Category: Evidence based practice

There is usually a resistance to implement new approaches and techniques to treating patients due to the firmly established traditions and norms. As a result, the evidence-based practice faces numerous serious problems and challenges. This review reveals barriers that nurse perceive when trying to implement their findings in their practice (Funk, Champagne, Tornquist, 1995). Many countries have engaged in surveying of their nursing staff on research-based activities. This reveals that this is a global challenge rather than a nationwide problem.

Sandra Funk creatively offered possible explanations why nurses fail to use research findings in their daily practices. She identifies the following to be some of the challenges facing the implementation of evidence-based practices. The nurses fail to notice that they have enough authority to shift patient care procedure, shortage of time for implementing new ideas, other nurses are just unaware of the new practices, physicians, supportive staff and administration fail to cooperate in the implementation process. Other problems identified by Sandra include; failure to understand the statistical analysis and inadequate facilities to implement the new practices. Generally, according to Sandra, inadequacy of time, facilities, knowledge and negative attitude towards implementation of the new practices are the major barriers to evidence-based practices.

Carol supports the idea that there exist some barriers that pose a potential hindrance to Evidence based practice implementation (Carroll et al., 1997). It is from her point of view that implementing and using research outcomes in nursing practice experience several setbacks. The constraints include inadequate knowledge concerning research methods, inadequate time for implementing new ideas or reading the research reports. She also makes it clear that the research reports are inadequate therefore; the nurses cannot access them to read and apply in their daily practices. The authorities are unwilling to change from old practices and join the practice of new ideas. She noted that there exists weaknesses in the evaluation of the new ideas, time factor and communication research procedures that are not supportive.

Kajermo in 1999, made investigation on nurses’ perceived barriers to carry out research and utilize the ideas. She found out that several factors contributed to failure of nurses to incorporate new ideas into the system (Kajermo & Nordstrom, 1999). The factors include inadequate accessibility to facilities, isolation from colleagues who have the knowledge and inability to understand the English language. A summary of the Kajermo’s barriers include research communication for instance, unavailability of reports, inadequate literature and unclear recommendations for the practices in the nursing fraternity. The research also identifies organizational disorders that relate to inadequate time for reading of researches, inadequate resources, implementation problems and poor leadership in health organizations together with low attitude from nurses themselves.

Retsas made surveys in Australian nurses and found out that perception of nurses interfere with their capability to make and use their research in clinical activities. According to Retsas, there are several reasons why nurses do not implement research activities. They include little time during job hours for implementing new ideas, inadequate facilities, inability to understand the research, less facilities and poor leadership among the authority. Additionally, physicians fail to cooperate with nurses while isolation of knowledgeable nurses takes the order of the day. In Retsas’ view, the nurses cannot access research materials, which imply that they are less, and cannot certify the requirements of all the nurses across the nation. An overview of the problems can be summarized into organizational problems, research communication and poor attitude from nurses towards the research activities (Retsas & Nolan, 1999).

A research carried out by Parahoo from Ireland pointed out that the perceptions of nurses cause barriers to carry out effectively evidence-based practices. Some of the factors that Parahoo identified included inability of authority to change the existing practices, inadequate understandability of the research reports and less time to integrate new ideas in the nursing practices (Parahoo, 2000). Additionally, the doctors were unwilling to cooperate with nurses in ensuring that new practices are infused into the system.

Another research from Finland by Oranta in 2002 made it clear that barriers made it impossible for the nurses to work with the evidence-based practices. They problems included inability to comprehend the research findings, problems of analyzing the research findings, unclear recommendation for evidence-based practices and inadequate access to relevant literature. The report provides that private organizations do not want to engage in evidence-based practices to support nurses in their daily activities (Oranta, Routasalo & Hupli, 2002).

Several researchers have proved that the time setting constraint is another problem in based practice delivery. Nurses feel that they engage in many activities which keep them very busy thus forget to involve in the based practices. Young noted that nursing continue to measure tasks rather than measuring critical thinking (Maljanian, 2000). According to Farrell, these tasks are time imperatives in which patients are organized in tight schedule with strict tasks-time grids. Farrell observed that the schedule is meant to trap the nurses. It is from the writer’s point that the schedules appear in most of the healthcare centers. Maljanian acknowledged that the schedule works well in some of the health organizations. Maljanian concludes by proposing that an integration of best current activities with care practices can lead to evidence-based practices in nursing which are synonymous in caring. Commitment to task-time imperatives reduces time for nurses to envision and explore sound evidence as a benchmark for evidence-based practices.

