The earliest stages of training as a nurse involve learning to follow protocols, but as you begin to advance, you will soon learn that a lot depends on your ability to think on your feet and solve problems. Over time, this becomes more and more challenging, so you will need protocols to help you approach it successfully. Evidence-based problem-solving is designed to ensure that you address problems using the best available information, that you enhance your understanding in the process, and that you put yourself in a position where you can pass on useful learning to your colleagues. In this way, you will be able to do a better job, and so will your whole team.
The importance of curiosity
All effective problem-solving begins with curiosity. This is why, when you’re first earning an online DNP, you’ll find that you are encouraged to ask questions about any aspect of what you’re taught that you find yourself wondering about — and this, in turn, is something that you should encourage in people you go on to mentor. Building up your stock of general knowledge will help to point you in the right direction when you’re looking for evidence. The process of asking questions — and paying close attention to how your tutor reply — will also help you to get better at framing them so that you are more likely to obtain useful answers.
The PICOT model
When it comes to asking questions in the course of your nursing work, the PICOT model will help you frame them in the most effective way. PICOT stands for population, intervention, comparison, outcome, and time. First, you need to define the population group you’re asking about. This could be simple, such as all elderly patients, or it could be intersectional, such as all elderly female patients. In the latter case, if you can’t find information on elderly female patients specifically, you may have to base your assessment on information on elderly patients and information on female patients. In this case, however, it is vital to think about how those two factors intersect, i.e., to ask if there are qualities (often risk factors) that occur as a result of being both female and elderly, but which do not apply more generally to either elderly people or women and to consider whether or not those factors are likely to be relevant to the problem you’re trying to solve.
The next factor you need to define is the intervention you’re asking about. This could be anything, but let’s take hydrotherapy. You then need to define your point of comparison. You might ask, “How do elderly women benefit from hydrotherapy, as compared to the general population?” Having asked that question, you would be ready to go looking for research that might answer it. You would then have to reflect on point four — the outcomes of that research — in relation to point five, the time over which those outcomes were measured. This would put you in a position to decide whether or not it might be useful to try treating your elderly female patients with hydrotherapy, and, if so, how long a course you would expect would be needed before getting the desired result. There would, however, be other factors to consider before making a final decision.
Quality of evidence
Before you rush to act based on the evidence you’ve looked at, you will need to consider the quality of that evidence. There are several questions you should be asking here. Did you find it in a reputable journal? Was it peer-reviewed? Were the people who carried it out, and the peer reviewers, suitably qualified in the subject area so that you can be confident that they knew what they were doing? Has anybody else replicated the research and got the same results? You should also read the research carefully and see if you can identify any other factors that might explain or complicate the results. For instance, did the participants have any other factors in common besides the characteristics you want to find out about?
Sometimes it is still possible to make useful decisions based on imperfect evidence, but if you do this, you should be extra cautious about any possible risks to the patient’s well-being, and you should let the patient know about your uncertainty before obtaining consent.
When you seek to base your decisions on evidence, you shouldn’t be leaving your own judgment at the door. As an experienced professional, you have the expertise of your own that can be brought to the table. Your decision should be based on but not dictated by the evidence you find. If you have doubts about it that you can’t pin down or questions you struggle to answer, remember that you can also draw on the clinical expertise of your colleagues. Look for parallels with the problem that you’re trying to solve in your past experience and theirs, and reflect on how what was learned then compares with what you have found in research. If you still can’t come to a clear conclusion, this is usually an indication that you need to seek out further evidence, perhaps by looking at material that is slightly less pertinent yet still has a bearing on the topic at hand.
What the patient wants
Where difficult decisions about treatment pathways are being made, it is always advisable to involve the patient as much as possible, unless they have specifically requested that you or other medical staff make all the decisions on their behalf. Obviously, patients vary in their ability to understand complex considerations, but you should never start with the assumption that they are incapable of understanding. If they are scientifically literate, in any discipline, then they should be able to make sense of research papers with a little support when it comes to terminology. Even if they are completely uneducated or have a subnormal level of intelligence, they should be able to make sense of the basic issues involved if you talk them through it patiently using simple language.
It’s increasingly common for questions about possible treatment to be initiated by patients themselves as they read up on their conditions on the internet. In some instances, this may alert you to possibilities that you hadn’t considered, whereas in others, even if they haven’t fully understood the issues, this makes a useful starting point for discussions that will help them to participate more meaningfully in determining the best way forward.
Evidence-based problem-solving is not simply about making better one-off decisions. It’s about contributing to the larger story of knowledge. This means that when you make decisions in this way, it’s important for you to evaluate the outcomes and reflect on their relationship to the evidence that you initially drew on. This is equally important whether the outcome is a success or failure, whether it corroborates earlier findings or contradicts them. Indeed, it’s still valuable even if your observations are inconclusive. If properly recorded, all of this information may help another nurse who is faced with a similar problem in the future. Most studies in the field of health care do not have a large cohort of participants to draw on, so the addition of data pertaining to further cases, as it accrues over time, can help to make them much more robust or to call them into question, potentially prompting further research, which may get them a little closer to establishing what’s really going on.
Share what you learn
Having gone through the whole evidence-based decision-making process and evaluated the outcomes, the final stage is for you to share what you have learned. There are several routes through which you can do this, and which is most appropriate is likely to depend on the scale on which you were working, though it might also be influenced by the significance of the results as a potential prompt for further research or technological development. If you think that you have something really important, you could write a scientific paper and submit it for peer review. Alternatively, you might choose to raise your findings in a letter to an appropriate journal. As an alternative to this, if you think the matter is less significant, or as an adjunct to it, you could discuss your findings with colleagues. Extending this into social media spaces used by nurses or other medical personnel can help you to reach more people and ensure that they all get the benefit of what you have discovered.
Evidence-based decision-making is one of the key processes through which nurses are able to ensure that their work takes a reasoned and collaborative approach, with benefits for their own patients and others. When it is approached properly and diligently recorded, even failures can contribute to the overall progress of the profession. It helps nurses avoid having to reinvent the wheel, and it gives future nurses a big advantage, by ensuring that patient care gets more and more effective over time.