Posted: March 28th, 2021

The history of evidence-based nursing practice, Research Report

The history of evidence-based nursing practice

Starting with Florence Nightingale in the 19th century and evolving in the medical field

The evidence-based practice in the community goes along with the nursing discipline further progress.

Evidence-based practice is a prerequisite for nursing education and graduate education

a way for the nursing discipline to minimize the gap between theory and practice. This paper describes the

Concept of evidence-based practice from a historical point of view in terms of care in the

Education and practice areas. The concept of evidence-based practice is defined and the Similarities and differences to evidence-based medicine are discussed. It is crucial that registered
Nurses proactively seek research knowledge to bridge the gap between theory and practice to close further. Apply best practice guidelines for care, review and implementation

Applied research results and the use of technological progress are just a few examples which care can progress as well-informed discipline.

Keywords: evidence-based care, education, practice, nursing history

What is evidence-based practice?
The classic definition of evidence-based practice (EBP) comes from Drs. David Sackett . EBP is “the conscientious, explicit, and rational use of the best evidence currently available to make decisions about the care of the individual patient. This means that individual clinical expertise is combined with the best available external clinical evidence from systematic research. ” 2

EBP has evolved over time to incorporate the best research, clinical expertise, individual values ​​and circumstances of the patient and the characteristics of the practice in which healthcare professionals work.

The history of evidence-based practice in nursing education and practice

Evidence-based practice developed into medical practice by Florence Nightingale in the 19th century

Doctors ‘ practice in the 1970s to the nursing profession in the late 1990s. It started as an idea too

provides better results for patients experiencing regrettable and unhygienic conditions, and

has developed into a foundation that has nurtured and nurtured the care to ensure safe and secure care competent care. Evidence-based, according to the International Council of Nurses (ICN, 2012)

Practice is a way for the nursing discipline to minimize the gap between theory and practice. It is also one important opportunity for nursing educators to disseminate basic knowledge of undergraduate studies and doctoral students of nursing. Improving the ability of nursing students

To record and apply evidence in their practice is “a fundamental university role”(Hickman, Kelly & Phillips, 2014, p. 598). This article discusses the concept of evidence-based analysis from a historical perspective practice, because it is nursing education and practice

Domains . This article first discusses evidence-based medicine and how this movement led to it Research use and evidence-based nursing practice. The term evidence-based

The practice is defined and the similarities and differences to evidence-based medicine are shown discussed . Finally, the authors discuss the implications for nursing discipline from the

Perspective of Research, Best Practice Guidelines, Evidence Informed Practice and Mobile

Technology .

Evidence-based Practice – An Emerging Concept

Florence Nightingale and Evidence-based Nursing

Florence Nightingale, though not widely recognized in the literature, is considered

by some nursing researchers ( Selanders , 2012; Lim, 2011; Sullivan-Marx, 2006; McDonald, 2001;

Kalisch & Kalisch , 1986) to enforce the concept of improving patient outcomes


solid evidence. Florence Nightingale is known for her work in military hospitals during

the Crimean War, which began in 1853 and lasted three years (Lambert, 2011). After her

After his experience in the Crimean War, Nightingale was asked to oversee the management of the barracks

Hospital in Scutari, Turkey, which was known for extremely unhygienic conditions (BBC History,

nd ). Here, Nightingale has critically examined how the environment affects patients

Health and results. In her 1859 book Notes on Nursing (1970) Nightingale

speaks to the “steaming and rubbing of the skin” (p. 53) and to personal cleanliness in the handling

direct patient care. She writes: “Compare the dirtiness of the water in which you washed yourself

When it’s cold without soap, cold with soap, hot with soap. You hardly find the first one

removed any dirt at all, the second a little more and the third much more “(p. 53). The

An evidence-based practice was not known at the time, but Nightingale used evidence that existed

were determined by experiments and critical examinations to positively influence the patient

Results . Her book Notes on Nursing could even be considered a best practice guide for

Nurses of the time.

Nightingale also used statistics to understand and predict patients

Morbidity and mortality ( Aravind & Chung, 2009, Nightingale, 1970). In notes to nursing her

writes : “If one compares the deaths of one hospital with those of another, any statistics are justified

considered absolutely worthless, which does not give the age, sex and diseases in all

Cases “(p. 55). Nightingale continues to discuss that doctors would expect recovery and often Treating patients should be similar with completely different patient demographics.

Nightingale, who at that time still lacked sufficient research knowledge, provided her with nursingPractice with evidence with the aim to improve the health outcomes of patients. She was a pioneer of evidence-based practice in nursing discipline.