Although nursing research started scientifically long time ago, the nursing profession is still struggling with ways of implementing the outcomes of the researches into the clinical practices. Young acknowledge the existence of nursing literature, nursing schools, Magnet hospitals, and evidence-based practice centers. It is from the researcher’s point of view that all the mentioned facilities can promote evidence-based practices. Young also identified that the approach to evidence-based practices are modeled in various nursing education areas. Matters that appear within current settings of clinical practice can easily affect nursing students. Young proposed that issues affecting implementation of evidence-based nursing approach within current nursing situations, must be dealt with nurse educators. They involve time factors, accessing of information and resources, nurses should research to gain skills and knowledge and introduce evidence-based practices into the current nursing tradition (Young, 2003).

Evidence-based practices can improve health care delivery to patients across the globe. It is unfortunate that existence of many challenges facing the effectiveness of the practice can render it unproductive. This calls for all stakeholders to step in and make more research and innovations to eliminate these barriers. It will enable nurses, physicians, doctors and co-workers to cooperate in serving patients using evidence-based practices.

References

Carroll, D.L. et al. (1997).”Barriers and facilitators to the utilization of nursing research,” Clinical Nurse Specialist, 11 (1), 207-212.

Funk, S., Champagne, M., Tornquist, E. (1995), “Administrators’ views on barriers to research utilisation”, Applied Nursing Research, 8 (1), 44-9.

Kajermo, K. & Nordstrom, G. (1999). Barriers to and facilitators of research utilization, as Perceived by a group of registered nurses in Sweden. J Adv Nurs.,27 (4), 798-807

Maljanian, R. (2000). Supporting nurses in their quest for evidence-based practice: Research utilization and conduct. Outcomes Man­agement for Nursing Practice, 10 (4), 155-158.

Oranta, O., Routasalo, P., & Hupli, M., (2002). “Barriers to and facilitators of research utilization among Finnish registered nurses,” Journal of Clinical Nursing, 11 (1), 205-213.

Parahoo, K. (2000). Barriers to, and facilitators of, research utilization among nurses in Northern Ireland. Journal of Advanced Nursing, 31 (2), 89–98.

Paramonczyk, A. (2005). Barriers to implementing research in clinical practice. J Canadian Nurse, 101 (3), 12-15.

Retsas, A., Nolan, M. (1999). “Barriers to nurses’ use of research: An Australian hospital study,” International Journal of Nursing Studies, 36 (2), 335-343.

Young, K. M. (2003). Where’s the evidence? American Journal of Nurs­ing, 103 (10), 11.

Introduction

Evidence-based practice (EBP) is firmly established as an essential component of nursing practice. Despite being present in some form in all nursing roles, its presence is arguably more prominent in professional nursing settings (RN). The RN’s responsibilities include planning patients’ care, analyzing their medical history, and administering medications (Ericksen, 2015). In addition, several managerial tasks and the duty of communicating with clinicians increase the scope of responsibilities. Most of these tasks directly determine patient outcomes depending on the quality of the made decisions. While it would be an understatement to say that practical nurses do not rely on evidence-based practices, in most cases, the outcomes of the patients are only indirectly dependent on EBP, which is the most obvious differentiation between PN and RN.

Methods of Communication

Two of the most evident methods of communication used in nursing practice are verbal and written communication. The former is used for everyday interaction with the patients, thus fulfilling their basic needs and providing counseling, education, and support necessary for improving long-term results. In both instances, the clarity and accessibility of the presented information determine the quality of care received by the patient. The written communication is responsible for providing clear instructions on treatment and healthy behaviors, thus facilitating the safety and trust of the patients. Therefore, non-native-English-speaking healthcare providers are obliged to provide oral and written translations of important documents, offer competent interpreter services, and notify the stakeholders of their right to use the services (VonBriesen, n.d.).

Challenges of Delivering Primary Health Care

An environment designed for emergency medicine poses two major challenges to delivering primary health care. First, it does not offer any feasible means of continuity of care, such as access to a detailed medical history or a scheduled follow-up visit, which leads to frequent admissions for avoidable conditions. Second, the inadequately long wait times often lead to complications caused by the escalation of initially simple conditions such as high blood pressure (Leydon, 2012).

The dilemma of Providing Care to Vulnerable Populations

One of the challenges of patient-centered care is the disruption of balance in addressing the needs of patients with different needs. While it may seem logical to allocate more time to patients with more pressing needs and demanding conditions, it contributes to the mistreatment of populations with less apparent health risks. This eventually creates a situation where the latter have greater chances of developing adverse health conditions. Unfortunately, I cannot think of any meaningful solution to the problem aside from introducing additional regulations that ensure adequate time for both groups, although I acknowledge that such an approach may result in complications.

