Evidence-based practice habits: putting more sacred cows out to pasture

For excellence in practice to be the standard for care, critical care nurses must embrace evidence-based practice as the norm. Nurses cannot knowingly continue a clinical practice despite research showing that the practice is not helpful and may even be harmful to patients. This article is based on 2 presentations on evidence-based practice from the American Association for Critical-Care Nurses' 2009 and 2010 National Teaching Institute and addresses 7 practice issues that were selected for 2 reasons. First, they are within the realm of nursing, and a change in practice could improve patient care immediately. Second, these are areas in which the tradition and the evidence do not agree and practice continues to follow tradition. The topics to be addressed are (1) Trendelenburg positioning for hypotension, (2) use of rectal tubes to manage fecal incontinence, (3) gastric residual volume and aspiration risk, (4) restricted visiting policies, (5) nursing interventions to reduce urinary catheter-associated infections, (6) use of cell phones in critical care areas, and (7) accuracy of assessment of body temperature. The related beliefs, current evidence, and recommendations for practice related to each topic are outlined.