When using evidence-based practice to research new treatments, interventions, or guidelines for particular procedures in a clinical setting, there are two types of evidence that are used: external evidence and internal evidence. External evidence is gained from direct research into a particular problem (American, n.d.). It usually takes the form of clinical trials or other specifically defined research project. Its purpose is to gather quantitative evidence that can be used in any number of clinical settings. It is usually tightly controlled, with dependent and independent variables and control groups over a specific population and time frame. Internal evidence is usually practice-based, using anecdotal evidence and experience gained from nurses on the unit. Many times, it would take the form of informal observations or surveys from unit nurses or administrators. These observations were than quantified into graphs and Powerpoint slides that would be presented on unit bulletin boards to chart progress or shortfalls in unit or hospital goals. Internal evidence lacked the rigorous process of using control variables to gather evidence in a scientific way that was present in strict clinical trials. That isnt to say internal evidence doesnt have any value, it does. It is used for quality improvement and is used to measure unit and hospital performance for things such as hand hygiene, falls, or hospital acquired infections such as CLABIs and CAUTIs. These performance measurements are then conveyed to JCAHO to gain hospital accreditation or determine Medicare and Medicaid payments. These quality improvement initiatives often play a huge role in determining the financial health of a hospital or hospital system. External evidence often plays a key role in developing these initiatives. Take for instance the use of Foley catheters in patients. Research done over many years through many clinical trials has determined that the longer an indwelling catheter is placed in a patient, the greater the likelihood of a CAUTI infection occurring. The hospital then takes this information and develops a hospital-wide initiative to reduce the number of Foley catheters placed and the time that they are used. As nurses, we are told to carefully empty and clean the catheters every shift and to justify why the patient needs a catheter. Often it is because patients tend to retain urine or are unable to ambulate after surgery. The hospital then keeps track of the number of Foleys placed and the rate of infection. This number is then conveyed to government agencies to determine whether a hospital is in compliance with infection safety protocols. American Speech-Language-Hearing Association. (.). Step 2: Gather evidence. EBP Process. Retrieved October 21, 2021, fromShow more