Portrayal in Media

In order to attract viewers, the popular media often deliberately introduces inconsistencies to the portrayal of emergency rooms. First, the technical details of many procedures are commonly misrepresented, mostly to make them apparent to the viewer, with defibrillators being the most common example (MedicalBag, 2014). Second, the formal side is often diminished or neglected in favor of action scenes that resonate with the viewer, such as rushing through the corridor with the patient in an unstable condition. Third, the ethical side of the profession can be inaccurately portrayed in order to attract viewers interested in on-screen romance.

People in the Waiting Room

The people who enter the waiting room are characterized by the presence of an apparent health risk as well as a possibility of further complication determined by the timely delivery of care. Therefore, it would be appropriate to describe them as stressed and vulnerable.

References

Ericksen, K. (2015). Practical nursing vs. professional nursing: Understanding the differences.Web.

Leydon, J. (2012). Emergency situation: The Waiting Room examines health care — and the lack of it — in America. Web.

MedicalBag. (2014). Fact or fiction: Do doctor dramas accurately portray real life in the ER?. Web.

VonBriesen. (n.d.). Health care provider’s obligations to non-English speaking patients. Web.

Empirically validated treatments are biomedical measures and/or medications that have favored biological treatment of a specific illness. This involves the precise handling of a medical case using treatments that have been discovered to work in the past. Such an approach does not necessarily mean that this specific treatment is the best solution for that particular medical illness. Several criteria have been identified to facilitate confirmation of an empirically validated treatment. One criterion describes that an empirically validated treatment has been proven by at least two superior experiments that show that the treatment is effective. A treatment is deemed to be effective when the results generated by the administration of such procedure are superior over the other treatment or the placebo control.

This may be determined through robust statistical analyses. This may be proven by employing a placebo in the experiment or by observing effective treatments in a conventional experiment consisting of amply sample sizes.

An empirically validated treatment may also be confirmed through the use of a vast amount of defined studies that show the efficiency of that particular treatment.

It is understood that these defined studies followed a competent experimental design and that the particular treatment being tested has been compared to another treatment, just like the placebo controls. Empirically validated treatments are also generally conducted based on a treatment manual.

This piece of documentation serves as the guideline for the investigator so that any modifications will be avoided, because any minor or major changes to a certain treatment may cause a different output or experimental result. In addition, this type of treatment provides precise descriptions of the samples that are included in the trial experiment. It is also important that empirically validated treatments are verified by at least two independent research groups that did not conspire to generate similar or exact observational results.

The healthcare profession involves the augmentation of a patient’s condition through therapeutic intervention. The shared moment between a healthcare worker and a patient who is unbearably suffering by himself provides guidance for the proper course of action, often resulting in greater patient satisfaction and healing potentialities (Gooden et al., 2001).

During this interaction, the healthcare professional establishes his presence by using a human care transaction mind-body-soul with another’s mind-body-soul in a lived moment.

Presence has been defined as a relational style within healthcare professional interactions that involves being with, as well as doing with. The core of this interaction is to learn and understand the circumstances of the situation and to direct the course of action to achieve the desired outcome of healing and recuperation on the part of the patient (Rachagan and Sharon, 2003; Hagihara A and Tarumi K, 2006). In addition, the focused shared moments with the patient and his family teach the healthcare professional to identify the key turning point necessary for the patient’s healing process (Gore and Ogden, 1998; Street et al., 2003). The professional learns the needs of his patient by being fully present and consciously relating to his whole being, enabling the professional to use aesthetic ways of discovering the obstructions in the hidden pathways preventing the healing process (Murphy DD and Lam CL, 2002). The healthcare professional plays a major role as a therapeutic agent by getting deeply involved with the situation using his inner energy of caring, being open and listening with solid awareness, and developing and sustaining a helping-trusting, authentic caring relationship (Ornstein, 1977; Heszen-Klemens and Lapinska E, 1984; Berry, 2007). Healthcare guidelines highlight that every healthcare professional is accountable for his decision and action and for maintaining competencies in every day of practice. This strong foundation requires that all nurses provide a therapeutic professional-patient relationship and provide care to patients under the scope of practice according to their needs, which will, in turn, lead to significant outcomes (Clark, 2002).

Healthcare workers use different types of presence in order to learn from their patients, in order a therapeutic relationship and mutual understanding under any circumstance.

