Introduction
Evidence based care (EBC) is a recent development in nursing practice meant to improve the quality of care offered. Under EBC, nurses base clinical decisions on evidence drawn from scientifically rigorous studies. EBC promotes positive outcomes. For nurses to identify and apply relevant information in clinical practice, they must understand the structural and functional relationship between data, information, knowledge and wisdom. When nurses conduct a search for evidence, they get data on the efficacy, safety or tolerability of various nursing interventions. Synthesizing this data gives information which can be applied in clinical practice. Knowledge is achieved through consistent use of application while wisdom is achieved through consistent and meaningful application of information. In this paper, the data, information, knowledge and wisdom continuum is evaluated in view of its application in EBC.
Research Question
EBC starts with identification of a problem in nursing practice form which research questions can be formulated. The aging population and the rise of chronic diseases have made care for geriatric patients to be an important division in health care facilities. Often, geriatric patients have multiple morbidities such as hypertension, diabetes, and urinary incontinence. The research question formulated is how fall episodes affect care for patients who have incontinence? This is a relevant clinical problem because I have obseverved that in the facility I work in, fall episodes in geriatric patients are treated separately from other morbidities the patient may have, yet from personal experience, fall episodes can sometimes trigger or make urinary incontinence worse.
Data
Data is raw facts that posses objective reality (Matney et al., 2011). Collecting data is the first step in applying EBC. For our case study on falls and urinary incontinence, data on the topic can be sourced from databases which keep track of published articles. There are various specialized databases such as CINAHL, MEDLINE, PubMed and Science Direct which can be used to conduct a search. These databases publish all types of research such as editorials, case reports, cohort studies, randomized trials, and systematic reviews. Case reports and editorials give data because they are based on a single case or the opinion of one expert. They offer little evidence. Searching the combined CCINAHL and MEDLINE databases with the keywords urinary incontinence and fall events generated 5,678 results. Majority of these are case reports and editorials and provide data and general information on the topic.
Information
Information is generated when data is organized in a structured manner. For instance, when a researcher studies the relationship between falls and urinary incontinence, s/he records data such as how likely is it that the patient who falls will develop incontinence. A collection of such data drawn from many observations and measurements can generate information on the relationship between urinary incontinence and fall events. Randomized controlled trials and systematic reviews give information rather than raw data (Jones, 2010). There are databases that specialize in giving evidence and information for clinical findings. For example, the Cochrane Database of Systematic Reviews which contains high level evidence on various interventions and drugs, the Database of Abstracts of Reviews and Effects (DARE) which contains meta-analysis and systematic reviews on clinical topics, the NHS Economic evaluation database which has cost benefit analysis for various interventions and drugs and the Evidence-Based Resources from the Joanna Brigs Institute which has evidence summaries and best practices information sheets.
Knowledge
When nurses are aware of information contained in systematic reviews and other high level evidence studies, they gain knowledge. For instance, Chiarelli, Mackenzie & Osmotherly found that urinary incontinence is associated with a high risk of falls (2009). This is information drawn form a systematic review. To transform the information to knowledge, nurses must apply it to clinical practice (Scott & McSherry, 2009). For instance, the above information can be applied through policy changes which ensure that incontinent patients have additional fall prevention and detection systems. This would make the knowledge benefit patients and generate positive outcomes.
Wisdom
Wisdom is achieved over long periods of time through the consistent application of knowledge. Experienced nurses based on knowledge can determine patients who are at a higher risk of falling or developing incontinence and implement preventive measures. Preventive medicine is ultimately more effective and economical than treatments and cure (Farley et al., 2010). Therefore wisdom can only be realized when nurses are able to relate research findings to actual clinical interventions improve the quality of care.
Conclusion
Applying evidence in nursing practice needs differentiating between data, information, knowledge and wisdom. Researchers generate data during studies and publish their findings. Conducting database searches generate data from these findings. For instance a case report of an incontinent patient who experienced a fall episode gives data. A collection of several such observations can generate information which is organized and well structured. For instance, the assertion that urinary incontinence increases the risk of fall is information. When this information is applied in clinical practice intermesh of interventions or policy changes that lead to positive health outcomes, it is transformed to knowledge. Consistent application of knowledge develops wisdom and leads to successful implementation of EBC.
References
Chiarelli, P. E., Mackenzie, L. A., & Osmotherly, P. G. (2009). Urinary incontinence is
associated with an increase in falls: a systematic review. Australian Journal of Physiotherapy, 55(2), 89-95.
Farley, T. A., Dalal, M. A., Mostashari, F., & Frieden, T. R. (2010). Deaths preventable in the
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Jones, K. R. (2010). Rating the level, quality, and strength of the research evidence. Journal of
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Matney, S., Brewster, P. J., Sward, K. A., Cloyes, K. G., & Staggers, N. (2011). Philosophical
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