CHAPTER 2
Professional Practice and the Mandate for Evidence-based Practice

FIVE THINGS TO LEARN FROM THIS CHAPTER

1. Evidence-based practice (EBP) originated from evidence-based medicine (EBM), which advocates a scientific approach to practice.
2. EBP consists of three interrelated parts: evidence; expertise; patients.
3. EBP is a stepped process involving asking questions; locating the evidence; appraising the evidence; integrating the evidence; and evaluating the outcomes.
4. Hierarchies of evidence illustrate the weighting given to different types of evidence in solving clinical problems.
5. There are limitations and criticisms relating to EBP that must be addressed when considering effective ways to use evidence for practice.

FIVE MINUTES WITH SARA, MIDWIFERY STUDENT

Do you see evidence being used in practice?

I think evidence is used in practice, but I do not always think that people know the reason behind why they are using it fully. Sometimes it seems like we as students are more aware of the evidence base on an issue than the registered staff who have been in practice a long time.

It takes a long time for evidence to filter through to practice, because of the EBP process. It also takes a lot of organisational support. COVID was a good example of how changes can be implemented quickly when everyone is on board and supporting it. Otherwise, it can take years to change the existing culture of the ward. The other issues are just the current pressures - no staff, no time.

In what assignment did you have to write about EBP?

I've written about EBP several times during my programme. Specifically, a couple of appraisal assignments and now my dissertation. However, EBP has been incorporated in most assignments throughout the course, particularly in year 2.

What advice would you give to students learning about EBP for the first time?

I think it's helpful to motivate yourself, for example thinking about the benefits to your own practice and your future working life. When you understand evidence you can understand the reasons for certain changes in practice and it can help you to keep up with developments. Healthcare is so dynamic, and things are always changing. You need to be able to adapt.

You should read the materials given and attend classroom lessons as we are all different types of learners. Ask questions, remember there are 'no silly questions!' EBP will be part of your future careers and it will be required on a daily basis. This reinforces the importance of understanding EBP so it can be put into practice in order to provide safe and quality care.

2.1 INTRODUCTION

In this chapter we will introduce you to the concept of evidence-based practice, which is more commonly known by its abbreviation, EBP. This may be something you are familiar with already or just starting to learn about, but what does it actually mean for you, the patients you care for, and the profession you are joining? This chapter will help you to understand how EBP can benefit your professional practice and the care you provide, but will also explain its complexities and how they can be discussed in your EBP assignments.

The chapter begins by explaining the relevance of EBP for healthcare professions and why research assignments are so commonly found in pre-registration healthcare programmes. The chapter then explores the historical development of the EBP movement, the evolution of its definition, and the EBP process. We then determine what is meant by 'evidence' and why hierarchies exist to rank some evidence as stronger than others. Finally, we present current debates and different perspectives on EBP and end by giving some guidance on how you can discuss EBP in your assignments.

2.2 RELEVANCE: WHY HEALTHCARE PROGRAMMES HAVE EBP MODULES

EBP or research-specific modules are common in all healthcare programmes. Even where there are no dedicated modules, assignment briefs and learning outcomes across several modules will specify that students need to demonstrate their ability to locate, understand, appraise, and apply evidence to various health topics. But why is this the case?

Although the use and role of evidence in practice are not always obvious, think for a moment what practice would look like if it was not informed by research evidence, and was instead based on what had always seemed to work. Do you think we could still advance patient care? Improve patient outcomes? Make the experience of being a service user better? The answer is no. To effectively navigate the evolving healthcare landscape, manage complex illnesses, meet the needs of diverse communities and collaborate within a multidisciplinary team, you must be able to engage with evidence.

In professional terms, EBP is an essential criterion for being a health registrant, as it supports standards of autonomy, accountability, and the maintenance of appropriate knowledge and skills. Being competent to engage with a range of evidence means that we can make informed judgements, as part of a healthcare team. This enables us to offer balanced advice to patients about what interventions may be most effective and what side effects might occur. It means we can work with our practice teams to decide what shift patterns might be safest and what skills are essential for the role. It helps us to weigh up the costs and benefits of a new health facility and how that might meet the needs of a particular community. It should come as no surprise, then, that EBP is embedded in our professional codes, meaning that it is a requirement of professional practice to be able to use evidence rather than an optional extra. Box 2.1 gives examples of some regulatory codes of practice and emphasises that joining a professional register means we are agreeing to practice in an evidence-based way.

Box 2.1 Extracts from Professional Codes

The Code (NMC 2018a, p. 9)

• 6. Always practise in line with the best available evidence

To achieve this, you must:

• 6.1. make sure that any information or advice given is evidence-based including information relating to using any health and care products or services

Standards of Proficiency for healthcare professionals (HCPC 2023a-c)

• 11. assure the quality of their practice
• 11.1. engage in EBP
• 11.2. gather and use feedback and information, including qualitative and quantitative data, to evaluate the response of service users to their care

Assistant Practitioner (Health) Occupational Standard (Institute for Apprenticeships and Technical Education 2016)

Knowledge

• Research and development in the health and social care sector to inform and improve quality of care
• Duty 10 Promote an evidence-based approach to providing health and care services, participating in quality improvement and research activity

In personal terms, there are additional benefits from developing EBP skills. Being able to acquire, understand, and apply evidence related to your field of practice can increase your confidence in practice within your team and when interacting with patients. More broadly, being proficient with evidence can encourage personal development and a self-motivated learning mindset that can help you problem-solve and manage challenges in all areas of life. What's not to love about that?

Having said that, we know it can feel like EBP is far removed from real life, conducted and reported by some distant researchers who understand little about the front line of providing care. But often those researchers are health professionals like you, and EBP is a way of bridging the gap between the vast bank of research evidence and the everyday world of practice.

So, your EBP modules and assignments are there to help you personally and professionally to understand the most effective ways of delivering healthcare, and to develop the skills to use evidence to improve your own practice interests.

Assignment Tip

EBP assignments vary considerably in their expected scope and focus, so you should check that you are clear on the assessment brief and learning outcomes for your specific module. For example, while most assignments will require a robust discussion of what EBP is and how it supports good practice, you should clarify how much is expected in terms of the related history, theory, and current debates. Key issues relating to EBP include the following, so check with your tutor if you are unsure:

• The relevance of EBP to healthcare professions
• The historical development of EBP
• The evolving definition of EBP
• The process of EBP and how it works in practice
• Types of evidence and evidence hierarchies
• Debates and criticisms about EBP

2.3 DEVELOPMENT: WHERE DID EBP COME FROM?

EBP is one of the most important developments of the last 50?years for helping healthcare professionals to provide safe and effective patient care. It evolved from EBM, a term that was coined in the early 1990s by Gordon Guyatt, although the foundation for the EBM movement was...