NHS Evidence and the Principles of Nursing Practice: Getting to grips with evidence-based practice
Dr Jenny Gordon, Programme Manager for Evidence into practice - Royal College of Nursing (RCN) believes NHS Evidence provides an excellent resource for nurses to use in supporting ‘Principle F’ of the RCN Principles of Nursing.
The RCN Principles of Nursing Practice, which were launched last year, outline what individuals can expect from nursing in any setting, whether they are colleagues, patients, or families and carers of patients.
They have been adopted by many organisations as a sign of their commitment to excellent nursing care and as a tool for improving quality. This article concentrates on Principle F, which is concerned with evidence-based practice, technical skills, education, training and clinical reasoning.
The Principles were developed in collaboration with nurses, patients, families, professional and patient organisations. As part of the engagement process, respondents stated that one of the Principles (Principle F) should address evidence-based practice, but also that nurses should have the ability to interpret and implement that evidence. This not only requires up-to-date training and skills but also the use of clinical reasoning, which is described in the principle as ‘the ability to apply evidence according to the needs or context of the individual patient’.
We know 35% of nurses use the internet for work purposes several times a day to access guidelines, best practice information, journal articles and policy information to inform care decisions and as part of their continuing professional development. The challenge is to provide the full range of information required in a way that is easy to access and assimilate.
There is a vast amount of information available on the internet and some of the information is not necessarily of good quality. Nurses need to be able to trust that the sources of information that they access are accurate and objective.
To access high quality evidence I recommend nurses use NHS Evidence as one of their tools - the portal that provides free access to authoritative clinical and non-clinical evidence and best practice, including guidelines, policy information and the latest research.
The new version of NHS Evidence provides nurses with rapid access to an even greater range of searchable and recognisable evidence resources including NICE, SIGN and the Cochrane Library.
Nurses who have an Athens account get free access to paid-for reference databases (e.g. CINAHL, the Cumulative Index to Nursing and Allied Health Literature). For nursing prescribers it also provides direct access to the British National Formulary (BNF) as well as resources collated by the National electronic Library for Medicines (NeLM) and the electronic Medicines Compendium (eMC).
Note: Nurses working in the NHS can register for a free NHS Athens password.
Driving up the standards of guideline production
A fundamental part of NHS Evidence is the NHS Evidence Accreditation Scheme which rigorously assesses the processes used by organisations to produce guidance. Organisations that have met this quality standard - such as The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Paediatrics and Child Health (RCPCH) - are able to display the NHS Evidence Accreditation Mark on their publications. NHS Evidence is currently evaluating how its accreditation programme can be extended to cover processes used to develop other types of guidance and advice - for example, commissioning guidance. Other developments planned for the NHS Evidence Accreditation Scheme include clinical decision support tools, which can bring substantial benefits to patients. NHS Evidence are currently working on an accreditation process to assess the information that underpins clinical decision support tools and are undertaking a pilot with a number of leading providers. The focus of the pilot is to look at how the information contained in these decision support tools is collected and quality assured for inclusion.
Keeping up to date with clinical practice
Keeping up to date with NICE guidance can be a difficult task. Since its formation, NICE has produced over 700 pieces of separate but interrelated guidance. In May NICE launched a new presentation of NICE guidance, as online interactive pathways. These bring together all related guidance in a particular topic area, including relevant implementation tools and Quality Standards. NHS Evidence provides access to NICE Pathways to allow visualisation and browsing of associated NICE products.
The pathways cover all NICE products including:
- technology appraisals
- interventional procedures
- clinical guidelines
- medical technology and diagnostics guidance
- public health guidance
- quality standards
- accompanying tools produced by NICE to support implementation.
Using NHS Evidence in practice
If we use nutrition as an illustration, and carry out a general search for ‘Nutritional Assessment’ on NHS Evidence, the search brings up 3,735 results. These results can then be filtered by date or type of information. By applying the types of information filter you get 114 results for nutritional assessment care pathways and 15 commissioning guides, so you can identify specific sources of evidence quickly. You can also filter by queries such as ‘symptoms’ or ‘therapy’. Medicines and devices are filtered alphabetically. This means that nurses can tailor the search to their individual requirements.
The NHS Evidence ‘My Evidence’ functionality provides the option of creating a personal log to track and record your searches as well as receiving personal alerts when new information becomes available. This is an important facility in terms of saving information for Continuing Professional Development (CPD) so as a nurse, your practice remains up to date.
‘Nurses and nursing staff promote care that puts people at the centre, involves patients, service users, their families and their carers in decisions and helps them make informed choices about their treatment and care’ (Principle D). Patients and service users often access the internet for information and often need a range of different information. Only patient information accredited under the Department of Health’s Information Standard is available through NHS Evidence so nurses can be confident about recommending this resource to their patients. Patients and service users may be less interested in clinical guidelines and more interested in treatment options or medicines. We need to make sure that patients have access to information that is written in a way that is easy to understand. Evidence summaries that give an overview of all the available evidence to help patients make choices about their care can be useful. Patient information leaflets/booklets may also be relevant.
If we search nutrition ‘patient choices’ on NHS Evidence, we find a number of the Patient UK publications: ‘Five Choices to help you stay healthy’ (2010); ‘Health benefits of the Mediterranean diet’ (2009); ‘Eating Disorders: a self help guide’ (2011).
There may also be specific cultural requirements that need consideration. Using nutrition again as an example, a search for ‘nutritional assessment’ - which includes ethnic specific considerations - yields 1,156 results on NHS Evidence, including: the American Heart Association guideline for assessment of cardiovascular risk in asymptomatic adults; the NICE Guideline ‘Pregnancy and Complex Social Factors’; and ‘European Food and Nutrition Policies in Action’ published by The WHO. This demonstrates the breadth of information available.
The ability to apply a combination of technical expertise, clinical reasoning and evidence appropriate to a range of healthcare settings develops over time, and as a result of formal teaching, experiential learning, effective mentorship and reflective practice. We need to continue to ensure that nurses have the opportunity to work and learn in this way. However, easily accessible evidence is a fundamental requirement in ensuring that patients experience safe, effective person-centred care. NHS Evidence can help make this possible by providing nurses with free, rapid access to comprehensive, up-to-date, quality information, and support tools to help implement best practice.