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Home > RNJ > 2008 > May/June > Editorial: So Where Is the Evidence?

Editorial: So Where Is the Evidence?
Elaine Tilka Miller, DNS RN CRRN FAHA FAAN Editor

In practice, we as nurses are constantly confronted by the question: Where is the evidence to support patient care decisions? As caregivers, we want to have access to the best possible evidence. Although meta-analyses or systematic reviews of randomized control trials (RCTs) are preferable for making decisions, the reality is that this kind of supporting evidence is frequently not plentiful.

It is imperative that we don’t get discouraged. The challenge to identify the best available evidence to support rehabilitation nursing practice should motivate us. For instance, in a recent project pertaining to health education, I discovered that only a few meta-analyses and systematic reviews regarding the education of clients with chronic diseases existed. Most of the evidence was either quasi-experimental studies or group consensus studies. It was surprising that the evidence supporting client-family educational interventions is not stronger. Rather than being disheartened by this state of the evidence, I was excited by the opportunity to join forces with other nurses and healthcare professionals (HCPs) to locate, evaluate, and even expand the science and evidence that guide rehabilitation nursing practice. We can all participate and our actions may take many forms:

  • Become a member of a journal club or a practice standard group that reviews and evaluates the current evidence within the literature (e.g., fall risk reduction, best practices involving wound care, educational interventions with low literacy patients and families).
  • Support the work of other HCPs who are generating best practices, research, and other forms of scholarship by sharing it with others (e.g., via publications and presentations).
  • Check evidence-based Web sites frequently to identify new evidence applicable to your practice (see several examples in Table 1).
  • Continue asking important practice questions to stimulate research and generate other forms of evidence.
  • Support the translation of evidence into practice by overcoming barriers such as limited staff knowledge and mentoring, few evidence-based protocols and guidelines, inadequate technological support, and complex staffing workloads.
  • Prepare manuscripts for publication that contribute to the expansion of available nursing knowledge.
  • Partner with healthcare professionals to serve as a coinvestigator or principal investigator in a pilot study or larger research study.

In this issue, the articles presented are not reporting the results of RCTs, but they do provide valuable evidence-based information that addresses salient issues affecting rehabilitation nursing practice. The topics covered in this issue—hope, strength training, the impact of disabilities on family functioning, falls, cognitive function, new therapies, and practice classification systems—all influence our rehabilitation nursing interventions and outcomes. Knowledge is not static, and the practice changes (e.g., wound care, needleless IV delivery systems, electronic charting) that have occured during ARN’s more than 30-year history lend weight to the idea that we need to continue searching for new ideas for treating our clients and improving outcomes.

Rehabilitation nurses must continually strive to become competent evidence-based practitioners and knowledgeable regarding the best available evidence to enhance their decision making. According to Pierce (2007), this competency involves building our skills for using evidence rather than just performing research. In addition, research has shown that nurses who use best clinical practices experience less burnout and higher job satisfaction than those whose practice is based on tradition (Melynk & Fineout-Overholt, 2005). It is essential, therefore, that rehabilitation nurses continue to ask those pivotal practice questions, scrutinize the quality of evidence, and participate in applying as well as expanding this evidence.

References

Melynk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott Williams & Wilkins.

Pierce, L. (2007). Evidence-based practice in rehabilitation nursing. Rehabilitation Nursing, 32(4), 203–209.