Delivering Care That Is Important

After hearing and reading about evidence-based practice for decades, it might seem logical to assume that most nursing and medical practice decisions are, indeed, evidence-based. Why wouldn’t they be? Indeed, in 2009, it did not seem far-fetched for the Institute of Medicine to set a goal for the year 2020 that “90% of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence.”¹ But it was. 

A 2011 survey of physicians and nurses showed that only 50% and 43% of their respective practices were evidence-based.² In 2016 – 7 years after the Institute of Medicine report was published – a study among chief nurse executives showed that they believe that evidence-based practice results in high-quality care, but the majority (60%) also indicated that it is “not at all” or only “somewhat” practiced in their facility.³ Examples of failure to implement evidence-based practices are also all too common in the world of wound, ostomy, and incontinence care. 

Potential or actual concerns or problems with recommendations are an important barrier to implementing evidence. In this issue of Wound Management & Prevention, Khan et al remind us about the 2014 study showing that offloading foot ulcers, the most important intervention to facilitate healing, in persons with diabetes mellitus was documented in only 2.2% of clinic visits.⁴ Of those, only 16% used a total contact cast, which has been shown to improve healing rates compared with removable casts. In this case, Khan and colleagues observed that a modification to the total contact cast might help overcome this barrier, as it did in the case study described. 

Developing strategies to link research to practice is another important tool to overcome barriers to implementing evidence-based practices. For example, also in this issue of Wound Management & Prevention, Gülnar and Çalişkan developed an outpatient care protocol to facilitate the implementation of evidence-based stress incontinence treatment strategies among female outpatients. Their research shows that the protocol itself was effective and confirmed that these strategies improve pelvic muscle exercise self-efficacy and quality of life. 

Health care professionals’ attitudes toward an intervention also matter. Hence, the importance of studies to measure these attitudes toward, for example, pressure injury prevention and care, as detailed in this issue by researchers from the Department of Medical Surgical Nursing, Nursing School, Fasa University of Medical Sciences, Iran. 

Also to be considered is the generation of evidence itself. Optimal strategies or techniques to manage many conditions or prevent complications have simply not been sufficiently studied. As described in this issue by Ohara et al, even though stomal mucocutaneous separation is a common complication following ostomy surgery that may have long-term negative consequences, studies examining surgical techniques to help prevent this complication are rare. It is hoped that their work, which showed important differences in the rate of complications, will inspire others to conduct similar studies that may, ultimately, help provide the evidence surgeons need to help reduce the risk of mucocutaneous separation.

This, and all issues of Wound Management & Prevention, contain much needed information to slowly, and sometimes painstakingly, help develop and implement the evidence that clinicians need and patients deserve. In 2009, and still in 2021, the observation that “care that is important is often not delivered and care that is delivered is often not important”¹ is unacceptable. 

The opinions and statements expressed herein are specific to the respective authors and not necessarily those of Wound Management & Prevention or HMP Global. This article was not subject to the Wound Management & Prevention peer-review process.

1. Institute of Medicine. Roundtable on Evidence-Based Medicine. Washington, DC: National Academies Press; 2009.

2. Ubbink DT, Vermeulen H, Knops AM, et al. Implementation of evidence-based practice: outside the box, throughout the hospital. Neth J Med. 2011;69(2):87–94.

3. Melnyk BM, Gallagher-Ford L, Thomas BK, Troseth M, Wyngarden K, Szalacha L. A study of chief nurse executives indicates low prioritization of evidence-based practice and shortcomings in hospital performance metrics across the United States. Worldviews Evid Based Nurs. 2016;13(1):6–14. doi:10.1111/wvn.12133

4. Fife CE, Carter MJ, Walker D, Thomson B, Eckert KA. Diabetic foot ulcer off-loading: the gap between evidence and practice. Data from the US Wound Registry. Adv Skin Wound Care. 2014;27(7):310–316. doi:10.1097/01.ASW.0000450831.65667.89