Evidence-Based Nursing Care: Principles and Practices from

Harvard University
Published in 2010
Introduction: As one of the most prestigious educational institutions in the
world, Harvard University is renowned for its commitment to excellence in
education, research, and evidence-based practices across various disciplines,
including nursing. Harvard University's School of Nursing is known for
producing highly skilled and knowledgeable nurses who are well-versed in
evidence-based nursing care.
Evidence-Based Practice in Nursing: Evidence-based nursing care is an
approach that integrates the best available evidence from research, clinical
expertise, and patient preferences to guide nursing practice. At Harvard
University, nurses are trained to critically appraise and synthesize research
evidence, and apply it to clinical decision-making to deliver safe, effective, and
patient-centered care. Evidence-based practice is based on the principle that
nursing care should be informed by the best available evidence, rather than
solely relying on tradition or personal opinions.
The Process of Evidence-Based Practice: At Harvard University, the process of
evidence-based practice is taught through a systematic and structured
approach. It involves five key steps:
1. Asking clinical questions: Nurses are trained to identify clinical questions
that arise from their practice, and formulate them using the PICO
(Patient/Population, Intervention, Comparison, Outcome) format. This
helps nurses to clearly define the problem or issue they are trying to
address.
2. Searching for evidence: Nurses are taught how to conduct systematic
literature searches using reputable databases, such as PubMed, CINAHL,
and Cochrane Library, to identify relevant research articles that address
their clinical questions. They are also trained to critically appraise the
quality and relevance of the evidence.
3. Appraising evidence: Nurses are guided to critically appraise the
research articles they find, using tools such as the Critical Appraisal Skills
Programme (CASP) or the Joanna Briggs Institute (JBI) appraisal tools.
 This helps them to assess the validity, reliability, and applicability of the
evidence to their clinical practice.
4. Applying evidence: Nurses are trained to integrate the best available
evidence with their clinical expertise and patient preferences to make
informed decisions about patient care. This involves developing a plan of
care that is evidence-based and tailored to the unique needs and
preferences of each patient.
5. Evaluating outcomes: Nurses are encouraged to evaluate the outcomes
of their evidence-based practice interventions, and use the findings to
inform further practice. This involves reflecting on the effectiveness of
the interventions and making adjustments as necessary to optimize
patient outcomes.
Benefits of Evidence-Based Nursing Care:
At Harvard University, nurses are taught that evidence-based nursing care has
numerous benefits, including:

1. Improved patient outcomes: Evidence-based nursing care is associated

with improved patient outcomes, such as reduced mortality rates,
decreased complications, and increased patient satisfaction. By
integrating the best available evidence into their practice, nurses can
provide high-quality care that is aligned with the latest research findings.

2. Enhanced clinical decision-making: Evidence-based nursing care provides

nurses with a systematic approach to clinical decision-making, which is
based on the best available evidence. This helps nurses to make
informed decisions about patient care, and reduces the reliance on
subjective opinions or personal biases.

3. Increased professional credibility: Nurses who practice evidence-based

care are seen as more credible and competent by their peers, patients,
and other healthcare professionals. By staying updated with the latest
research and incorporating it into their practice, nurses can enhance
 their professional reputation and contribute to the advancement of the
nursing profession.

4. Cost-effective care: Evidence-based nursing care is associated with cost-

effective care, as it reduces unnecessary interventions, minimizes
complications, and optimizes resource utilization. This can result in cost
savings for patients, healthcare organizations, and the healthcare system
as a whole.

5. Professional growth and development: Incorporating evidence-based

nursing care into practice promotes continuous learning and
professional growth. Nurses at Harvard University are encouraged to
stay updated with the latest research findings, engage in critical
appraisal of evidence, and apply it to their practice. This helps nurses to
develop a lifelong learning mindset and continuously improve their
clinical skills and knowledge.

Challenges and Barriers to Evidence-Based Nursing Care: While evidence-based

nursing care has numerous benefits, there are also challenges and barriers that
nurses may face in implementing it. Some of the common challenges include:
1. Access to reliable evidence: Accessing reliable and up-to-date evidence
can be challenging, as there is an overwhelming amount of information
available, and not all of it may be trustworthy. Nurses at Harvard
University are taught to critically appraise the quality and relevance of
the evidence they find, and to use reputable sources for their literature
searches.
2. Time constraints: Nurses often face time constraints in their busy clinical
practice, which may hinder their ability to conduct thorough literature
searches, critically appraise evidence, and apply it to their practice.
However, at Harvard University, nurses are encouraged to prioritize
evidence-based practice and allocate dedicated time for engaging in
evidence-based care.
3. Resistance to change: Implementing evidence-based nursing care may
require changing established practices, which can be met with resistance
from nurses, patients, and other healthcare professionals. Overcoming
 resistance to change and promoting a culture of evidence-based practice
requires strong leadership, education, and communication.
4. Lack of skills and knowledge: Not all nurses may have the necessary skills
and knowledge to critically appraise research evidence, and apply it to
their practice. Harvard University addresses this challenge by providing
comprehensive education and training in evidence-based nursing care,
and promoting ongoing professional development.
5. Patient variability: Patients may have unique preferences, values, and
needs that may not always align with the evidence-based
recommendations. Nurses at Harvard University are trained to consider
patient preferences and values in conjunction with the best available
evidence to provide patient-centered care.
Conclusion: In conclusion, evidence-based nursing care is a fundamental
principle taught at Harvard University, aimed at promoting safe, effective, and
patient-centered care. Nurses are trained to follow a systematic approach that
involves asking clinical questions, searching for evidence, critically appraising
evidence, applying evidence to practice, and evaluating outcomes. Evidence-
based nursing care has numerous benefits, including improved patient
outcomes, enhanced clinical decision-making, increased professional
credibility, cost-effective care, and professional growth. However, there are
also challenges and barriers that nurses may face in implementing evidence-
based practice, such as access to reliable evidence, time constraints, resistance
to change, lack of skills and knowledge, and patient variability. Overcoming
these challenges requires ongoing education, leadership support, and a culture
that values evidence-based practice. By integrating evidence-based nursing
care into practice, nurses at Harvard University and beyond can contribute to
the advancement of nursing and provide high-quality care to their patients.