Why is evidence-based practice important?
EBP is important because it aims to provide the most effective available care with the goal of improving patient outcomes. Patients expect the most effective care based on the best available evidence. EBP encourages the hiring of healthcare professionals to investigate and let us think: why am I doing this? Is there evidence that can guide me to do this more effectively? As a health professional , it is part of providing a professional service to ensure our practice is informed through the best available evidence. EBP also contributes to meaningful use of limited health resources and to taking into account relevant evidence in decisions on the financing of health services. 4

What happened before the evidence-based practice?
Previously, EBP health professionals relied on the advice of experienced colleagues, who were often considered at first sight, to their intuition and what they were taught as students. The experience is subject to prejudice, and what we learn as a student can quickly become obsolete. Relying on older, more knowledgeable colleagues as the only source of information can give you outdated, biased and incorrect information. This is not to say that clinical experience is not important – it is indeed part of the definition of EBP. Rather than relying solely on clinical experience in decision-making, healthcare professionals need to harness clinical experience along with other types of evidence-based information. 5

Fact-based medicine

While Nightingale has developed a small following in the literature that upholds her work Within military hospitals, most of the literature was evidence of evidence-based practice tracks the onset of evidence-based practice, originally known as evidence-based medicine, back to Archie Cochrane in the 1970s (Brady & Lewin , 2007, French, 1999, Hulme , 2010).

Before and during this period, much of the patient care decision-making was based individual medical assessment and selection; It was believed that every doctor thought that right thoughts and the right things done “(Eddy, 2005, p. 9). Randomized controlled trials and other research institutions began to develop and it was found that the decisions of

Doctors were often based on unfounded assumptions and that there were a variety of assumptions

Medical practices for similar diseases (Eddy). During the term

Evidence-based medicine was not coined until 1992, when Cochrane considered that resources were limited

It would always be a problem within the healthcare system and clinicians should strive to use it
the procedures that proved most effective (Cochrane Collection, 2013).

Cochrane claimed that randomized, controlled trials are the most reliable form of Evidence and its promotion of randomized controlled trials formed a basis for health care

Decision-making that evolved into an evidence-based medical movement ( Aravind & Chung, 2009). This movement allowed the clinicians to rely on a common thread

practice .

In the early 1990s, the notion of evidence-based medicine was finally marked in the literature and clear by David Sackett defined ; a definition that remains among the most used


Literature even today ( Aravind & Chung, 2009, Beyea & Slattery, 2013, French, 1999). Sackett , Rosenberg, Muir, Haynes & Richardson (1996) defined the term as “the conscientious, explicit and the prudent use of current best evidence in individual care decisions

Patients “(p. 71). To take full advantage of evidence-based medicine, Sackett et al. recommended

Clinicians formulate a diagnosis based on evidence and research and then involve the person

Patient preference , values ​​and beliefs in this process (1996). While Cochrane in the 1970s

the concept of evidence-based medicine to the value of randomized controlled trials focused ,

Sackett’s definition of evidence-based medicine required a higher level of critical thinking. Sackett et al. put a greater focus on the use of patient values ​​to validate

Research results on patient safety and patient-centered care. The definition of evidence-based

Medicine was then taken and renamed as an evidence-based practice, like other professions,specifically in health care, adopted it for their own use.

Evidence-based practice in nursing discipline

The definition of evidence-based practice within the nursing profession has evolved

wherein strictly clinically to integrate base a more holistic approach, in appropriately reflects

the entire nursing research and practice. This is not only evident in clinical practice

Adoption , it can also be used in the context of education and theory of students and graduates of nursing

Development (Stevens, 2013). Evidence-based nursing practice is, according to ICN

Defined as a “problem-solving approach to clinical decision-making that searches for

the best and newest insights, clinical expertise and assessment, and patient preference values

in the context of caring “(2012, p. 6). Likewise, the Canadian Nurses Association (CNA,

2002) argues that evidence-based practice is based on decision-making and accustomed

Optimize patient outcomes, improve clinical practice, and ensure accountability. In one (n

[ evidence-based practice project in Hong Kong, French (1999), recruited a number of registered

Nurses (RNs) with experience in evidence-based practice use and discussed three

Vignettes helping him to revise the definition of evidence-based practice. One of the more

A striking feature of the French discussion is the use of implicit knowledge in the implementation

the evidence-based practice.