The evidence-based practice focuses on observational studies to improve the methodological quality and effectiveness of the intervention. There is currently a vast amount of information regarding the incidence and prevalence of healthcare-related infections, as well as mortality data. Unfortunately, these significant figures are not efficiently disseminated and more importantly, not integrated into the general protocol of healthcare, because they have not been discovered by healthcare personnel for their own perusal and for integration into their routine services. Health care informatics is a recent area that involves the integration of health science, computer science, information science, and cognitive science to assist in the management of healthcare information (Saba and McCormick, 2001). By using the statistical information offered by these different fields of science, healthcare informatics may be divided into the areas of medical informatics, health informatics, dental informatics, and nursing informatics. The areas of medical, dental, and nursing informatics overlap in several areas such as information retrieval, clinical care, ethics, imaging, computer security, electronic medical records, and computer-assisted instruction.

The use of statistical information via informatics has been used in the field of medicine for more than two decades and has resulted in the establishment of the specialty field of medical informatics. Such area uses information technologies in relation to functions carried out when performing their duties (Hannah, 1985). It covers the entire range of information technology that is useful to nursing, especially for patient care, nursing practice, and healthcare management. It essentially helps in the processing of medical data, knowledge, and information to aid in medical practice and delivery of health care.

A parallel global scheme has existed for clinical trials, namely the Cochrane Collaboration, as well as the World Health Organization (WHO) Department of Reproductive Health and Research, aim to provide a comprehensive tabulation of available data on their specific fields of investigation. Such reviews also aim to calculate case-fatality rates and the proportion of preventable deaths by specific interventions. The development of search and retrieval strategies using statistical information should be sensitive and specific enough because there is so much information available in the databases and internet sources that it would seem very difficult for healthcare personnel to sieve through all the unnecessary and irrelevant entries. Databases are technically pools of information that may be useful should the right search results be presented to the investigator, or these may be useless if the investigator ends up with more confusion than when he just started using the database.

Statistical information that has been pooled into a central registry may serve as a convenient and systematic resource for the retrieval of medical information that is very useful for critical care management in the healthcare setting.

Two of the most recognized and employed databases in the medical field are MEDLINE and EMBASE. Both are universal bibliographical records of primary literature, with MEDLINE covering mostly North American publications, while EMBASE covers more European reports. Unfortunately, these two databases only have 30 to 50% overlap in their entries (Topfer, 1999). Unfortunately, databases employing evidence-based practice do not include unpublished reports, either because the investigators assumed that nobody else would be interested in looking at their data or because the investigators thought that a report that shows no significant differences is not worth publishing. In addition, non-English reports are not included in most of the databases due to language restrictions, yet these types of reports usually show statistically significant results as well as larger treatment effects. CINAHL is another database that healthcare practitioners, especially nurses, utilize for information on patient care and delivery.

It has been very useful in medical specialties including descriptive and explanatory information on nursing topics.

The employment of statistical information as applied to nursing care is highly interdisciplinary, with certain areas overlapping with computer science and education.

Nursing informatics provides a direct route to information connecting nursing informatics to research, especially evidence-based practice, and this provides a quicker mode for nursing to gather information on specific patient cases. In the earlier days, a healthcare practitioner needs to read a lot of research reports, journals, and books in order to be up-to-date with the latest trends in health care diagnosis, treatment, and delivery. The use of statistical knowledge and information as directly applied to evidence-based nursing provides a quicker way to access so much information that is available around the globe. It also saves time for the healthcare practitioner in researching for answers to their healthcare questions, leaving them more time to provide quality health care to their patients. In addition, the networking and establishment of databases serves as an essential tool to the construction of virtual global hospitals, wherein doors do not exist, but actually, bridges are erected.

