Decision Making the Explicit Evidence-Based Way: Comparing Benefits, Harms and Costs 

Abstract
Decisions that nurses make in clinical practice are a significant contributor to effectiveness and cost effectiveness of health care.  This paper explores the relationship between evidence, decision tools and the effectiveness of the nursing contribution to health services.  Whereas research evidence, to varying extent, has been used to inform decision making in nursing for some time, explicit evidence-based decision-making, or ‘balance sheet’ decision-making, is less familiar.  A continuum of decision-making will be explored within the international trend of the Effectiveness Movement, drawing on international literature and local experience.  Included in this discussion will be the concept of explicit evidence-based decision making, the guideline development movement as exemplified through the New Zealand Guidelines Group, information technology in decision-support, and some of the challenges of an evidential approach to nursing. 

Keywords
evidence-based nursing, decision making Clinical Practice Guidelines

Introduction
In October 1997 the New Zealand Guidelines Group (hereinafter referred to as the NZGG) expanded its training programme (hitherto solely for medical practitioners) to include most health care professional, and disability support groups.  During this training the present authors were introduced to the concept of explicit evidence-based decision making through clinical care interventions in the form of Practice Guideline development.  The difference between an evidence-based approach and an explicit evidence-based approach is that the former is usually without an estimation of the impacts of practice change, or costs:  and the latter always projects the benefits, harms, and costs of alternative practices (Handley, 1997).  Within this explicit approach is the "balance sheet".  A balance sheet presents information on the outcomes of health quantified benefits, harms and costs, thereby supporting clinical decision making by demonstrating the consequences of the interventions being considered (Eddy, 1996).