Volume 5, Issue 1

Leonard Gibbs, Prof. Emeritus, Department of Social Work, University of Wisconsin—Eau Claire

My comments are directed especially to nurses who read this journal with the intention of making a direct and positive impact on their own survival. This is grounded in my professional work with nurses and others in the development and dissemination of information about evidence-based practice (EBP) for health care professionals and my personal experience in health care. I would like to acknowledge some of these nurses who were important in EBP and share my unique thoughts about EBP for nurses that come from my personal perspective.

Joan Werner of the School of Nursing at the University of Wisconsin - Eau Claire, a kindly, warm, and caring friend with a wonderful combination of unpretentiousness and an incredibly well-trained methodological acumen, shared my interest in improving clinical reasoning for decades. We reasoned that, precisely because we cared so deeply about the welfare of our clients/patients, we would learn to avoid common errors in reasoning that could cause harm. Joanie and I developed a Professional Thinking Form that tests ability to name and define common practice fallacies (Werner & Gibbs, 1987; Gibbs & Werner, 1999). I have also had the opportunity to learn from and to collaborate with Susan Moch and Lois Taft, also of the School of Nursing at the University of Wisconsin - Eau Claire. We three have given day-long workshops to teach evidence-based practice skills, including how to pose well-built clinical questions, how to use methodological filters to search efficiently for current best evidence, how to critically appraise evidence for its utility, and how to integrating the best evidence into practice (Gibbs, Moch & Taft, 2004). We worked hard during the workshops, and collaborating with Lois and Susan was a wonderful opportunity to hear a new perspective and to just have fun together. In the spring of 2007, I spoke about Evidence-Based Practice: Making Life-affecting Judgments and Decisions at the Developmental Disabilities Nurses Association in Albuquerque, NM. During all of these activities I have enjoyed and appreciated my nurse colleagues, and I have learned much from them.

Recently, I have seen another side of nurses that only deepens my respect and appreciation - this time as a patient! In the spring of 2005, I was diagnosed with inoperable metastatic prostate cancer. The first nurse I met after my diagnosis was Diane Mann, a research nurse who authored a study at the Mayo Clinic titled: "A Phase II Immunotherapeutic Trial: Combination Androgen Ablative Therapy and CTLA-4 Blockade as a Treatment for Advanced Prostate Cancer." I have kept my monthly appointments with Diane for over two years. Diane is one of the reasons I have a will to live. She has been incredibly helpful, in collaboration with Dr. Eugene Kwon, PI on the study, by giving me not only treatment and information, but much more: she cares whether I live or die. On September 17,2007, my bone pain became so severe that all I could do was pace and vomit until I was admitted to the hospital for five days for an ileus. Frankly, I was in such pain and in such a daze from the Oxycodone medication that I do not recall the names of the nurses who helped me during my hospitalization, but I do recall nurses’ gentle reassurances, specific instructions, and kindly humor and, finally, the control of my pain.

Why then am I writing this letter for nurses? I am writing to make the same point I made during my presentation on Evidence-Based Practice: Making Life-affecting Judgments and Decisions at the Developmental Disabilities Nurses Association’s Annual Meeting in 2007. I want nurses to apply the process of evidence-based practice in light of questions related to their own health so they will have a better chance to survive and live long, healthy lives. Nurses need to be alive so they can enjoy their own lives and so they can continue to help others like me.

I had a huge and costly transfer of a learning problem in 2003 when I went to see my doctor for a routine flight physical after having just written a book, Evidence-Based Practice for the Helping Professions: A Practical Guide with Integrated Multimedia, www.evidence.brookscole.com. At the time I saw my doctor, my mother had just died of breast cancer in 2002, my father had died three weeks later of esophageal cancer, and my sister had just been diagnosed with breast cancer. My maternal grandfather had died many years earlier of prostate cancer at age 66. My doctor and I knew these facts. My doctor said, "Your PSA is up a bit, but it is below 4. We will have to watch it." At that moment, I did not pose the following well-built clinical evidence-based practice question regarding my own healthcare:

Systems change to implement best practices is addressed in detail (chapter 16) to assist leaders to apply the evidence and to implement the most compelling evidence to improve clinical care outcomes.

For a sixty-year-old white male with a family history of prostate and breast cancer, his prostate specific antigen (PSA) moving from .8 to 1.9 in 20 months, what is the probability that he has prostate cancer?

If I had applied the EBP process to myself, following the steps of EBP (Straus, Richardson, Glasziou & Haynes, 2005), beginning with my own well-built question, I believe that my life and those of my dear family might have been very different. If I had searched then, I would have discovered "nomograms," or tools that calculate risk and suggest a specific probability for cancer given family history, age, and PSA test results. This brings me to the point of my letter to you.

There is nothing in this life so grim that something useful may not come of it. Therefore, after my diagnosis I began searching the Internet for ways that individual patients can get the help that will walk them through the EBP process specific to their own medical history - questions specific to their own diagnosis and care, the most useful research, and help interpreting the research regarding their care. Disappointed with what I found, I collaborated with my dear wife, Betsy, and with Dr. Eamon Armstrong, a champion of EBP and award-winning EBP teacher, to create a website called "evidence-based practice as if your life depended on it." Here is the address of our website:

www.uwec.edu/lgibbs/index.htm

The website begins with my story and why the website was created, includes a definition of EBP, and then walks the user through the following steps

• Step One: Schedule regular check ups.
• Step Two: Share your current medical history.
• Step Three: Learn how to pose a well-built clinical question regarding your own care.
• Step Four: Search for the current best evidence regarding your question
• Step Five: Critically appraise the evidence for its implications for action.

We hope our website helps you to improve your chances of survival so that you, as a nurse, can continue to give patient care to people like me.

During all of these activities I have enjoyed and appreciated my nurse colleagues, and I have learned much from them.

Len Gibbs

Author information (adapted from the UWEC web site with permission)

Gibbs, a national expert on evidence-based practice in social work, conducted workshops on evidence-based practice and critical thinking at professional conferences and universities throughout the nation. He wrote extensively on the subject and authored several books including "Evidence-Based Practice for the Helping Professions and Scientific Reasoning for Social Workers: Bridging the Gap Between Research and Practice." He was instrumental in getting the Prostate Cancer Risk Calculator - Forecasting the Risk of Disease posted on the web.