Best practice in nursing: A concept analysis

Background: Since the early 1990s a shift has occurred in the understanding of what constitutes quality healthcare. This is evidenced by the emergence of new concepts in the nursing literature, including best practice. Although authors have analyzed the concept of best practice in the healthcare sector, further analysis is required to distinguish the concept's unique meanings, and significance for the nursing discipline. Objectives: This paper seeks to clarify use of the concept of best practice in the nursing literature over the last two decades, and contributes to explaining its defining characteristics, applicability, and significance. It also distinguishes the concept's unique meanings and usefulness in comparison to other related terms. Methods: An evolutionary concept analysis method was selected for this analysis. First, a representative sample of nursing sources was obtained utilizing the CINAHL database. This database was searched for sources in English, during the years 1993-2013, with both best practice and nursing in the title. Data was then collected from the sample of retrieved literature on attributes of best practice, antecedent and consequential occurrences, variations, and empirical references. The following related concepts were also explored for purposes of comparison and to situate the understanding of best practice in-context: practice development, evidence-based practice, and standard of care. Findings: Use of the concept of best practice in the nursing literature may be categorized into four distinct domains: educational, administrative, clinical and theoretical/conceptual. Exploration of defining attributes revealed that best practice may be characterized as: directive, evidence-based, and quality-focused. Antecedent occurrences in the sample sources were most commonly related to identification of a specified need or problem, somewhat defined by the domain. The implied consequential occurrences were ultimately better outcomes. Conclusion: Best practice is more than practice based on evidence. It represents quality care which is deemed optimal based on a prevailing standard or point of view. Specific best practices in nursing are significant because they serve to direct nurses regarding solutions to identified problems/needs. Continued analysis of the concept of best practice is required to further distinguish it from related concepts, and to expand our understanding of the relative meaning of best from multiple perspectives. (C) 2014 Elsevier Ltd. All rights reserved.