References

1. Berry PA (2007): The absence of sadness: darker reflections on the doctor-patient relationship. J. Med. Ethics 33(5):266-8.
2. Clark PA (2002): Confidentiality and the physician-patient relationship – ethical reflections from a surgical waiting room. Med. Sci. Monit. 8(11):SR31-4.
3. Gooden BR, Smith MJ, Tattersall SJ and Stockler MR (2001): Hospitalised patients’ views on doctors and white coats. Med. J. Aust. 175(4):219-22.
4. Gore J and Ogden J (1998): Developing, validating and consolidating the doctor-patient relationship: the patients’ views of a dynamic process. Br. J. Gen. Pract. 48(432):1391-4.
5. Hagihara A and Tarumi K (2006): Doctor and patient perceptions of the level of doctor explanation and quality of patient-doctor communication. Scand. J. Caring Sci. 20(2):143-50.
6. Hannah KJ, Guillemin EJ and Conklin DN, eds. (1985): Nursing uses of computer and information science. Amsterdam, The Netherlands: Elsevier Science, 1985.
7. Heszen-Klemens I and Lapinska E (1984): Doctor-patient interaction, patients’ health behavior and effects of treatment. Soc. Sci. Med. 19(1):9-18.
8. Murphy DD and Lam CL (2002): Functional needs: agreement between perception of rural patients and health professionals in China. Occup. Ther. Int. 9(2):91-110.
9. Ornstein PH (1977): The family physician as a “therapeutic instrument”. J. Fam. Pract. 4(4):659-61.
10. Rachagan SS and Sharon K (2003): The patient’s view. Med J Malaysia. 58 Suppl A:86-101.
11. Saba VK and McCormick KA (2001): Essentials of computers for nursing: informatics for the new millennium. 3rd ed. New York, NY: McGraw-Hill.
12. Street RL Jr, Krupat E, Bell RA, Kravitz RL and Haidet P (2003): Beliefs about control in the physician-patient relationship: effect on communication in medical encounters. J. Gen. Intern. Med. 18(8):609-16.
13. Topfer LA, Parada A, Menon D, Noorani H, Perras C, Serra-Prat M (1999): Comparison of literature searches on quality and costs for health technology assessment using the MEDLINE and EMBASE databases. Int. J. Technol. Assess. Health Care 15:297-303.

Introduction

The ultimate objective of healthcare practice is to meet the needs of all patients. Many nurses identify and implement various concepts in their respective clinical areas to ensure that high-quality care is available to different individuals. One of these approaches is evidence-based practice (EBP). This discussion examines how EBP is used in my primary care unit.

Use of Evidence-Based Practice

Every practitioner in my unit is always encouraged to use EBP in order to deliver high-quality and timely medical services to the targeted patients. This concept has been applied using a number of strategies. The first one is that nurse leaders (NLs) guide caregivers to solve health problems using emerging ideas and knowledge from the latest research studies. Secondly, best practices and clinical guidelines published within the past few years are introduced in the unit to meet the needs of every patient. Thirdly, family members are usually encouraged to offer their insights during care delivery. Additionally, clinicians utilize every concept gained from lifelong learning to offer superior medical support.

Personally, I believe that the use of EBP in my unit has delivered several benefits. For instance, many people have been able to receive timely and high-quality services. The approach has also increased the level of patient safety. The department has recorded reduced healthcare delivery costs within the past two years. Such a practice also explains why the disparity in patient outcomes has decreased significantly.

Sources of Information

As described earlier, the HL in my unit presents timely information from journal articles and publications to different nurse practitioners (NPs) or groups. Teams are guided to consult new books describing emerging theories in nursing practice. The latest clinical guidelines, leadership styles, and care delivery models are identified and used in the unit. Practitioners are always encouraged to engage in continuous learning, identify new concepts, and share them with their teammates. These strategies explain why high-quality services are always available to different patients.

Barriers and Improvements

Several barriers to the use of EBP exist in my clinical site. For example, many caregivers and nurses lack adequate knowledge regarding the utilization of this concept. Some nurses are usually unable to critique the latest studies in nursing. The unit’s inability to introduce appropriate changes is another barrier affecting different NPs. The organization also lacks appropriate incentives and resources to implement emerging medical concepts. Additionally, the unit has also failed to encourage the use of modern technologies in healthcare practice. If these obstacles are addressed, high-quality and culturally competent care will be available to the greatest number of individuals.

I believe that advanced practice nurses (APNs) can promote EBP in their respective healthcare units. They can do so by studying widely and using acquired knowledge or concepts to expand their care delivery models. They can also form multidisciplinary teams in order to improve the experiences of many patients. APNs should be encouraged to collaborate with physicians, dieticians, and psychologists in an attempt to achieve their potential. Available educational resources and health information technologies should also be utilized whenever delivering medical services.

Conclusion

The above discussion has revealed that EBP can improve patient outcomes and care delivery. The involvement of HLs, physicians, and APNs is something that has made it possible for my unit to meet the needs of many patients. In conclusion, every NP in the targeted organization should be guided to engage in lifelong learning and embrace the use of modern health informatics.

EBP Use Evaluation

End-of-life care is a complicated area of healthcare as it is full of challenges for working nurses. The process of caring for the dying is often charged with practices that are more connected to emotional support than to medical treatment (Ingebretsen & Sagbakken, 2016). However, as many patients in these facilities may have health-related issues, nurses engage in both communicational and therapeutic practices. The use of evidence-based practice (EBP) in hospice nursing is often complicated by the nature of care, as nurses rely on their personal experience and interactions with their coworkers (Klein-Fedyshin, 2015).

