A definition of Evidence Based Practice (EBP) is:
“the conscientious, explicit and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health (and social) care decisions” (Sackett et al. 2000: 71-72)
Evidence based practice will be important to me when I am making clinical decisions on my caseload as an Occupational Therapist.
It is also important to me a ‘civilian’ and someone who uses the NHS healthcare system in the UK. When I last visited the doctor, the antibiotics he prescribed would have been chosen from 100s available on the market, and it’s likely his decision was influenced (or dictated?) by the research done on the best antibiotic for my particular problem. It won’t have been one that would 100% guaranteed cure my problem, but the evidence would have pointed to the fact that there was very high chance it would. So s/he tried that one first.
Thankfully it did cure my illness first time, but had it not, the decision on what treatment to try next would have also been based on the evidence available on the next best medicine. This way treatment resources are used in the most efficient way possible, and there is the highest chance of the patient being cured soonest.
I’ve also looked for evidence-based recommendations without realising it, such as on how much exercise I should do and how much food I should eat to stay healthy. I wanted to know how many times a week I should exercise to make a difference, and how many calories a day I should eat to maintain my weight, so I checked what advice the NHS gave – which was based on research carried out to discover these thresholds. I also check the nutrition information on foods which has been created though researching the content of those foods, and also by researching how much of each nutrient a human needs to create ‘recommended daily amounts’.
When I worked for the NHS previously and offered guided CBT (Cognitive Behavioural Therapy) self-help to people, this was as a direct result of research showing that CBT helped most people with mild to moderate anxiety and depression to actually overcome their problems without having to see a qualified CBT therapist.
I think the benefits of evidence based practice are that for the majority of ‘average’ people it will mean their illness is likely to be treated in the fastest time. However this is also a downside because it means for a minority of people outside the average the treatment prescribed won’t help, or may not be culturally appropriate. But no matter which NHS doctor they see they will get the same level of treatment and the same options; it doesn’t vary depending on the individual GP’s opinion. Also treatment resources are used in the most cost effective way; money isn’t wasted on offering treatments that aren’t proven to help.
EBP is made up of three components:
Research + Clinician Expertise + Patient Preference = EBP
Some authors such as Burns & Grove (2001) and DiCenso et al.(1998) have argued however that the EBP equation should also include the impact of the health system. The NHS or a pain clinic are examples of health systems in this context. The impact of a health system on EBP could include things such as how cost-effective the care is (Burns & Grove 2001); or how accessible assets/resources are (DiCenso et al.1998). So usually EBP is described as having three components, but it could also be expressed thusly:
Research + Clinician Expertise + Patient Preference + Health System Restrictions = EBP
An alternative to evidence-based practice is knowledge-based or evidence-informed practice (Rycroft-Malone 2004). This could include knowledge from sources such as:
- organisational knowledge (eg a charity having experience/guidelines for treating a problem, in the absence of official NHS research)
- practitioner knowledge (eg a GP’s long term experience of a particular illness or patient)
- user knowledge (eg service users knowing what works for them and what doesn’t)
There is also the new concept of values-based practice as an approach to work positively with client differences/diversity, which uses clinical skills to resolve complex or conflicting values especially in MH. More can be found out about it here or in the article by Peile & Fulford (2015).
Burns, N. and Grove, S.K. (2001). The practice of nursing research: Conduct, critique, and utilisation. (4th ed.) Philidelphia: W.B. Saunders Company.
DiCenso, A., Cullum, N. and Ciliska, D. (1998). Implementing evidence-based nursing: some misconceptions. Evidence-Based Nursing. 1 (1), 38-40
Rycroft-Malone J, Seers K, Titchen A, Harvey G, Kitson A and McCormack B (2004) What counts as evidence in evidence-based practice? Journal of Advanced Nursing 47(1): 81–90.
Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenburg, W. and Haynes, R.B. (2000) Evidence-Based Medicine: How to Practice and Teach EBM. London: Churchill Livingstone pp71-72