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Evidence-Based Practice

The systematic and simple approach described inthe article by Graham, Harrison, Brouwers, Davies,and Dunn (“Facilitating the Use of Evidence in Prac-tice: Evaluating and Adapting Clinical PracticeGuidelines for Local Use by Health Care Organiza-tions,” September/October 2002 JOGNN) is aninspiration for any nurse who has ever attended aconference or read a study and with hope and enthu-siasm attempted to implement a practice change. Afrustration in my 30-plus-year career in nursing hasbeen attempts to improve patient care that have beenmet with, “but we’ve always done it this way” or“that will never work.” At times, the words are noteven used, and the new approach or practice simplyfalls by the wayside.

Graham et al. (2002) present a formula that canbe applied to improving pain management forneonates undergoing circumcision, lowering thecesarean rate, or implementing any other evidence-based practice. In Polit and Hungler’s (1999) discus-sion of nursing research trends in the 1990s andbeyond, they noted, “There is also an increasingemphasis on developing mechanisms for utilizing theresults of nursing research in actual practice” (p. 8).This is the mechanism.

The framework presented by Graham et al. isorganized into 10 steps and illustrated with a flow-chart that gives a clear, concise picture of theprocess. The authors describe each step and providepractical suggestions for establishing a guidelineevaluation group, reviewing and evaluating guide-lines, and developing a recommendation matrix.

This straightforward but detailed instruction isbrought to life through the example of selecting andimplementing breastfeeding practice guidelines. Thisexample was fresh and interesting and allowed theauthors to walk the reader through the basics ofeach step.

I also read with interest the article by Geyer, Ells-bury, Kleiber, Litwiller, Hinton, and Yankowitz (“AnEvidence-Based Multidisciplinary Protocol for Neona-tal Circumcision Pain Management,” July/August2002 JOGNN). The authors presented single andcombined methods that can be used to implement

pain management guidelines to improve practice anddecrease the discomfort of our smallest patients. Toooften suggestions such as these are met with theexcuses of lack of time and doubts as to their effec-tiveness. Application of the practical approach ofGraham et al. (2002) can help to break down thesebarriers and give nurses the tools they need to applyresearch to their practice. Thank you for publishingthis helpful article.

Phyllis Reed, RN, BSNUniversity of Missouri-Columbia

REFERENCES

Geyer, J., Ellsbury, D., Kleiber, C., Litwiller, D., Hinton,A., & Yankowitz, J. (2002). An evidence-based mul-tidisciplinary protocol for neonatal circumcisionpain management. Journal of Obstetric, Gynecolog-ic, and Neonatal Nursing, 31, 403-410.

Graham, I. D., Harrison, M. B., Brouwers, M., Davies,B. L., & Dunn, S. (2002). Facilitating the use of evi-dence in practice: Evaluating and adapting clinicalpractice guidelines for local use by health careorganizations. Journal of Obstetric, Gynecologic,and Neonatal Nursing, 31, 599-610.

Polit, D. F., & Hungler, B. P. (1999). Nursing research:Principles and methods. Philadelphia: Lippincott.

The article by Graham, Harrison, Brouwers,Davies, and Dunn, “Facilitating the Use of Evidencein Practice: Evaluating and Adapting Clinical Prac-tice Guidelines for Local Use by Health Care Orga-nizations” (September/October 2002 JOGNN),presents a framework for health care organizationsto use when evaluating and adapting existing prac-tice guidelines within their facility. I am a lactationconsultant at a hospital that is struggling to adoptbreastfeeding policies that will influence practice toimprove the quality of care provided to mothers andinfants and ultimately increase breastfeeding initia-tion and duration rates.

Increasing the rates of breastfeeding initiationand duration is a national U.S. health objective. Oneof the goals of Healthy People 2010 (U.S. Depart-ment of Health and Human Services, 2000) is toincrease the breastfeeding rates to 75% in the early

10 JOGNN Volume 32, Number 1

LETTERS