patient preferences to provide evidence-based practice.

Evidence-based practice:

• Involves an ability to access, summarise and apply information from the literature to everyday clinical problems (Kessenich 1997).
• Includes evidence, nursing theory, clinical expertise and patient involvement to provide optimum nursing care (Scott and McSherry 2009).
• Holistic care, working with patients to provide effective treatment; acceptable to the patient and cost effective (McSherry & Robert (ed) 2002).

What is evidence-based community health nursing practice?

‘An ongoing process by which evidence, nursing theory and the practitioner’s clinical expertise are critically evaluated and considered in conjunction with patient, group and/or community involvement to provide delivery of optimum community nursing care for the individual, group and/or community’.

Categories of evidence: findings from research, knowledge from basic sciences and clinical knowledge.

• Research evidence; randomised control trial is the ‘gold standard’.  However, in many clinical cases randomisation is impossible due to ethical, political, cultural or practical reasons.
• Non-experimental studies; useful in identifying risk factors or those most likely to benefit from a particular approach.
• Clinical knowledge; refers to experience, anecdotal accounts, case histories and expert opinion.  These can be affected by location, memory and selective recall.  Expert opinion depends on who the experts are the basis for their opinions.

Sources of evidence-based practice: journals, speciality organisations, government organisations, commercial organisations and guidelines for nursing practice.

Evolution of evidence-based nursing and community health nursing

Before evidence-based practice was introduced into nursing, the focus was on translating research to practice rather than systematically determining the worthiness of the research findings prior to implementing in practice.

During 1970-1980s there was an increased use of nursing research in practice but still a gap between nursing research and practice.

Cochrane (1972) termed ‘evidence-based’ from a research group led by Guyatt.

Evidence-based nursing was proposed by Ingersoll (2000) to be defined as ‘conscientious, explicit and judicious use of theory derived from research-based information in making decisions about care delivery’.

Currently there is growing support for implementing evidence-based practices in a more systematic manner.

Evidence-based nursing (EBN) pushes beyond evidence-based medicine in the areas of qualitative research, integrating the patient experience into practice decisions.  EBN underscores assessing and incorporating the patient’s preferences into the clinical decision-making process.

Brownson et al (2003, 2007) proposed 6 new concepts in evidence-based public health nursing:

• Making decisions based on the best available quantitative and qualitative scientific evidence
• Systematic use of data and information systems
• Application of programme-planning frameworks, based on behavioural science theory
• Engaging the community in assessment and decision-making
• Making sound evaluations
• Disseminating what is learned to key stakeholders and decision-makers.

Three circle model of evidence-based clinical decisions

 

The most commonly applied framework in EBPH

 

Evidence-based public health (EBPH) is unique:

• Randomised control trials are often not available and they usually do not inform public health decisions.  EBPH is more likely to rely on cross-sectional studies, quasi-experimental designs and time-series analyses; it may lack a comparison group.
• EBPH addresses resource allocation in overburdened systems.
• EBPH has constructed a detailed, stepwise process that guides decision making and initial questions.

Uniqueness of public health nursing:

• Community health nursing research may take more time until the outcome can be adequately measured than clinical research.
• May rely on qualitative research as evidence.
• Relies heavily on the community, patient, participant’s experiences and preferences.

Implications for community health nurses:

• Community health nurses need to identify which practices are based on research evidence, clinical knowledge or tradition.
• Nurses need to stay current using the newest research findings.
• There is a need to ask community-based questions to study issues with a variety of community populations; use appropriate designs and disseminate the findings.
• Nurses need to integrate evidence from multiple sources to include qualitative research, population studies, economic studies, social studies, etc
• Nurses need to integrate the community, patient or participant experience into practice decisions.
• Nurses must assess and incorporate the community/patient/ participant’s preferences into the decision-making process.

Ruth Newson