Nurses balance the art and science of healing. As healthcare professionals, nurses follow the best evidence possible to provide care for patients and their families. In addition to evidence-based practice, high ethical standards and personal courage are key components of nursing.1,2,3 Being a professional nurse demands intellectual rigor and personal responsibility borne to a very high level. During times darkened by fear of disease and mistrust of science, nurses must mark a bright line between evidence-based healthcare guidance and opinions based on economic expediency or political ideology.
Randomized, multicenter, double-blinded, and pragmatic studies are the gold standard in healthcare research. However, these types of investigations may take more time than is available to clinicians in urgent need of patient care guidance. In addition, there may not be sufficient amounts of high-quality, peer-reviewed literature available during a rapidly evolving crisis such as the COVID-19 pandemic. In these instances, nurses and others involved in healthcare must make decisions based on evaluations of the best available evidence, including expert opinion.
Evidence should be evaluated using a predetermined method. Fortunately, there are easily accessible tools such as GRADE (Grading of Recommendations Assessment, Development and Evaluation)4 to evaluate the quality of medical literature, and the American Association of Critical-Care Nurses’ Levels of Evidence,5,6 which is an aid to evaluate the strength of available evidence. Other sources for evidence-based guidance are specialty professional associations, such as the American Association of Critical-Care Nurses (AACN),7 national organizations such as The Joint Commission8 or Institute for Healthcare Improvement,9 and U.S. government agencies such as the National Institutes of Health10 or Centers for Disease Control and Prevention,11 and international bodies such as the World Health Organization.12
All healthcare decision-making, whether it be for individual patients or the nation, must be anchored in the best scientific evidence available. All individuals have a responsibility to seek truth and reject misinformation or propaganda, especially those in leadership positions. As do nurses, local, state, and national leaders must rely on experts and best available evidence to guide public health actions.
The best available evidence should guide all healthcare decisions. This is true for the individual healthcare professional at a patient’s bedside and for civic leaders who make local, state, and federal healthcare policy. Even when fast-moving public health crises make it impossible to find sufficient amounts of peer-reviewed research, public policy decisions must be based on carefully evaluated healthcare information and the guidance of fully qualified experts.
Recommended Actions for Nurses
- Use evidence-based practice, a problem-solving approach that involves the conscientious use of current best evidence, in making decisions about patient care.
- Be aware of conflicts of interest—professional, financial, or political—when evaluating data and evidence.
- Correct false healthcare information at every opportunity among your peers, your neighbors, or your loved ones. The general public may lack your expertise in evaluating evidence.
- Be ardent defenders of evidence-based science and respect for expert knowledge, especially when these are attacked for commercial or political gain.
- Speak out against censorship of scientific ideas or the silencing of legitimate experts who provide advice for the betterment of public health.
Recommended Actions for Healthcare Policy Makers
- Use the resources of your office to sift fact from falsehood and communicate with integrity in the service of your constituents.
- Work closely with healthcare experts to understand the nuances of the challenges.
- Implement healthcare directives that have been scientifically proven to establish or maintain public health, even if they are unpopular or difficult to maintain.
- Encourage the free flow of evidence-based scientific ideas and promote the voices of legitimate experts who seek to communicate advice for the public welfare.
- Intervene to protect public health experts from verbal abuse, violent threats, or harassment, even if the advice they offer is unpopular with other civic leaders or your constituents.
- Dedicate the powers of your office to ensure that local, state, or federal healthcare institutions have the funding and resources necessary to sustain excellent public health.
- Collaborate with others, regardless of political differences, to do what is best for the public’s health.
- Day L. Nursing practice and civic professionalism, Am J Crit Care. 2005;14(5):434-437.
- Day L. Courage as a virtue necessary to good nursing practice, Am J Crit Care. 2007; 16(6):613-616.
- American Nurses Association. Code of Ethics for Nurses. Washington, D.C.: American Nurses Association; 2001. Accessed August 1, 2020. https://www.nursingworld.org/coe-view-only
- The Grading of Recommendations Assessment, Development and Evaluation Working Group. Accessed August 1, 2020. http://www.gradeworkinggroup.org
- American Association of Critical-Care Nurses. AACN Levels of Evidence. Accessed September 1, 2020. https://www.aacn.org/clinical-resources/practice-alerts/aacn-levels-of-evidence
- Peterson MH, Barnason S, Donnelly B, et al. Choosing the best evidence to guide clinical practice: application of AACN Levels of Evidence. Crit Care Nurse. 2014;34 (2):58-68. https://doi.org/10.4037/ccn2014411
- American Association of Critical-Care Nurses. Clinical Resources. Accessed September 1, 2020. https://www.aacn.org/clinical-resources
- The Joint Commission. Accessed August 1, 2020. https://www.jointcommission.org/
- Institute for Healthcare Improvement. Accessed August 1, 2020. http://www.ihi.org/
- U.S. National Institutes of Health. Accessed August 1, 2020. https://www.nih.gov/
- Centers for Disease Control and Prevention. Accessed August 1, 2020. https://www.cdc.gov/
- World Health Organization. Accessed August 1, 2020. https://www.who.int/