Evidence and the “Ah Ha” Moment

Implementation of evidence in practice…sounds easy, but it isn’t always straightforward.  There is a lot of evidence and a whole clinical guideline industry for high profile issues ranging from falls prevention and constipation to diabetes and cardiac care. However numerous healthcare issues arise daily that don’t have a corresponding care pathways or treatment algorithms.

In my first practice as an NP, I was on my own.  I relied quite a bit on the research, evidence and guideline tools on hand, but I was often caught with nothing.  One example sticks in my head and all my previous students will recognize this story.  One day a Mom arrived at an appointment with her 8-year-old son.  He had a common wart on one of his toes.  Over-the-counter treatment patches hadn’t worked.  I tried cryotherapy, but the boy was terrified of it.  In frustration, I went into my office and searched for information about wart treatments.  I found one research article that compared the use of duct tape to cryotherapy[1]. Amazingly the duct tape removed warts.  I then determined that the risk of using duct tape was low, it was cost effective and the boy would likely agree to the treatment, so I suggested it to the somewhat amused mother.  She called me at the office a week later to tell me that the duct tape worked….her boy’s wart was gone.

The reason I tell this story time and again is because of the impact it had on me and, subsequently, my practice.  It was my ‘ah ha’ moment, if you will.  The elusive link between evidence and successful treatment was made and I became more aware of the value of evidence in practice.  I also became more acutely aware of the barriers.  I was lucky to have a computer with internet access and a subscription through an online university library to complete the search.  The issue was simple and, although the sample was small, the treatment option in the study didn’t pose a significant potential threat to the patient.

We have an obligation to provide the best care possible to our patients.  The trick is figuring out how.  The information world has changed dramatically even in the 10 years since I searched for wart treatments.  The fact that you’re reading this blog is a testament to the potential of the technical age.  I encourage each of you to embrace social media and technology for the benefit it can provide to practice.  However, don’t forget the personal touch.  In the first blog I mentioned research that revealed nurses turned most often to each other as a source of practice information.  Our own practice stories can be as powerful, maybe more so, than a computer search on the road to implementation of evidence into practice. I encourage you to remember your own ‘ah ha’ moments and tell your peers.  Search together and make the most of the resources you have to give the best possible care.

 

 

 


[1] Focht, D., Spicer, C., & Fairchok, M.  (2002).  The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart). Archives of Pediatric and Adolescent Medicine, 156(10), 971-974.  doi:10.1001/archpedi.156.10.971 Retrieved http://archpedi.jamanetwork.com/article.aspx?articleid=203979

 

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