Research use versus evidence-based practice

Many models have been developed from evidence-based medicine to aid development

Understand how this concept can be applied to other health professions ( Hulme , 2010).

Especially for nursing one of the methods where evidence-based practice was paramount

was conceptualized by research use ( Hulme ). While evidence-based practice

Includes a patient-centered approach (Rycroft-Malone et al., 2004), making it easy to use the research

the consistent application of the research steps to critically examine and implement research evidence

Evidence in practice ( Beyea & Slattery, 2013). Research use is a categorical process that

does not include some of the holistic qualities inherent in nursing, for example

The tacit knowledge of the French. This process has a place in the development of a care

However, knowledge base is important to understand how evidence-based practice influences


Patient care and minimizes the theory of practicing gaps in nursing. Evidence-based care is one

Broad concept to improve patient safety, reduce healthcare costs and ultimately

Providing a framework to support decision making in patient-specific situations ( Beyea &

Slattery, 2013). Beyea & Slattery argue that the use of research tends to focus on research

Performing exceptionally reliable research studies before determining their value or value

in a clinical practice area (2013). This path gives cause for concern as priorities such as patient

Safety and the importance of patient preferences and values ​​may be lost

What is considered the best proof.

Best practice guidelines

In the 21st century, one way in which nursing is based on evidence-based practice is to:

Improving patient outcomes and patient care is the use of best practice guidelines. Many care

Organizations have taken the initiative and created various best practice guidelines

RNs to the principles of evidence-based practice in patient care decisions

make . In Canada, the Registered Nurses Association of Ontario (RNAO) has taken the lead

Creation and dissemination of over 50 best practice guidelines on a variety of patient care topics, including:

Pain therapy , end-of-life care and collaboration between RNs. According to the CNA (2010)

Best practice guidelines are based on the most rigorous research available; B. systematic

Reviews and randomized controlled trials, but also research based on expert opinions

and consensus “( paragraph 5).

The literature has argued that evidence-based practice is rooted in medicine

Medicalizing patient care has the potential to neglect the other required aspects

for holistic care by the nursing profession (French, 1999; Mantzoukas , 2007;

Melnyk et al., 2004). French (1999) claims that this evidence-based practice has evolved

from evidence-based medicine, it has limitations in its application to nursing and others

Occupations in health care . He argues that evidence-based practice depends too much on the positivist

The perspective and outcomes of clinical trials often replace other equally relevant aspects

of nursing research. ICN (2012) and CNA (2002) agree, inter alia, that in the first place

The most reliable form of evidence is the systematic review, followed by the randomized

controlled study. However, ICN and CNA are also very clear that the individual nurses

Opinion and experience as well as patient preferences and values ​​are equally relevant to styling

these guidelines. The research base of the nursing profession began as a theoretical basis.

Theories such as Carper’s fundamental patterns of knowledge have permeated literature as such

Way, the nursing profession of conceptualization and also as a means of practice in all management

Nursing Domains (1978). Properties , which are inherently RNs, such as compassion, sharp perception,

and the knowledge gained through experience can not always be quantified, but also

need a place under best practice guidelines to improve patient outcomes. It is

It is however important to realize that evidence-based practice can not exist with only one piece

Research results . Nursing experience and legitimate research evidence should continue to exist

work together to inform evidence-based practice.

Evidence-based practice and technology

One aspect of providing safe and evidence-based patient care is access to large amounts of data

Amount of information about mobile technologies (Doran et al., 2010). The use of this


Technologies are taught by nursing instructors to provide nursing students with evidence-based

based thinking in the clinical area (Raman, 2015). Obstacles to the use of evidence-based procedures

In the clinical area, both RNs and students lack wireless access

Knowledge of relevant and current research results (Doran et al.). By the use of

Mobile technologies can bring current research results directly to the point of care. In addition to

By overcoming the obstacle of accessibility, mobile technology can also improve the relevance of

this knowledge. A study by Doran et al. Investigated the use of mobile technologies

such as personal digital assistants (PDAs) and the implications for the support and use of

evidence-based practice of nursing staff (2010). Doran et al. discovered that if given

Necessary aids (eg smartphones) for the nursing staff were more related to accessing resources

Medicinal and medical information as well as best practice guidelines.

The use of mobile technologies improves access to evidence-based practice

Resources . This is especially important when new nurses and nursing students practice basic skills

Skills .

