florence nightingale and early origins of evidence-based nursing
TRANSCRIPT
Florence Nightingale and Early Origins of Evidence-Based Nursing
Cheryl Grohn, MPH, BSN, RN-BCRegional Director, Clinical Informatics North West Region
What is Evidence-based practice?“Conscientious, explicit and judicious use of
current best evidence in making decisions about the care of the individual patient.” 1
Integration of clinical expertise, patient values and best research evidence into decision making process for patient care.
In increasing numbers, nurses as members of interdisciplinary teams are implementing evidence-based practice changes. 2
1 Dr. David Sackett, 1996.
2 Baumann, SL, 2010
Evidence Based Medicine, University of Illinois at Chicago University Library, http://researchguides.uic.edu/content.php?pid=232200&sid=1921074
“The most important practical lesson that can be given to nurses is to teach them what to observe – how to observe – what symptoms indicate improvement – what the reverse – which are of importance – which are of none.”
(Nightingale, 1860)
Florence Nightingale in HistoryNightingale believed
that caring for the sick was a component of Christianity
She was a passionate statistician, developing many of her own survey instruments and in graphical presentation of data
One of Nightingale’s graphs
Nightingale’s work after Crimea
Believing many deaths occurred due to poor nutrition, lack of supplies and overworking of soldiers, she began gathering evidence to present to the Royal Commission on the Health of the Army
She emphasized sanitary living conditions as of great importance. Consequently, she reduced peacetime deaths in the army and turned her attention to sanitary designs of hospitals and introducing sanitation in working-class homes
Nightingale’s TheoryShe believed that studying trends in sanitation
and healthcare provided many answers to questions of disease and mortality
She continued to campaign to improve health standards, publishing 200 books, reports, and pamphlets
Her beliefs led to improvements in hygiene and healthier living and working conditions in hospitals and homes
Her vision was of professional nursing for the sick and the poor versus untrained lay labor
Nursing is a continuous learning process because new and better practices are always being developed
Evidence-based PracticeSystematic data collectionMortality in battle conditionsUniform collection of hospital statisticsExplored differential mortality among
aboriginal peoplesStudied impact of trained versus
untrained nurses on mortality in workhouses
Conducted a landmark study of maternal mortality from puerperal fever
Using Evidence to Guide Policy DecisionsNightingale campaigned to have
statistical knowledge guide public policy decisions.
Unfortunately her proposal was never acted on; it would have undoubtedly led to the earlier and better use of evidence in public policy, health care and other matters
Nightingale’s Important Practical LessonTeach nurses what is important to
monitorHow to monitor itWhat trends show improvementWhat trends show negative
changeWhich indications are importantWhich indications don’t matter
Evidence Based Practice combinesResearch Data CollectionNurse experiencePatient wishes and needs
Benefits of Evidence-based practiceImproves patient outcomesSupports nursing modelReduces healthcare costs by
providing the right treatment the first time
Improves care giver satisfaction