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Non-Pharmacological Examples of Evidence-Based Practice

The world of medicine is constantly changing, and healthcare professionals cannot afford to stay stagnant and "do what we have always done." Instead clinicians must focus on proven best-practice strategies based on peer-reviewed research for optional patient outcomes. This is the basis of evidence-based practice (EBP). Patients need it, payers demand it, and accreditation requires it.

The National Academy of Medicine (previously known as the Institute of Medicine) has a goal of "90% of clinical decisions will be supported by accurate, timely and up-to-date clinical information, and will reflect the best available evidence."

Additionally, today's healthcare consumers assume a more active role in their care. Clinicians and patients work together to make decisions using a shared-decision model. Patient-centered care invites the patient's input of their goals and wishes into their plan of care.

Nurses are at the forefront of translating and integrating research into care delivery through evidence-based practice. This helps patients receive the most effective care based on the most current research possible.

What Is Evidence-Based Practice?

Healthcare based on EBP considers three major components: the best research evidence, clinical expertise, and the patient's values and preferences. The EBP process encourages nurses to individualize patient care and empowers them to provide high quality care (Melnyk 2019).

           Best Research Evidence + Clinical Expertise + Patient Input = EBP

Evidence-based guidelines, or clinical practice guidelines, are statements of evidence and consensus of experts based on a review of the best available research. Guidelines are not hard rules; they help guide patient care while leaving room for personalization.

Three Non-Pharmacological EBP Nursing Interventions

Every day in your nursing practice, you make decisions about interventions for your patients. Yet are they based on clinical practice guidelines or EBP? Do they take into account patient values or wishes? For example, if your patient is interested in complementary therapy to control nausea and vomiting, you might explore evidence for ginger, aromatherapy or acupressure. Below are three examples of non-pharmaceutical nursing EBP interventions.

1. Use exercise to fight cancer-related fatigue.

Cancer survivors have named cancer-related fatigue a major cause of distress in their lives, according to the National Comprehensive Cancer Network. Exercise (or physical activity) is the only research-based intervention proven to relieve cancer-related fatigue and recommended for practice by the Oncology Nursing Society (ONS). The ONS uses a stoplight color model to guide interventions for symptom management. Green for "go" are interventions recommended for practice, such as exercise to manage fatigue.

2. Encourage patients to chew gum after abdominal surgery.

Chewing gum is thought to reduce post-operative ileus (POI) — "a malfunction of intestinal motility" — by aiding the recovery of the digestive system. One surgical unit nursing team offers sugar-free gum to alert patients, and instructs them to chew four times a day or more starting six hours after surgery. This intervention is a result of an EBP nursing research pilot study. This simple, cost-effective intervention can reduce POI, reduce costs, and alleviate the patient's pain and suffering.

3. Use a structured, culturally sensitive approach to spiritual needs of patients.

EBP interventions extend to holistic patient care. Patients and caregivers often rely on spirituality and religion to assist them with serious illness. However, many nurses lack the time and preparation necessary to successfully meet those needs. An evidence-based spiritual toolkit can help bridge this gap. Additional resources can be found at your hospital or in your community to improve spiritual well-being.

Is EBP Just for Patients?

Nurses often have high levels of stress, anxiety or depression. In addition, those working in high intensity areas like critical care, pediatrics or oncology may experience compassion fatigue, moral distress and secondary trauma. This can result in high staff turnover or burnout. Mindfulness-based stress reduction (MBSR) is a proven intervention through EBP that can help preserve the psychological well-being of nurses.

Mindfulness is simply paying attention to the present moment, purposefully focusing on what is happening, what you are doing and the space around you. MBSR can improve well-being by helping to decrease inflammation, lower blood pressure, fight fatigue, lower pain, and improve stress and mood. This skill is learned, and it can improve well-being for both nurses and patients

EBP is about challenging the status quo and changing your nursing practice to best meet the needs of your patients. It is about asking questions, acquiring the best evidence, and improving patient care. EBP applies to all aspects of holistic nursing care — the mind, body, and soul of patients and nurses.

Linda Chan, one of the 2018 DFW Great 100 Nurses, is an evidence-based practice certified nurse. She says, "I derive a lot of work satisfaction from being involved in the EBP process: asking a question, forming a team, analyzing the evidence, creating an implementation plan, evaluating outcomes, and disseminating results. Knowing this process makes a difference increases my sense of well-being as a nurse."

Earning your Bachelor of Science in Nursing (BSN) through an online RN to BSN program can help you better understand how to apply EBP into your everyday nursing practice as program content focuses on how to ingrate research, practical knowledge and clinical experience to enhance your nursing practice.

Learn more about the University of Southern Indiana's online RN to BSN program.


Sources:

NCBI: Institute of Medicine Roundtable on Evidence-Based Medicine

Agency for Healthcare Research and Quality: Strategy 6I: Shared Decisionmaking

Wolters Kluwer: Evidence-Based Practice in Nursing & Healthcare

NCBI: Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence: Part III

National Comprehensive Cancer Network: Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue

NCBI: The Effect of Exercise on Cancer-Related Fatigue in Cancer Survivors: A Systematic Review and Meta-Analysis

Oncology Nursing Society: Fatigue

Oncology Nursing News: Gum Chewing Helps Prevent Intestinal Blockages in Oncology Patients After Abdominal Surgery

NCBI: A Spiritual Care Toolkit: An Evidence-Based Solution to Meet Spiritual Needs

NCBI: Mindfulness-Based Stress Reduction for Psychological Distress Among Nurses: A Systematic Review

UT Southwestern Medical Center: UT Southwestern Nurses Named Among DFW's Great 100 Nurses

Medpage Today: Management of Postoperative Ileus (POI) Following Bowel Resection

Linda Chan, personal communication, September 19, 2019

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