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Changing practice on the basis of evidence
Proving that one nursing intervention or system works better than another has long been a challenge for the profession. Some practice is not grounded in any evidence at all, but rather on a premise that it has always been done in a particular way and is generally considered to be effective.
Ideally everything that nurses do would be evidence-based. But many innovations are sparked by someone's professional intuition, a hunch that changing the way that something is done would be for the better. There would never be any change at all if everyone had to wait for the outcome of a randomised controlled trial before proceeding.
Clinical supervision is an example of an initiative that has been rolled out across the UK on the back of flimsy evidence that it actually works. At least that is the view of research nurse Jane Wright, writing in this week's Nursing Standard.
Another example arose last week when Sally Brearley, chair of the prime minister's care and nursing quality forum, pointed out that there is a paucity of evidence to support 12-hour shifts. Some nurses may like them for personal and professional reasons, and they may save employers money because there are fewer handover periods. But Ms Brearley wants to know more about their effect on patient outcomes.
She could also have mentioned 'intentional rounding', the system advocated by the prime minister in which patients are asked every hour or so if there is anything they want or need. The National Nursing Research Unit (NNRU), which celebrated its 35th anniversary last week, has looked for such evidence and found only a few studies, most of them conducted in the United States.
In one of its excellent Policy+ papers, the NNRU says intentional rounding can produce better outcomes for patients. But it also points out that the system has not been compared properly with other nursing interventions, and that many questions remain. Who does it? How often? For which patients?
What are the implications for skill mix and staffi ng levels? What will it cost? The answers could be uncovered by robust nursing research, but how would that be funded? Nursing as an academic discipline remains relatively young and under-resourced, and the situation is unlikely to improve quickly in a system that rewards traditional academic subjects more richly.
Editorial | September 19 2012 | Volume 27 No 3
Further reading
News: Cameron's care forum chair calls for research into effects of long shifts
Letters: Evidence-based nursing is the cornerstone of our profession
Letters: PM wants nurses with pretty hats doing 'trolley dolly' rounds
Art & Science: Clinical supervision: a review of the evidence base
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Nursing Standard is published every Wednesday by RCN Publishing Company Ltd, the publishing company of the Royal College of Nursing.
It seeks to promote professional excellence, and encourage creativity and innovation in nursing, midwifery and health visiting practice. Nursing Standard also aims to enhance nurses' and healthcare assistants' career development and to help them achieve and maintain a healthy and rewarding working environment. Nursing Standard is editorially independent and the opinions expressed are not those of the RCN or of the contributor's employing organisation unless specifically stated.
The RCN Publishing Company is a wholly owned subsidiary of the Royal College of Nursing, the world's largest organisation for nurses. RCN Publishing produces one weekly, eight monthly and two quarterly nursing publications. Nursing Standard, the flagship journal, is the UK's biggest selling weekly for nursing. It is produced by RCN Publishing Company along with a suite of specialist nursing journals - Cancer Nursing Practice, Mental Health Practice, Learning Disability Practice, Nursing Children and Young People, Nursing Management, Emergency Nurse, Nursing Older People, Nurse Researcher and Primary Health Care. RCN Publishing Company also produce the RCN Bulletin, a major source of up-to-the-minute information for RCN members in all specialities, grades and working environments. With the latest nurse vacancies from trusts nationwide, it has become the most cost-effective nurse recruitment magazine available.