Johns Hopkins Nursing Evidence-Based Practice Thrid Edition: Model and Guidelines

(^8) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
Research utilization was the initial effort to promote the translation of research
into practice. The use of tradition and ritual was a strong basis for care by many
nurses. In an effort to use research in clinical practice, the Western Interstate
Commission for Higher Education (WICHE) initiated the first major nurse-based
EBP project (Krueger, 1978). Research, a relatively new professional discipline
for nurses, was just beginning to develop; nurses were interested in conducting
research useful to clinicians. Nursing science targeted the study of nurses at this
time rather than examining the impact of clinical interventions used in practice.
Another early attempt at using research in practice was the Conduct and Utiliza-
tion of Research in Nursing Project (CURN) (Horsley, Crane, & Bingle, 1978).
Ten areas were identified as having adequate evidence to use in practice (Horsley,
Crane, Crabtree, & Wood, 1983):
■■ Structured preoperative teaching
■■ Reducing diarrhea in tube-fed patients
■■ Preoperative sensory preparation to promote recovery
■■ Prevention of decubitus ulcers
■■ Intravenous cannula change
■■ Closed urinary drainage systems
■■ Distress reduction through sensory preparation
■■ Mutual goal setting in patient care
■■ Clean intermittent catheterization
■■ Deliberate nursing interventions to reduce pain
These efforts were the beginning of using research in practice. EBP is more than
research utilization as science; experience, patient preference, and internal or-
ganizational data are all used to improve patient outcomes. Building on these
early efforts, EBP has developed to include increasingly sophisticated analytical
techniques; improved presentation and dissemination of information; growing
knowledge of how to implement findings while effectively considering patient
preferences, costs, and policy issues; and a better understanding of how to mea-
sure effect and use feedback to promote ongoing improvement.