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Promoting evidence-based practice in spinal cord injury/disorders health care
Nelson A, Weaver FM. Promoting evidence-based practice in spinal cord injury/disorders health care. SCI nursing : a publication of the American Association of Spinal Cord Injury Nurses. 2004 Jul 1; 21(3):129-135.
IntroductionWe are continuously challenged to provide high-quality, appropriate, timely, and cost effective care for persons with spinal cord impairment (SCI). One strategy to address this goal is the use of evidence-based practice (EBP). EBP is defined as the diligent and careful use of current research in the day-to-day management of individual patients. It affects clinical decisions, patient treatments, and patient/provider interactions (Haynes, Sackett, Gray, Cook, and Guyatt, 1996; Sondenaa, Nesvik, Solhaug, and Soreide, 1997). In an ideal world, evidence would be incorporated into practice immediately, but in the real world this process can take years. Rarely do busy clinicians have time to analyze and synthesize all pertinent clinical research applicable to each clinical issue that arises in practice. Advances in science and new technologies are growing at a pace that exceeds the assimilation ability of even the most dedicated clinician. To this end, clinical tools, such as practice guidelines (CPG), can provide a summary of the best evidence. Implementation of CPG can improve the process and outcomes of health care, decrease practice variation, and optimize resource utilization (Cook, Greengold, Ellrodt, and Weingarten, 1997). The series of articles presented in this issue of SCI Nursing describe several different approaches to implementing CPG in diverse SCI practice settings. The purpose of this article is to provide an overview of the process of applying research to practice. Applying research to practice requires a systematic approach to overcoming clinician-perceived barriers. Nurses play a pivotal role in implementing CPG and other EBP initiatives. This article is organized into four main sections: 1.Six common myths about implementing evidence into practice will be described, and efforts to dispel each myth will include current 'evidence' for implementing research into practice. 2.Two national initiatives will be described that support clinicians in bridging the gap between clinical practice and research: (a) Consortium for Spinal Cord Medicine CPG and (b) SCI Quality Enhancement Research Initiative (QUERI). 3.Three strategies for overcoming barriers to implementing EBP will be discussed: (a) creating a culture of EBP, (b) building capacity to change to EBP, and (c) sustaining and reinforcing EBP through organizational infrastructure. 4. 'Lessons learned' in implementing EBP in SCI practice will be presented. This opening article serves to introduce the reader to subsequent articles published in this issue of SCI Nursing, focusing on the arduous, yet rewarding process of effective implementation of EBP.