Chapter 1 of Evidence-Informed Health Policy, published by Sigma, explores the rationale for adapting clinical practice-focused models for use in policymaking.
KEY CONTENT IN THIS CHAPTER
- The use of evidence in policymaking
- The evolution of evidence-based practice (EBP)
- Adapting EBP for use in health policy
- Why now is the time: reaching critical mass
- The use of research and evidence in policymaking in other countries
- The imperative for using evidence in health policymaking
- Evidence-based versus evidence-informed
- Definitions of evidence-informed policymaking
The Use of Evidence in Policymaking
Healthcare providers and consumers expect that the policies that drive, guide, and underpin healthcare will be safe and effective. Strong governmental health policy forms the foundation for healthcare funding, sustains programs for special needs groups who might otherwise find it challenging to access adequate care, and, at the state level, establishes the parameters for health professionals’ scopes and standards of practice.
Nurses and other healthcare professionals involved in various professional organizations work tirelessly to advance health policy initiatives and have long mentored newcomers to their organizations who desire to do this work. Time, experience, and trial and error make for great teachers, and much of policymaking is informed by those factors. However, today’s healthcare environment is so complex that trial, error, and opinion are insufficient for developing informed policy. It is therefore incumbent upon educated health professionals to press for the judicious use of science and evidence in policymaking. To do that, we must arm ourselves not only with the best evidence but with a full and realistic understanding of the political processes that are part and parcel of policymaking.
This chapter reviews the evolution of the use of evidence in the practice of medicine, in nursing and healthcare, and to inform policymaking. It presents some of the most-used evidence-based practice (EBP) models and discusses the rationale for adapting clinical practice-focused models—that is, EBP models—so they can be useful in the policymaking environment. Finally, it addresses controversies surrounding the terms evidence-based and evidence-informed and defines evidence-based policymaking.
The Evolution of Evidence-Based Practice
Historically, good conventional medical practice was based on tradition, and clinical measures considered to be successful were passed on from mentor to student. This unquestioned practice of treating patients based on an oral tradition of unknown or forgotten origin began to change in the late Middle Ages, when physician-scholars—often men of the cloth—took on the practice of medicine. These healers focused on gaining a new understanding of past thought and practice through the exploration of natural science and experimentation and the search for medical truth (Daly & Brater, 2000). Historians believe the early foundations of evidence-based medicine were laid in the 17th and 18th centuries—a positive effect of the Enlightenment, as medicine turned toward the evaluation and interpretation of scientific evidence (Gerber, Lungen, & Lauterbach, 2005). The use of EBP, as we have come to know it, grew out of this long, slow evolution toward EBM.
Evidence-Based Medicine to Evidence-Based Practice
As the conduct of research in medicine evolved, practice developed and changed in response, keeping pace with the available science. But as this conduct of research became more sophisticated and the practice of medicine matured, physicians realized that findings from a single study—no matter how robust—were insufficient to ethically justify sweeping change in practice. Accordingly, practitioners sought to integrate a body of work culled from the best research findings into their practice.
In addition to the problems associated with insufficient evidence, the time it takes to conduct research and the lag between publication of research and adoption of the knowledge gleaned by that research into practice also became apparent. Incredibly, the average time lag in the health research translation process is 17 years (Morris, Wooding, & Grant, 2011). To improve this process, the field of translation science developed. Titler (2014) defines translation science as “a field of research that focuses on testing implementation interventions to improve uptake and use of evidence to improve patient outcomes and population health, and to explicate what implementation strategies work for whom, in what settings, and why” (p. 270).
Time and experience yielded valuable lessons about how to translate findings from research into practice. But science, isolated from the realities of practice, could not serve the needs of both practitioners and patients. Human factors needed to be considered, including clinician experience and judgment, as well as the patient’s lived experience, values, and healthcare objectives. As a result, a process that integrated scientific findings, the patient’s needs, and the practitioner’s expertise was developed by physicians for use in medicine. It was, and is still, called evidence-based medicine (EBM).
As EBM evolved, its definition included reference to the conscientious use of current best evidence for making decisions about patient care (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). An updated and well-accepted definition is: “Evidence-based medicine (EBM) requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances” (Straus, Richardson, Glasziou, & Haynes, 2011, p. 1).
The term EBM is self-limited because it refers only to the practice of medicine. Consequently, other health professions sought to broaden the definition and embraced the more inclusive term practice. The term evidence-based practice is now widely used among non-physician healthcare providers.
More than 50 models of EBP have emerged in the literature to address the needs of nursing practice, education, and science; one EBP model is transdisciplinary (Satterfield et al., 2009; Stevens, 2013).
Click here to read the rest of Chapter 1 and view supplemental materials from Evidence-Informed Health Policy in Sigma's Virginia Henderson Global Nursing e-Repository. RNL
Jacqueline M. Loversidge, PhD, RNC-AWHC, is an associate professor of clinical nursing at The Ohio State University College of Nursing. She has extensive experience in the regulatory setting through her work with the Ohio Board of Nursing and through committee work for the National Council of State Boards of Nursing.
Read related article in RNL: “Not your usual health policy center.”
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