For example, the process of pain assessment in patients with such conditions as cancer may not be supported by EBP and based on previously used procedures and scales. According to Herr et al. (2010), this problem is reoccurring in hospice care, where the use of specific guidelines for pain assessment may be infrequent. In one of my recent clinical experiences, I encountered a similar situation when my coworker based the examination on his previous knowledge of cancer pain rather than adhering to any type of official recommendations.

Care Based on EBP

In the discussed case, the process of pain assessment was not based on EBP. However, some nurses used a valid scale for pain evaluation during patients’ admission to the hospital. In many situations, workers are able to recognize the usefulness of strict guidelines, but it may seem as though their decisions are not based on recent and reliable research but on practices that were implemented some years ago. Thus, while some nurses used numeric rating scales, others chose to rely on their professional experience and neglected some questions from the scale (Herr et al., 2010). As a result, the use of EBP was not consistent.

Questions

Research Questions

1. Which practices do hospice nurses in the discussed clinical setting prefer?
2. Which existing pain assessment scales can be used for end-of-life patients with cancer pain?
3. Why do hospice nurses use specific recommendations periodically and not consistently?
4. What is the current state of research on EBP in hospice care?

PICOT Question

In end-of-life care, what is the effect of nurses following specific guidelines for pain assessment compared to the sporadic use of evaluation recommendations for patients with cancer over 6 months?

Barriers to Implementation

The culture in the discussed clinical setting is not based on following EBP practices. Many nurses do not possess the necessary knowledge to research information effectively during work. Furthermore, most of them do not have enough time to devote to learning. Thus, many of the activities in the organization are based on previous experiences as nurses share their thoughts with each other. It is a common problem in end-of-life care, as many hospice nurses cannot or do not want to engage in research at their place of work. It can happen because of poor information and computer literacy skills, access to EBP resources, time, and organization’s training plans (Klein-Fedyshin, 2015).

In the current setting, nurses’ lack of time may be the main barrier to implementing an EBP solution. According to Majid et al. (2011), this issue is among the main possible barriers to using EBP in nursing practice. Nevertheless, as any barrier, this problem can be overcome with planning (Polit & Beck, 2017). The organization’s management can be consulted about this problem to suggest some scheduling changes for nurses working on implementing the researched EBP. More nurses’ time can be devoted to research. It is vital to highlight the significant impact that these changes may bring.

References

Herr, K., Titler, M., Fine, P., Sanders, S., Cavanaugh, J., Swegle, J.,… Tang, X. (2010). Assessing and treating pain in hospices: Current state of evidence-based practices. Journal of Pain and Symptom Management, 39(5), 803-819.

Ingebretsen, L. P., & Sagbakken, M. (2016). Hospice nurses’ emotional challenges in their encounters with the dying. International Journal of Qualitative Studies on Health and Well-Being, 11(1), 31170.

Klein-Fedyshin, M. (2015). Translating evidence into practice at the end-of-life: Information needs, access and usage by hospice and palliative nurses. Journal of Hospice and Palliative Nursing: JHPN, 17(1), 24-30.

Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y. L., Chang, Y. K., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association: JMLA, 99(3), 229-236.

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

In healthcare, evidence-based practice (EBP) is considered to be the best approach to all activities for clinicians. However, hospitals and other organizations often fail to implement relevant and recent EBP research into their system (Polit & Beck, 2017). Thus, nurses have to develop a framework that will address the issues of their workplace and introduce EBP knowledge to other employees. In my organization, the support of EBP is hindered by multiple factors. First of all, nurses are not given enough time to devote to reading or discussing research. Furthermore, there exist no efforts to facilitate group learning. While nurses are encouraged to study on their own terms, no feedback or evaluations are provided to them. The organizational culture does not allow clinicians to provide feedback and does not evaluate their active participation. The lack of all mentioned above practices creates barriers for successful EBP implementation.

In order to improve the current view of EBP in the organization, one has to design a new program which supports education. The dissemination of studies’ findings can be done through various activities. Cullen and Adams (2012) suggest a number of general steps – creating awareness, building knowledge, promoting action, and pursuing sustained use. Each of these stages can also utilize various strategies, depending on the particular organizational culture. In the discussed hospital, a “multi-dimensional EBP program” proposed by Aitken et al. (2011) can be introduced (p. 244). This initiative includes such activities as a journal club, EBP workgroups, and nursing rounds. Also, the organization needs to allocate time and rearrange nurses’ schedules. In a journal club, nurses are introduced to the concept of EBP – the first step in the model of Cullen and Adams (2012). Nurses meet regularly and discuss the latest articles connected to their field of work. Most importantly, they are encouraged to evaluate the authors’ results and conclusions to understand which evidence can be considered valuable and trustworthy. Thus, their knowledge about the latest practices grows.

