Evidence-Based Practice for Nurses

» consider important patient subgroups and patient preferences, as appropriate;

» be based on an explicit and transparent process that minimizes distortions,

biases, and conflicts of interest;

» provide a clear explanation of the logical relationships between alternative care

options and health outcomes, and provide ratings of both the quality of evidence

and the strength of the recommendations; and

» be reconsidered and revised as appropriate when important new evidence war-

rants modifications of recommendations.” (p. 3)

Nursing practice guidelines can be found at the Registered Nurses’ Associa-

tion of Ontario Nursing Best Practice Guidelines Program (http://www.rnao

.org), the National Guideline Clearinghouse (http://www.guideline.gov), and

the Royal College of Nursing (http://www.rcn.org.uk). Clinical practice guide-

lines may also be written and made available to educate and enhance decision

making for the public. The guidelines can be very helpful to the layperson who

is faced with making choices about health care.

Understanding the process of clinical practice guideline development can

assist nurses in evaluating the merit of clinical practice guidelines. Depend-

ing on the area of practice, the team of experts may be multidisciplinary in

nature. Guidelines are typically focused on patient problems that involve

many disciplines working toward similar patient goals. Practice guidelines

may be created locally, nationally, or internationally. Often they are devel-

oped by professional organizations or federal agencies. Examples include the

Gerontological Nursing Interventions Research Center (http://www.nursing

.uiowa.edu/excellence/evidence-based-practice-guidelines), the Association

of Women’s Health, Obstetric and Neonatal Nurses (http://www.awhonn.org

/awhonn/), the American Pain Society (http://americanpainsociety.org/), and

the Oncology Nursing Society (http://www.ons.org). Systematic reviews of

the literature are frequently used to assist a group of experts with integrating

the larger body of literature pertinent to the practice guideline development.

If current systematic reviews of the literature are not available, the experts

must use the rigorous systematic review process for assimilating the body of

literature to create practice guidelines.

As new evidence is generated from primary research reports, systematic

reviews of the literature and practice guidelines must be revised and updated.

The Agency for Healthcare Research and Quality (AHRQ, 2014) has developed

Locate a nursing clinical guideline and explore the process that was used to develop the

guideline. How do you think the guideline changes practice patterns?

CRITICAL THINKING EXERCISE 12-4

318 CHAPTER 12 Other Sources of Evidence