Evidence-based nursing: a change dynamic in a managed care system

The emerging evidence-based decision-making phenomenon represents a new opportunity for nursing professionals. This opportunity arises because managed care brings about a new motivation to incorporate existing evidence and research skill into the health care delivery process. In order to participate fully in managed care systems nursing research must be uncompromising in its focus on the characteristics of the client group, the processes of intervention and the outcomes of intervention. It is argued that evidence-based nursing, as a process, needs to consider three questions. How do we know what practice needs to be changed? How do we enable this change in practice? and how do we ensure that change brings about no further harm? The greatest danger in the process of identification and prioritizing by a group is the bias that can occur because of conscious and unconscious habits associated with power relationships within groups. Nominal Group and Delphi techniques are suggested to alleviate this. Action research is proposed as a method of dealing with, the critical issue of risk management.