Welcome to the January 2009 edition of the International Journal of Nursing in Intellectual and Developmental Disabilities

By Joan Earle Hahn PhD, APRN, BC, CDDN

This issue of the International Journal of Nursing in Intellectual and Developmental Disabilities (IJNIDD) focuses on evidence-based practice (EBP), which is receiving greater attention in all healthcare arenas including nursing with persons with intellectual and developmental disabilities (I/DD). The idea for this issue emerged after two conferences in which four of the authors of this issue presented about EBP to nurses at two national meetings for nurses and other professionals working with persons with I/DD. Ann Smith, IJNIDD editor in chief, invited authors Hahn, Gibbs, Leger, and Leibold, who presented at those meetings, to submit papers for this issue. A call for papers also brought in authors Graff and colleagues to discuss evidence-based practice in nursing for persons with I/DD.

Evidence-based nursing is a term that was exemplified according to some authors early in the nursing discipline by Florence Nightingale. The term, which has received greater focus in nursing since the 1990s, parallel to a movement toward evidence-based practice in medicine, has been defined by the International Honor Society for Nurses, Sigma Theta Tau, as "an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served." EBN has increasingly become a focus across settings where nurses practice, including practice with persons with developmental disabilities. As Leibold et al. in this issue point out, evidence that supports nursing recommendations for persons facing health issues (i.e., surgery) may be lacking for individuals with I/DD facing the same health concerns. Nurses have a key role to promote EBN practice with individuals with I/DD, their families, and their communities to decrease uncertainty of the practices we choose, promote best patient outcomes, and provide best practice that is compatible with patients' preferences and values.

In this issue, an overview article by the issue editor, Hahn, presents a brief historical overview of EBP and sets the context of EBN with persons with I/DD using examples of evidence from the literature. Hahn outlines five steps on how to use EBP to further its application in nursing practice to support individuals with I/DD, families, caregivers, and other team members in healthcare and in the community. In a second article, Graff and colleagues review the World Health Organization ATLAS-ID report of the first global survey about resources and services for persons with developmental disabilities. The reported evidence-based knowledge highlights key concerns and factors in ongoing health disparities for persons with developmental disabilities across the world. This review provides information about nurses worldwide who provide the care in 68% of countries and points the way for nurses to address these disparities. In a third article, Leger et al. provide several examples of EBN practice to improve the outcomes of persons with sickle cell disease and spina bifida. These examples illustrate various ways nurses can use EBN that may begin with anecdotal reports (i.e., patient allergic reactions to latex) and builds with the collection of evidence from other sources (i.e., shared nursing expertise), as well as evidence from patient perspectives captured using participatory research methods. In the fourth article, Leibold et al. provide an excellent clinical example of EBN that builds on evidence from clinical nursing practice combined with evidence from the research literature, nursing clinical expertise, and patient and family values. A retrospective chart audit about post-operative outcomes identified key areas in need of evidence-based protocols. Research of the current research-based literature in the context of patient and family viewpoints led to proposed EBN practice changes in policies and nursing practice. Future evaluation of a new EBN nursing pre-operative protocol will determine whether these recommended EBN changes are effective in improving patient outcomes. These articles illustrate that nurses have enormous potential to increase EBN practice in this nursing specialty.

Linda L. Lindeke reviews the book Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice edited by Melnyk and Fineout-Overholt in 2005. This is a resource that nurses should have in their library, especially as they delve into EBN.

Finally, a letter by Dr. Leonard E. "Len" Gibbs expressed his belief that nurses and others should view EBP "as if your life depended on it." In his letter to the editor, Gibbs acknowledges nurses who have worked with him professionally in teaching others about EBP and those who have touched his life personally and profoundly as he faced a life-threatening condition for which he wished more evidence had been available to assist in decision-making earlier in the course of his illness. Dr. Gibbs, professor emeritus of social work at the University of Wisconsin at Eau Claire, was a forerunner worldwide in education of healthcare professionals about evidence-based practice and the importance of using evidence to guide healthcare decision making. He was dedicated to the role that nurses and EBP can play in promoting well being and quality in the lives of nurses, health professionals, families, and individuals, including individuals with developmental disabilities. He stressed the importance of asking the right questions and using evidence and expert decision making in the context of the health and values of the individual. Sadly, Dr. Leonard Gibbs died on Friday, June 13, 2008, prior to publication, after a courageous three-year battle with metastatic prostate cancer.

We dedicate this issue to Dr. Len Gibbs. I would personally like to thank him for his kind words and for the knowledge that he has shared with us.

Dedication
to
Leonard E. "Len" Gibbs, Ph.D.
September 3, 1943 to June 13, 2008