Of Sacred Cows and Evidence-Based Practice

I wrote this for my synthesis paper in one of our PhD subjects

                Ever since the ancient times, people have realized and accepted the fact that there is nothing permanent in this world but change. One of the ancient philosophers, Heraclitus (500BC; Graham, Summer 2011) compared existing things into the flow of the river: ”Into the same rivers we step and do not step, we are and are not."  This illustrated how change happens constantly. Man, being part of this world, is also affected by change. “All good men desire to change.  He longs to develop and to perfect himself” (Von Hildebrand, 1990). Under this line of thinking, nurses try to improve their Nursing practice. And since Nursing is a science, Nursing Practice should be based on science, wherein research is used to answer questions, establish protocols, and promote critical thinking and decision making at the bedside (Rauen, Chulay, Bridges, Vollman, & Arbour, 2008).

            Many new ways of practice had been introduced based on evidence – that is, research findings that are relevant and applicable to clinical situations with the aim of better outcomes for the patients. This is referred to as Evidence-Based Practice. The Institute of Medicine defines evidence-based practice (EBP) as “the integration of best research, clinical expertise, and patient values in making decisions about the care of individualized patients (Rauen, Chulay, Bridges, Vollman, & Arbour, 2008). More accurate measurement of blood pressure (Rauen et al, 2008), less- restricted visiting policies (Makic, VonRueden, Rauen, & Chadwick, 2011), unit guidelines for urinary catheterization (AACN Bold Voices, 2012) and the development of the seven domains and associated quality indicators for End-of-Life (EoL) care in critical care  (Efstathiou & Clifford, 2011) are among the results of the nurses’ efforts to discover better and safer ways of doing things.

            However, one irony about change, although constant and good people desire it, is that people also tend to resist it.  Change requires willingness and ability to change practices, regardless of the tradition and commonly held beliefs (Rauen et al 2008). Sometimes, though, it is not easy to leave tradition and one’s “security blanket” that were referred to by Rauen et al as sacred cows. John Maxwell (2011) describes this process   as the “pain of change”. It is painful to break the habit of doing things. It can be tiring and toilsome work, requiring persistence and resourcefulness (Sanborn, 2008). It is especially difficult if one's opinion or beliefs very much differ from the new evidence being presented. Several studies support positive outcomes for on-duty napping (Fallis, MacMillan, & Edwards, 2011). The authors noted that in nurses working either 8-or 12-hour night shifts, sleep deprivation increases the risk for patient errors, near misses, and personal injuries on shift and while driving home. Furthermore, the authors also concluded that sleep deprivation, sleep disturbance, and fatigue are also significant contributing factors to impaired personal health. They thus broached into the idea of restorative naps within work to address these problems. This proposal may be a welcome practice to many night duty nurses, but one can meet resistance among the traditionalists.

            More resistance can be expected to Daly’s (2008) proposal to withhold cardiopulmonary resuscitation unless there is prior order from the physician. She recommended  “to restrict use of CPR to those patients who provide adequately informed consent and for whom CPR has a reasonable chance of success” (Daly, 2008). This revolutionary idea based on research may not have many takers but this and the other new discoveries (too revolutionary or not), give growth and development to nursing science and consequently, to practice. Because of EBP’s, more specific and clear guidelines are present, that can signal to the staff the orientation of the goals of care and the interventions to be provided (Ells, 2010).

            EBP can further grow if there is a unified research agenda among muti-disciplines in health that are based on the assessed needs of a particular place. The effort to do this was shown by the multisociety task force for critical care who came up with a comprehensive agenda for critical care research using input from a broad range of stakeholders to serve as a blueprint for future initiatives (Deutschman, Ahrens, Cairns, Sessler, & Parsons, 2012).

            In summary, evidence-based practice has shown many ways of having a deeper knowledge about the patients, families and about the processes followed by the health team so that there is improved efficiency and safety in practice that would bring about better outcomes of care. Although resistance to change due to traditonal beliefs and practices may be encountered, these traditionalists who resist “putting their sacred cows out to pasture” will eventually be convinced if better outcomes are consistently manifested. With a concerted effort from the members of the different health disciplines who pulls the cart together in one direction based on one research agenda, we can expect greener pastures ahead.