Background and history to evidence-based practice (EBP)

Alan Glasper and Colin Rees

the conscientious, explicit and judicious use of current best evidence about the care of individual patients” (Sackett et al 1997 p 2) has become the accepted mantra of the health care professions.

How to Write Your Nursing Dissertation, First Edition. Alan Glasper and Colin Rees.© 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.

Historical aspects of evidence-based practice

• Ancient civilisations undoubtedly attempted to base their medical practice on the best evidence available at the time. The first controlled trail is cited in the bible in the book of Daniel. Here, chapter 1 verses 1 through to 21 clearly describe the comparison between two groups of children; one group eating the royal food, namely meat, and wine of the King Nebuchadnezzar, and the second comparison group of children who received a vegetarian diet in the form of pulses and who drank only water. The aim of this comparative trial was to establish differences in “countenance”, which usually refers to appearance, especially of the face, and how it is perceived by others.

Historical aspects of evidence-based practice

• Daniel’s group of 4 boys ate pulses (beans) and drank water and the remainder ate the king's food. After the 10 days, Daniel and the 3 other Israeli royal boys of royal blood had a better countenance than the other Israeli children who enjoyed the diet of the king.

• NB Stolberg et al (2004) have some concerns about this first recorded trial , not least being the lack of science in the randomisation of the individuals participating in the trial. This is important as without it, there could have been biasing factors (that is, characteristics that might distort the results) in the physical make-up of the two groups and this might have influenced the outcome, and not the type of food.

Historical aspects of evidence-based practice

• Harvie (2002) describes how Lind, a young naval surgeon’s assistant, conducted the first modern controlled clinical trial in 1747 in a quest to discover the cause of scurvy, a condition caused by a nutritional deficiency of vitamin C, that killed many sailors and passengers on long voyages in the seventeen hundreds

• In 1747 Lind conducted the trial on 12 men with scurvy where one group (n=2) received 2 oranges and 1 lemon a day. These two men made a good recovery, whereas the others who were given non-citrus treatments, including sea water, consequently did not recover. Despite the evidence, it was to be another 48 years before the British admiralty began to issue lemon juice to naval seamen for the prevention of scurvy.

Historical aspects of evidence-based practice

• Why the English are called Limeys?

• It would have been logical to have nicknamed the English Lemonies after their conquest of scurvy. However by the mid-nineteenth century the British government decided to spend its resources on West Indian limes rather than Mediterranean lemons, believing that limes were very similar to lemons Tragically, the amount of vitamin C in limes is significantly less than in lemons, and scurvy returned to blight the British Royal Navy.

Historical aspects of evidence-based practice

Many fruits contain vitamin C

Historical aspects of evidence-based practice

• Studies performed in the 1940s during world war 2 showed that high levels of vitamin C could be obtained from rose hips and the the British government began collecting rose hips to make rose hip syrup as a source of vitamin C.

Markham (1953, p.580)If Lind had used rose hip syrup in his trial for scurvy the English might now be referred to as “Rosies”!

The contribution of the nursing profession to evidence-based practice

• Within nursing, the use of data as a source of decision making can be traced back to Florence Nightingale (McDonald 2001) who powerfully demonstrated her commitment to systematic data collection. After her return from the Crimean war, Nightingale was haunted by the excessive loss of life mainly caused by disease and not bullets by a factor of 7. She began to lobby for a real investigation into the root cause of this and began to analyse and present data in a way even a non-statistician could understand.

Sue is fascinated by the contribution of nurses from the past to EBP

ReferencesSackett, D.L., Rosenberg, W.M.C. and Haynes, R.B. ( 1997 ) Evidence based medicine. How to teach EBM. Churchill Livingstone, Edinburgh.Stolberg, H.O., Norman, G. and Trop, I. ( 2004 ) Fundamentals of clinical research for radiologists. Randomised controlled trials. American Journal of Roentgenology, 183, 1539 – 1544.Harvie, D . ( 2002) Limeys. The true story of one man’s war against Ignorance, the Establishment and the deadly Scurvy. Sutton Publishing, Stroud, UK.Markham, C. Justin and Markham, M. (1953) The vitamin C content of wild rose hips. J. Chem. Educ., 1953, 30 (11)McDonald , L. ( 2001 ) Florence Nightingale and the early origins of evidence-based nursing. Evidence Based Nursing Notebook , 4 , 68 – 69 .