Nurses’ attitude towards EBP should incorporate its practical applicability. For these purposes, they should learn how to use the examined studies in the workplace. In this case, EBP groups and rounds help integrate the learned information into practice. Moreover, EBP leaders and mentors – experienced nurses or other health care professionals, can assist other workers in investigating new findings (Cullen & Adams, 2012). A similar approach is expressed in the model called the Advancing Research and Clinical Practice through close Collaboration (ARCC) (Fineout-Overholt, Williamson, Kent, & Hutchinson, 2010). Nurses’ role is imperative in the dissemination of findings – they promote organizational change, work to implement new initiatives, and assess the current state of all operations. To develop a sense of responsibility in nurses, one should also suggest such concepts as recognition of local progress and continuous feedback (Cullen & Adams, 2012). Specialists who understand that their commitment to EBP brings many positive changes to the quality of care are likely to continue using these practices.

The importance of EBP and research in nursing is crucial. Such findings help nurses develop new practices and locate problems in currently used procedures and methods. As a result, workers, patients, and the organization benefit in their own ways. The quality of care improves, nurses feel more empowered and capable, and the organization raises its status. Thus, it is vital for nurses to participate in EBP promotion through collaboration and open discussion. To achieve this, nurses need allocated time, peer support, and access to academic research.

References

Aitken, L. M., Hackwood, B., Crouch, S., Clayton, S., West, N., Carney, D., & Jack, L. (2011). Creating an environment to implement and sustain evidence based practice: A developmental process. Australian Critical Care, 24(4), 244-254.

Cullen, L., & Adams, S. L. (2012). Planning for implementation of evidence-based practice. Journal of Nursing Administration, 42(4), 222-230.

Fineout-Overholt, E., Williamson, K. M., Kent, B., & Hutchinson, A. M. (2010). Teaching EBP: Strategies for achieving sustainable organizational change toward evidence‐based practice. Worldviews on Evidence‐Based Nursing, 7(1), 51-53.

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Medical professionals should engage in advocacy in an attempt to address most of the risks and challenges affecting their patients. Falls are capable of resulting in injuries and extending patients’ hospitalization period. It affects both young and older people in different regions. The purpose of this paper is to identify and describe the economic, legal, and political factors that may contribute to the implementation of evidence-based or sustainable practice changes.

Economic Factors

The occurrence of falls can affect the quality of medical services available to different patients. The implementation of a practice change will present superior clinical guidelines that have the potential to minimize such sentinel events. From an economic perspective, any increase in a country’s gross domestic product (GDP) will present additional resources for transforming or improving care delivery and introducing superior fall prevention mechanisms (Wilson et al., 2016).

The additional costs associated with such sentinel events will disorient the quality and effectiveness of the healthcare industry. The recorded expenses can, therefore, inform new ideas or strategies for minimizing falls in different medical facilities. The end result is that increased savings will be made and allocated to meet other healthcare demands.

Legal Factors

Legal forces are contributors of policy changes and practice improvements in the health care sector. Hospitals can focus on emerging laws and regulations regarding this issue and go further to implement powerful evidence-based procedures in their respective units. Practitioners, health managers, and clinicians can introduce desirable changes since any fall can result in malpractice lawsuit, thereby affecting their professional goals. Institutions can also consider the nature of these sentinel events and embrace new preventative measures, procedures, or policies (Polit & Beck, 2018).

Most of the existing laws support every patient’s rights and autonomy. Since falls are capable of undermining such liberties, it becomes necessary for hospitals to introduce evidence-based changes that result in positive results and be on the safe side of the law.

Political Factors

Politics have continued to reshape people’s thoughts, engagements, economic goals, and policies. The decision to elect like-minded leaders means that new practice changes will emerge that can minimize the percentage of falls recorded in different facilities. Similarly, positive political situations in a given country or region will create the best environment for undertaking numerous researches and presenting superior practice changes.

More stakeholders will be willing to be involved and examine the nature of this health problem from different perspectives. The final result is that superior models or workplace practices will emerge that can improve the experiences of patients and minimize falls (Salmond & Echevarria, 2017). The existence of a favorable political climate will empower or encourage more professionals to engage in advocacy and eventually support the introduction and implementation of evidence-based practices changes in different medical facilities.

