Getting Real

Michelle Troseth, RN, MSN, DPNAP, FAAN, Chief Professional Practice Officer, Elsevier Clinical SolutionsAccomplished and highly-qualified RN and Chief Professional Practical Officer Michelle Troseth writes The Case for an Evidence-Based Practice Framework for All Clinicians.

Ok, I'll bite.  As nurses, how do we do evidence-based care? In the real world?

In nursing school, we were exhorted to make evidence the basis for our practice.  In practice, that meant:  look things up.  Find the current research.  Judge its quality, i.e. look for that "gold standard" -- double-blinded, randomized, preferably longitudinal, with good controls, big Ps and corroborated by meta-analyses.  Make this the basis for our clinical decisions.

It is good advice in theory, but how do we make it our practice?  More to the point, have we seen a single nurse who actually does any of this in real life?  Are we supposed to sit in front of the computer instead of doing actual patient care?  A pink slip would be waiting at the end of our shift!

So how do we get the best evidence into our hands, just-in-time, at the point of care, without losing time (of which we already have not nearly enough)?

I offer a modest proposal.  Ms Troseth's company is a major provider of clinical information to nursing students.  We used lots of their materials in nursing school, some on paper (e.g. text books) and some on-line (e.g. case studies and test prep modules).  Linking the evidence upon which these materials are based to the real-world tasks that the NurseMind app tracks -- in real-time, on the hospital floor, while the nurse is working his or her shift -- will get it into his or her hands in a hospital-sanctioned way, at the point of care, and with virtually no overhead in terms of time taken away from patient care.

Need to review the best evidence for a particular task that you're about to do?  E.g. you need to place an NG tube.  It's a month or two since you last did one and you want a review of the best evidence so you can give the best possible care to your patient.  A couple of taps on the NG tube task icon in your pending task list in the app and you're watching the one-minute NG tube video.  The app put the link there because it knew you had this task coming up.  The same support you had as a nursing student on your clinical rotations proves invaluable to you as a working nurse.  Evidence-based practice is now realistic.  Problem solved.

Let's make it happen!