Internal versus External Evidence
After PICO formulation, gathering evidence that addresses the question is the next step. There are two types of evidence in nursing research: internal and external evidence. These two types of gathering evidence differ in various ways. First, internal evidence comprises the knowledge gained through formal training and education, general experience acquired from day-to-day operations, and specific experience accumulated from an individual nurse-patient relationship. Internal evidence refers to the data a clinician gathers directly from the clients seeking treatment. Internal data includes both objective data compiled in the course of a client’s assessment and the clinician’s subjective observations about the client’s behavior, feelings, and attitudes (Ellis, 2019). Examples of internal evidence include clinical expertise, outcome management interventions, quality improvement initiatives, and primary client data. Clinicians apply their clinical expertise and experience to track the client’s specific needs or situation. External evidence refers to the information accessible from research. In simple terms, external evidence is the evidence obtained from scientific literature, particularly from randomized control trials, study results, data analysis, and study conclusion. External evidence helps clinicians determine the effectiveness of a service delivery model in treating a certain group of patients. Examples of external evidence include randomized control trials, clinical practice guidelines, systematic reviews, and best practices that support changes in clinical practice.
Both internal and external evidence help improve the quality of care in clinical settings. The explicit utilization of internal evidence combined with valid external evidence leads to the formulation of evidence-based clinical decisions. Internal evidence helps clinicians apply daily experience in client-to-client scenarios to offer quality care. This helps in determining the suitable intervention to apply in the treatment plan. Also, internal evidence allows clinicians to rely on the observable client’s behavior, attitude, and feelings to inform treatment planning (Alatawi et al., 2020). This helps prevent misdiagnosis and thus boosts patient outcomes and patient safety. External evidence assists clinicians in determining whether the service delivery approach is effective in implementing change in clients. Also, external evidence benefits clinicians by providing a reference point on the models and treatment approaches that have worked for clients presenting with different conditions. This helps prevent medication errors and improve patient safety, quality of care, and patient outcomes. Also, external evidence helps to keep practices relevant and current, raising clinicians’ confidence level and decision-making skills. Whether to use internal or external evidence in treating a client depends on the client’s presenting symptoms, past history, and response to prior treatment interventions.
References
- Alatawi, M., Aljuhani, E., Alsufiany, F., Aleid, K., Rawah, R., Aljanabi, S., & Banakhar, M. (2020). Barriers of implementing evidence-based practice in nursing profession: A literature review. American Journal of Nursing Science, 9(1), 35-42.
- Ellis, P. (2019). Evidence-based practice in nursing. Learning Matters.