Evidence-based Practice - Evidence-based Practice Vs. Intuition

Evidence-based Practice Vs. Intuition

Evidence-based practice (EBP) involves complex and conscientious decision-making which is based not only on the available evidence but also on patient characteristics, situations, and preferences. It recognizes that care is individualized and ever changing and involves uncertainties and probabilities.

EBP develops individualized guidelines of best practices to inform the improvement of whatever professional task is at hand. Evidence-based practice is a philosophical approach that is in opposition to rules of thumb, folklore, and tradition. Examples of a reliance on "the way it was always done" can be found in almost every profession, even when those practices are contradicted by new and better information.

However, in spite of the enthusiasm for EBP over the last decade or two, some authors have redefined EBP in ways that contradict, or at least add other factors to, the original emphasis on empirical research foundations. For example, EBP may be defined as treatment choices based not only on outcome research but also on practice wisdom (the experience of the clinician) and on family values (the preferences and assumptions of a client and his or her family or subculture).

Research oriented scientists, as opposed to authors, test whether particular practices work better for different subcultures or personality types, rather than just accept received wisdom. For example, the MATCH Study run at many sites around the US by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) tested whether particular types of clients with alcohol dependence would benefit differentially from three different treatment approaches to which they were randomly assigned. The idea was not to test the approaches but the matching of clients to treatments, and though this missed the question of client choice, it did demonstrate a lack of difference between the different approaches regardless of most client characteristics, with the exception that clients with high anger scores did better with the non-confrontational Motivational Enhancement approach which has been demonstrated superior in a meta-analysis of alcohol treatment outcome research and only required four as opposed to twelve session within Project MATCH.

The theories of evidence based practice are becoming more commonplace in nursing care. Nurses who are “baccalaureate prepared are expected to seek out and collaborate with other types of nurses to demonstrate the positives of a practice that is based on evidence.” Looking at a few types of articles to examine how this type of practice has influenced the standard of care is important but rarely internally valid. None of the articles specify what their biases are. Evidence based practice has gotten its reputation by examining the reasons why any and all procedures, treatments, and medicines are given. This is important for refining practice so the goal of assuring patient safety is met.