Evidence-based practice is, as the name suggests, the idea that occupational practices should be based on scientific evidence.
Evidence-based practices were first introduced in medicine. Since then, they have become common in nursing (Ellis, 2016), education (Pring & Thomas, 2004), management, psychology (Hersen & Sturmey, 2012), architecture, urban planning, public policy (Loversidge & Zurmehly, 2019), law, philanthropy, and other fields.
A simple example of evidence-based practice is when a therapist chooses to pivot to a new therapy strategy with a patient after receiving compelling new evidence in the academic literature that demonstrates its effectiveness.
Definition of Evidence-Based Practice
Evidence-based practice requires a systematic approach to the translation of research findings into practice.
Evidence-based practice requires a systematic approach to the translation of research findings into practice.
Supporters of evidence-based practice claim that it can to bridge the gap between research and practical application (Reynolds, 2000, p. 19).
Evidence-based practices distinguish between research that has immediate practical significance and research that doesn’t.
In the case of medicine, this:
“….helps doctors to ignore the vast quantities of clinical research which are not of direct relevance to practice” (Reynolds, 2000, p. 19).
Evidence-based medicine, which is where evidence-based practice originated, consists of five explicit steps (Reynolds, 2000, pp. 22-23):
- A Specific Question: First, the clinician, faced with a patient or group of patients, constructs a specific question concerning their care. This could relate to the diagnosis of the problem, the most effective treatments and their possible side-effects, or the best method of delivering services to meet patients’ needs.
- Finding the Best Evidence: The second stage consists of finding, as efficiently as possible, the best evidence to answer the clinical question.
- Evaluating the Validirty and Usefulness: Third, the clinician evaluates the evidence for its validity and usefulness.
- Applying the Practice: Fourth, the results are applied to the specific patient or group of patients.
- Evaluating the Practice: Finally, the outcome of the intervention is evaluated.
Evidence-based practices in other fields tend to follow a similar process that is modified to fit the context.
Evidence-Based Practice Examples
1. Hand Hygeine (Healthcare)
Hand washing in hospitals emerged rather late in human history – around the 1840s according to the History Channel. This was based on some rather gruesome evidence.
Doctors began to notice that mothers’ deaths during childbirth were far higher in the doctors’ wards (about 98.4 deaths per 1000 births) compared to midwives’ wards (36.2 per 1000 births).
One Hungarian doctor, Ignaz Semmelweis, started conducting some tests to see why women were dying at such high rates in doctors’ wards. At first, he thought the priests’ bells were scaring women as priests would walk through doctors’ wards only. But rerouting the priests did nothing.
Then, he noticed that the doctors did a range of tasks during their day the midwives didn’t – including handling cadavers. He hypothesized that the doctors might be bringing matter from the cadavers into the wards on their hands. So, he made them wash their hands.
The result was fantastic – deaths during childbirth plummeted in the doctors’ wards.
Interestingly, it took Semmelweis a long time to convince other European doctors to follow his evidence-based practice, but eventually, his arguments won everyone over.
2. Cognitive Behavioral Therapy (Psychotherapy)
Cognitive Behavioral Therapy (CBT) is a psychological treatment grounded in empirical research.
It aims to help people re-frame their thoughts by identifying when a thought might be leading them astray. Amd teaches them to reframe their thoughts into ones that are more productive.
This therapy has been demonstrated to be effective for a range of disorders, including depression, anxiety disorders, and eating disorders.
Therapists and councillors have been compelled to bring CBT into their practice, and often replace medicinal treatments with CBT, due to substantial evidence that it is as effective as, or more effective than, psychiatric medications.
This intervention, then, is an example of how a therapeutic treatment is used because evidence suggests it’s highly effective.
3. Play-Based Learning (Education)
There was a period of time where play in the classroom was considered unacceptable – children should learn through repetition and rote learning!
But learning theorists in the early- to mid-20th Century, including Maria Montessori, Rudolph Steiner, and Mildred Parten, presented new evidence that play-based learning supports children’s cognitive development.
Following this evidence, a range of school curricula around the world have proactively encouraged play as a means for stimulating learning and development in the classroom.
4. Hot Spots Policing (Criminal Justice)
Hot spots policing focuses on small geographic areas or places, usually in urban settings, where crime is concentrated.
The majority of criminal events occur in these relatively few places, often termed ‘hot spots.’
