Evidence-based practice, evidence-based medicine, evidence-based nursing and evidence-informed decision-making began with Florence Nightingale in the 1850s during the Crimean War. She noted a connection between poor sanitary conditions in the hospital and rising death rates among wounded soldiers (Bite-Sized History of Mathematical Resources, n.d.). “It is Nightingale who developed the coxcomb, a visual display to demonstrate how military deaths could be prevented” (Morin, 2010, p. 2). Her subsequent efforts to sanitize hospitals to save soldiers led to dramatic drops in patient mortality.
Much of the original work on evidence-based practice (EBP) focuses on EBP in medicine. Although the term “evidence-based medicine” (EBM) reportedly was first used in the 1980s, the practice gained wide recognition in 1992 when the Journal of the American Medical Association published an article by the evidence-based medicine working group on its role in medical education. According to Montori and Guyatt (2008), that article brought both the term and the concept to the attention of a wider medical community. The working group published a series of 25 articles between 1993 and 2000 that outline criteria to evaluate current evidence to support clinical decisions. This body of work forms the basis of most of the critical appraisal tools used today (Guyatt & Rennie, 2002).
Read varying definitions of evidence-based practice, evidence-informed decision-making, and other related terms. Read more
Relevance of evidence-informed decision-making to nursing practice
Patients depend on nurses to do the best on their behalf. As part of their professional accountability, nurses must continually examine the best way to deliver care. Read more
Types of evidence
According to the Canadian Nurses Association, a variety of sources are being used by nurses to facilitate their use of evidence. These sources include systematic reviews, research studies and abstraction journals that summarize valid, clinically useful published studies, and clinical practice guidelines. “Guidelines are based on the most rigorous research available, and when research is not available, they are grounded in expert opinion and consensus” (Canadian Nurses Association, 2010, p. 4). Read more
Barriers to nursing: Evidence-based practice/Evidence-informed decision-making
Barriers to evidence-based practice involve individual nurse characteristics, organizational characteristics, the nature of research information and the health-care environment. Read more
Strategies to promote evidence-based practice/evidence-informed decision-making by nurses
There are several evidence-based strategies to promote a culture of evidence-based practice or evidence-informed decision-making. Read more
The Registered Nurses Association of Ontario (RNAO) launched the Nursing Best Practice Guidelines (NBPG) Program with funding from the Government of Ontario. This site offers: guidelines covering five broad clinical areas: Gerontology, Primary Health Care, Home Health Care, Mental Health Care and Emergency Care – some of these are available in French. The site also provides a toolkit for implementing these guidelines and health education fact sheets for patient teaching.
Includes evidence-based clinical guidelines for all health care professionals. SIGN is part of the NHS Quality Improvement Program for Scotland. Many of the SIGN guidelines relate to the NHS priority areas of cancer, cardiovascular disease, and mental health. National Guidelines Clearinghouse (United States)
The Centre for Evidence Based Nursing (CEBN) produces reliable research evidence for clinical nursing through primary research and systematic review. Some full text articles are available in their publication: Health Policy Matters.
This bilingual site provides Clinical Practice Guidelines which are produced or endorsed in Canada by a national, provincial/territorial or regional medical or health organization, professional society, government agency or expert panel.
The next move: leading interprofessional collaboration
Collaborative practice is becoming the norm but to achieve this goal changes are needed in attitudes, in operations and in systems. We all have to recognize the importance of working with government, unions, regulators and other stakeholders.
Influenza is a serious illness that disproportionately affects certain populations who have a higher risk of complications. Influenza immunization, as the most effective method of preventing the flu, allows health-care workers to protect themselves, their families and those in their care.
Have You Thought About the Social Determinants of Health?
The health of Canadians is not shaped primarily by the medical treatments they receive or the lifestyle choices they make but by the living conditions they experience. These conditions have come to be known as the social determinants of health.
The resources within this section are offered to inform your cultural awareness, competency, and safety so as to enhance your capabilities to work with your clients in addressing their health and wellness needs