Evidence-based nursing: how far have we come? What’s next?

This text is based on the Joanna Briggs Oration, given at the 2005 Joanna Briggs International Conference, Adelaide, Australia. It is printed here with permission. This paper provides an opportunity to reflect on evidence-based nursing. Where have we been? How far we have come? What are the current issues, and where are we going in terms of incorporating high quality evidence into clinical, education, management, and policy decisions? Is evidence-based nursing a passing fad, or does it contribute to quality, efficient health care? Although the use of evidence is often recommended in relation to healthcare reform, institutional change, healthcare practitioner competence, or healthcare practitioner education, opponents argue that there is no evidence that evidence-based healthcare makes a difference. There are no sensitive system indicators; healthcare costs are highly influenced by the adoption and spread of technology; and mortality and morbidity are also influenced by many factors. Yet, evidence-based health care should have an impact on all 3 of these outcomes. One of the earliest reviews to assess the effect of research based nursing practice on patient outcomes identified 84 relevant studies and showed “sizeable gains” in patients’ behavioural, knowledge, physiological, and psychosocial outcomes compared with patients who received routine nursing care.1 However, evidence-based nursing is more than research utilisation. It is the incorporation of the best research evidence along with patient preferences, the clinical setting and circumstances, and healthcare resources into decisions about patient care.2 More recently, Thomas et al updated their review of the use of guidelines by healthcare practitioners other than physicians. They identified 18 studies of 467 healthcare providers (participants were nurses in all but 1 study). Although reporting of methods was poor in all included studies, 3 of 5 studies found improvements in at least some processes of care, and 6 of 8 studies …