Cochrane in Nursing: 20 years and counting of evidence-based health care

In 1998, in the first published paper in the first published edition of Evidence-Based Nursing, Anne Mulhall began her article by asking the question ‘Why has research-based practice become so important and why is everyone talking about evidence based health care? But most importantly, how is nursing best placed to maximise the benefits which evidence-based care can bring?’ 1 This was five years into the Cochrane Collaboration’s now 20 year history and already Mulhall cited what she then referred to as ‘the initiative’ as an important source needed to maximise the potential of evidence-based nursing. 1 Just over ten years later, in March 2009, the Nursing Care Field was registered with the Cochrane Collaboration. This long delay alludes perhaps to the snags around the distinction between ‘evidence-based practice’ with its integration of qualitative and more theoretical knowledge and ‘research-based practice’s’ more rigid criteria around quantitative studies with randomized controlled trials touted as the gold standard. Indeed it would be unrealistic to look to qualitative studies in search of evidence of effectiveness.

In the field of evidence-based nursing, the Cochrane Collaboration has made a number of important contributions. One of them has been to endorse and promote recognition of the systematic review as a significant and valuable source of evidence that provides the results of numerous relevant individual studies which have undergone stringent appraisal, synthesis and interpretation. Facilitating the increased involvement and use of nursing professionals in Cochrane reviews by establishing the Cochrane Nursing Care Field has been one very significant way that Cochrane has increased the capacity of nurses to conduct, access and use Cochrane’s work.

The Cochrane Collaboration has grown and indeed diversified; now incorporating clinical controlled trials and (sometimes) non-randomized observational studies. For consideration for inclusion into a Cochrane Intervention review, evidence from qualitative research must necessarily be subjected to methods of review that are correspondingly rigorous to quantitative evidence.

Cochrane’s swift development into one of the most internationally recognised organizations in evidence-based health care has contributed immensely to the widespread implementation of evidence-based practice and not least in the world of nursing.

To give a simple but very telling example relating to one of the most universal health care practices, consider wound cleansing. While the management of both chronic and acute injuries has evolved dramatically in recent decades, Cochrane reviewers Fernandez and Griffiths noted the lack of attention paid to the kinds of solutions used.2 In summary, their results found no evidence that using normal tap water to cleanse acute wounds in adults or children increases or reduces infection. Furthermore no strong evidence was found to show that healing or the reduction of infection was improved by wound cleansing. One of the authors’ conclusions was that in the absence of potable tap water, cooled boiled water as well as distilled water can be used as cost-effective wound cleansing agents.2 It is findings like this that can have substantial impact on health care even in some of the most undersupplied regions in the world.

Mulhall concluded her article with some considerations for those who wished to embrace the then emerging field of evidence-based nursing. The first was that nursing must shed its suspicion of quantitative evidence and cultivate a skilled critique of it. 1 As the Cochrane Collaboration enters its second decade, it can be rightly proud that it has made great strides in establishing and advancing nursing professionals’ trust and appreciation for quantitative evidence, truly delivering critically important justification for numerous evidence-based health care practices.

Dr Micah Peters BHSc MA(Q) PhD

Research Fellow, Synthesis Science

The Joanna Briggs Institute

School of Translational Health Science

Faculty of Health Sciences

The University of Adelaide, AUSTRALIA

 

Micah is a member of the Cochrane Nursing Care Field

1      Mulhall A, Nursing, research, and the evidence. Evid Based Nurs [Internet]. 1998 Jan [cited 2013 Aug 16];1(1). Available from: http://ebn.bmj.com/content/1/1/4.full.pdf+html

2      Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database of Systematic Reviews [Internet]. 2012 [cited 2013 Sept 5];2. Available from: http://onlinelibrary.wiley.com.proxy.library.adelaide.edu.au/doi/10.1002/14651858.CD003861.pub3/pdf/standard

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