Ana Belem López-Morales,1 Antonio Barrera-Cruz1
1Instituto Mexicano del Seguro Social, Coordinación de Unidades Médicas de Alta Especialidad, Coordinación Técnica de Excelencia Clínica, Ciudad de México, México
Correspondence: Ana Belem López-Morales
Keywords: Evidence-based nursing; Nursing care; Clinical reasoning
The historical evolution of the nursing profession for disciplinary advancement requires scientific development of the profession, ongoing staff training, coordination and integration with other professions and the need to acquire new knowledge and skills. Together these elements make clear that the role of nursing is to live up to its commitment to society.1 At all times, nursing care requires the articulation of scientific knowledge, experience gained through daily tasks, and a focus on the patient which promotes safe care from a holistic perspective.
In Mexico, nurses are immersed in a care process that requires the use of systematized and standardized models that contribute to the implementation of strategies and action plans, using guidelines and protocols.2 From diversity in systems and nursing work plans, the Health Sector derived the project SICALIDAD, with criteria and methodology with specific standards and protocols for the development of the Nursing Care Plan (PLACE, Plan de Cuidados de Enfermería), in order to standardize nursing care and unify criteria in care.3
In this sense, the PLACE is a technical tool for documenting and communicating the patient's situation and evaluating nursing care through results. To this end, the Permanent Committee on Nursing proposed a General Guideline for the Preparation of Nursing Care Plans, based on the taxonomies of the North American Nursing Diagnosis Association (NANDA), the Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC).3
The current structure of PLACE uses a standardized universal language that allows it to be reproducible and comparable; it uses the NANDA taxonomy of nursing diagnoses as the basis for the selection of outcomes and interventions (NIC-NOC). The combination of these three elements and their application in the clinical setting, make it feasible to demonstrate effectiveness of care and even measure its quality. The analysis of the expected results through appropriate indicators using qualitative and quantitative methods allows us to assess interventions’ suitability and effectiveness in addressing real health problems or each explicit risk in nursing diagnoses.
In current practice, nursing professionals recognize the importance of research and the use of the best scientific evidence as the basis for the development of a body of self-knowledge and support in making clinical decisions.
However, it must be recognized that despite efforts made in this area, nursing interventions based on the best evidence is not common practice, although the causes have not been fully studied. In some health institutions, dedicating time for planning and recording nursing care, called individualized nursing care, or "crafted plans," is almost impossible, and the questions most often asked are: How can I write care plans? Where will I get the time? This is a perfectly valid concern, since most nurses move in complex environments that limit meticulous care planning.
Perhaps the way to address the lack of time and other factors is that starting with the implementation of PLACE, and through its management and evaluation, proposals which enable improvement in methodological quality are defined through the reasoning methods that promote networking for clinical analysis, such as in the case of Model Analysis of the Current Status Result (AREA, Modelo Análisis de Resultado del Estado Actual), as well as current scientific evidence of high methodological rigor.4,5
In context, Evidence Based Nursing (EBN) is the process by which the nursing professional makes clinical decisions; its aim is to facilitate the inclusion and use of the best available evidence, grounded in research, clinical experience and patient preferences, in the context of available resources.6,7 Therefore, the use and application of the EBN in developing clinical practice guidelines and care plans is an area of opportunity for a professional practice that responds to the patient expectations in solving health problems.6-8
It is also a corresponding way to contribute to professional health institutions to incorporate quality standards for health care management. Protocols and care plans, and establishing the standard of care in a given situation, should be designed and formulated to meet predetermined standards of clinical quality.