Implications for the nursing profession

It is imperative that RNs actively seek research knowledge to fill this gap

between theory and practice continues. A study by Stokke , Olsen, Espehaug and

Nortvedt (2015) examined the positive feelings and practice of evidence-based practice with 356

Nurses . They found that the majority of nurses believe that the use of evidence-based procedures contributes

However, for more positive outcomes for patients, many also said that they did not use evidence

consistently and were not confident in how it should be implemented in practice. according to

According to the ICN (2012), the use of evidence-based methods challenges the current approach to care

Practice and patient care, and in this way RNs is responsible for this practice. In the heart of

Nursing is patient-centered care, patient safety and improved patient outcomes. With this in

Mind should RNs strive to understand the broader concept that is an evidence-based practice and

Work within their organization and educational institution the most complete, to ensure and sound

Evidence is used and the policies implemented cover all aspects of care

Care .

Discussion and recommendations
Education programs and related curricula serve as a guiding medium for the design of medical expertise, skills and attitudes, and therefore provide a vital role in determining the quality of care provided. 10 Unique recommendations were related to the ubiquitous integration of EBP in made throughout the academic and clinical curricula. Such integration is facilitated by the explicit inclusion of EBP as a core competency in occupational standards and requirements in addition to accreditation processes. 11

Another focus on communication skills was also seen as key to improving EBP competence, particularly with regard to the achievement of shared decisions between patients and healthcare professionals on evidence-based decisions. A systematic review by Galbraith et al . 12, which examined a “real” approach to evidence-based medicine in general practice, confirms this recommendation by calling for further attention to be paid to the communication skills of healthcare essay help professionals in the context of general practice evidence-based practitioners. This is consistent with the recommendations of Gorgon et al. 13 for the need to familiarize students with the intricacies of the “real” contexts in which EBP is used.

EBP experts, along with trends in empirical research and recognized pedagogical theories, repeatedly provide recommendations for improving EBP teaching and learning strategies. These include (1) the clinical integration of EBP teaching and learning, (2) the deliberate effort of educators to embed EBP in all elements of programs for healthcare professionals , (3) the use of diverse, dynamic teaching and assessment strategies, the in context are specific and relevant to the individual learner / cohort, and (4) “framework” of learning.

In addition to addressing challenges such as the organization of the curriculum and the content / structure of the program , it is recommended to identify the main obstacles to implementing optimal EBP training in order to bring about positive change. 20 Highlighted strategies for overcoming such obstacles included (1) Training of trainers, (2) development and investment of a national coherent approach to the EBP education and (3) structural involvement of the EBP learning in the workplace environment.

National surveys on EBP education offer 21 22 found that a shortage of academic and clinical staff with knowledge of teaching EBP is a barrier to effective and efficient student learning. This was confirmed by results of EBP expert interviews that the allegations of Hitch and Nicola-Richmond match 6, that recommended educational practices and resources are available, their acceptance is somewhat limited. In order to improve the quality of EBP teaching, effective teacher / leader training is required. 10 16 23 24 This formal education should cover academic and clinical trainers. It is necessary to help employees to have confidence and competence in teaching EBP and to provide opportunities for learning in all educational programs to enable concrete changes in this area.

A national and coherent plan, with the associated investment in health education, to integrate EBP has been identified as important for educational outcomes. The lack of a coordinated and coherent approach and the perceived value of EBP in the midst of competing interests, notably in the health agenda, should result in an “ad hoc” approach to implementation and investment in EBP education and related EBP core resources. The results of a systematic review of recommendations for the implementation of the EBP 16 draw attention to a number of actions at national level that have the potential to further promote and facilitate EBP education. Such interventions are at government level policy direction regarding EBP education requirements for health care programs and the rate and funding of a national institute for the development of evidence-based guidelines.

The inclusion of EBP activities in routine clinical practice can promote the consistent participation and implementation of EBP. Such installation can be facilitated at various levels and settings. At the healthcare level, support has been given to providing computer and Internet facilities at the point of care location with associated content management / decision support systems that provide access to policies, protocols, critically evaluated topics, and condensed recommendations. At local workplace level, access to EBP mentors, the establishment of consistent and regular journal clubs, large rounds, examinations and regular research meetings are important to embed EBP in the health and education environment. This, in turn, can foster a culture that could in practice support the monitoring and updating of EBP in day-to-day practice 16 , and theoretically could facilitate the coherent development of cohorts of EBP leaders.

There are study restrictions that need to be recognized. Four of the five respondents were medical professionals. Further involvement of health professionals could have increased the representativeness of the results. However, the primary selection criteria for the participants was extensive and recognized expertise in EBP training, the basic requirements of which exceed certain occupational limits.


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