Criminologists have found ample evidence that focussing resources on these hot spots can help to reduce crime rates, improve public safety, and more efficiently distribute police resources.
As a meta-analysis by Braga, Papachristos and Hureau (2014) concludes:
“The results of our research suggests that hot spots policing generates small but noteworthy crime reductions, and these crime control benefits diffuse into areas immediately surrounding targeted crime hot spots.”
Strategies used during hot spot policing include increasing police patrols, and problem-oriented policing strategies. Nevertheless, strategies need to be carefully catered in order to ensure prejudice, profiling, and discrimination do not occur.
5. Motivational Interviewing (Social Work)
Motivational Interviewing (MI) is a counseling approach designed to create safe spaces for clients to share their thoughts, have them heard with empathy, and lastly, to motivate clients to achieve change in their lives.
The eventual goal is to instil intrinsic motivation within the client, which can lead to long-term changes in behavior.
The concept has gained prominence in social work practice because a substantial corpus of evidence has emerged underpinning its effectiveness.
For example, two meta-analyses have found MI to effect change for clients:
“MI produced statistically significant, durable results” (Lundahl et al., 2010)
“Psychologists and physicians obtained an effect in approximately 80% of the studies, while other healthcare providers obtained an effect in 46% of the studies. When using motivational interviewing in brief encounters of 15 minutes, 64% of the studies showed an effect.” (Rubak et al., 2005)
6. Dialectical Behavioral Therapy (Psychology)
DBT is a cognitive-behavioral treatment developed by Marsha Linehan for individuals with borderline personality disorder who engage in self-harming behaviors.
DBT combines principles of behavioral psychology, which are used to promote change, with mindfulness and acceptance strategies from eastern meditation traditions.
The efficacy of DBT has been shown in numerous randomized controlled trials for a variety of behavioral, emotional, and cognitive outcomes.
7. Formative Assessment (Education)
Formative assessment is an educational approach that involves testing students’ learning and development part-way through a unit of work.
It generally involves giving students pop quizzes or in-class assessments, followed by feedback on their work that they can use to identify weaknesses to work on prior to a final test.
It’s also extensively used to adjust teaching strategies mid-stream to better suit students’ needs.
Meta-analyses consistently find that it can help support student learning and outcomes:
“…meta-analysis research found consistent positive effects of formative assessment on student learning” (Lee et al., 2020, p. 125)
This ongoing, interactive assessment allows teachers to identify and address gaps in students’ understanding, helping students to learn more effectively. Evidence indicates that formative assessment can significantly enhance student learning.
8. Action Research (Various Fields)
Action research embraces the principles of evidence-based practice by empowering practitioners to gather their own evidence in their own contexts.
It is a method of research that involves practitioners conducting studies of their own practice, often in collaboration with their clients, patients, and students.
The action researcher conducts analysis of their own practice then uses the feedback gathered during their research process to make adjustments to their practice. Following this, more action research studies will take place, with scholars continuing to update and improve their work over time with the support of evidence collected during their research.
One big benefit of an action research approach is that the data is collected in their own settings, making the findings of the case studies extremely relevant to their practice.
9. Effective Altruism (Philanthropy)
Effective Altruism is a philosophy and social movement that advocates for making the world a better place in the most effective way possible.
It is unique in the fact that it researches the most effective companies to donate to, based on factors like bang-for-your-buck, how much money is wasted on administration and marketing, and so on. The idea is to ensure your philanthropic donations do the most good in the world.
Often, it finds that people should donate to highly efficient charities who work on causes such as global poverty in the developing world, where one dollar can go a long way in saving and improving lives.
10. Use of Checklists in Surgery (Healthcare)
Checklists are used in medicine, particularly in surgical procedures, to reduce errors and improve patient safety.
The WHO’s Surgical Safety Checklist is a prominent example. It includes a series of checks to be done before induction of anesthesia, before the incision of the skin, and before the patient leaves the operating room.
The introduction of this checklist in healthcare has resulted in significant reductions in both morbidity and mortality (Kramer & Drews, 2016), leading to its widespread adoption.
Evidence-based practice has underpinned significant improvements in outcomes across multiple professions, from healthcare to social work, to education. By basing your work on evidence rather than anecdote or assumptions, we can have higher standards in our professions and better serve our communities. However, this comes with burdens, such as the need for ongoing professional development and consistent action research to assess whether outcomes of interventions match our expectations.
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