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In Kathleen Dracup and Christopher W. Bryan-Brown’s editorial titled "Evidence-Based Practice Is Wonderful ... Sort Of " (July 2006: 356–358), they reflect that changing hospital culture is difficult. They explain that nurses and physicians currently are aware of evidence-based guidelines and that following these guidelines improves patients’ outcomes. I agree that most critical care physicians in a teaching hospital environment recognize and use current evidence-based practice, but I must disagree that most critical care nurses are aware of evidence-based practice.

In fact, some critical care nurses and most critical care step-down nurses are not aware of current guidelines for specific diseases such as the guidelines for treatment of atrial fibrillation by the American College of Cardiologists (ACC) and the American Heart Association (AHA). I know because I have asked critical care nurses in the step-down unit what they think is the best way to treat acute episodes of atrial fibrillation. The answers I receive are somewhat correct, but they are never based on current ACC/AHA guidelines. A recent online survey¹ revealed that 60% of active nurses have a low-to-moderate level of awareness of evidence-based practice.

Furthermore, most step-down critical care nurses do not feel proficient in suggesting evidence-based practice to a physician or other healthcare provider. I believe this is because they are unaware of best-practice guidelines. Teaching rounds are not commonplace in step-down units, effectively preventing the valuable teaching and coaching conversations that otherwise could be taking place.

When nurses are unaware of current evidence-based therapies, they tend to treat a patient using their current knowledge base (which is limited) or simply by following doctors’ orders. Nurses and physicians should be aware of evidence-based guidelines and should practice evidence-based care. Nurses also should speak about best practice therapies when they suggest treatment and should become comfortable doing so.

Lori R. Chester, RN
Brownstown, Mich

REFERENCE

1. Advance for Nurses (September/October 2006). Available at: http://www.advancefornurses.com. Accessed October 6, 2006.

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