Conclusion

The occurrence of falls in different settings and facilities makes it impossible for the affected individuals to record positive health outcomes. The introduction of new changes can make it possible for different clinicians to empower their patients and overcome the challenges associated with this sentinel event. Those involved should consider every existing or favorable political, economic, and legal factor in order to present evidence-based suggestions. Such measures will eventually support the introduction of powerful practice changes in different healthcare settings. The possible outcome is that the percentage of falls in hospitals will reduce significantly.

References

Polit, D. E., & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer.

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1), 12-25. Web.

Wilson, D. S., Montie, M., Conlon, P., Reynolds, M., Ripley, R., & Titler, M. G. (2016). Nurses’ perceptions of implementing fall prevention interventions to mitigate patient-specific fall risk factors. Western Journal of Nursing Research, 38(8), 1012-1034. Web.

One of the most effective ways to ensure high quality of care and procedure standardization in health care is the implementation of evidence-based practice (EBP). EBP is based on the most recent and relevant scientific findings and may be opposed to common knowledge within the healthcare system. This essay will discuss the discrepancy between research findings and their use in the workplace and two common obstacles to EBP introduction.

Obstacles at Individual Level

Adequate implementation requires making meaningful changes at all levels. Admittedly, health providers such as nurses play a significant role in reforming the healthcare system. Khammarnia, Haj Mohammadi, Amani, Rezaeian, and Setoodehzadeh (2015) found that nurses had difficulties with introducing advised practices due to the lack of time to read literature and enhance their computer illiteracy. Moreover, there might be a reluctance to make amendments to the usual workflow at their medical facility.

Obstacles at Organizational Level

It is safe to assume that personal struggles with EBP could be overcome if managers provided ongoing support for nurses. Gifford et al. (2018) reason that ideally, the managing board and supervisors of a medical facility could implement task-oriented and relation-oriented encouraging behaviors. In the first case, they would operationalize the vision and mission of their facility by explaining new procedures whereas in the second case, they would counsel and guide employees. It is easy to see how such an approach could be too time-consuming for many managers and thus, rejected, which constitutes the second obstacle to EBP implementation.

Conclusion

Proper evidence-based practice implementation is associated with better patient outcomes, health providers’ job satisfaction, and decreased financial burden on patients, medical facilities, and insurance companies. Despite the extensive body of evidence about the benefits of EBP, there is a lot of space for improvement in terms of implementation. On the individual level, nurses might be lacking the knowledge, awareness, and personal resources to embrace new policies. On the organizational level, some systems are characterized by a high degree of rigidity and lack of support.

References

Gifford, W. A., Squires, J. E., Angus, D. E., Ashley, L. A., Brosseau, L., Craik, J. M., … & Graham, I. D. (2018). Managerial leadership for research use in nursing and allied health care professions: A systematic review. Implementation Science: IS, 13(1), 127.

Khammarnia, M., Haj Mohammadi, M., Amani, Z., Rezaeian, S., & Setoodehzadeh, F. (2015). Barriers to implementation of evidence based practice in Zahedan teaching hospitals, Iran, 2014. Nursing Research and Practice, 2015, 357140.

Patient falls constitute one of the most serious problems in adult-gerontology primary care. The nursing model that can be used as a framework to promote the management of the identified issue is patient-centered care. Although this approach is known to increase patient satisfaction, scholars argue that it may not be beneficial for evidence-based practice (Delaney, 2018). Nevertheless, it seems possible to apply patient-centered care to reduce patient falls in evidence-based nursing.

Patient falls belong to the most frequently reported adverse events. Even though the focus of the selected area of advanced practice nursing in primary care, the nurse must be able to consult patients about this adverse event. There are over 1 million cases recorded annually (Aydin, Donaldson, & Aronow, 2015). Not only are patient falls the cause of high morbidity and mortality but they also lead to substantial financial losses.

Older adults have a high risk of falls and maybe at an increased risk of falls at a hospital. Adults may have no disposition towards falls when they are in the community, but they may develop the risk once they are at a hospital, where they experience debilitation and have a low level of personal vulnerability awareness. Recent studies indicate that preventing patient falls altogether may be impossible, so scholars and practitioners focus their efforts on preventing falls with injury (Aydin et al., 2015).

The selected nursing care model can promote the resolution of patient falls incidence. According to Aydin et al. (2015), spending more direct hours with patients is the simplest yet the most effective measure nurses can take.

Fox et al. (2013) remark that patient-centered care has the potential to decrease the risk of falls through evaluation. Particularly, a standardized assessment of patients’ cognitive and physical functioning within the first day of admission can alleviate the danger. Fox et al. (2013) emphasize that the assessment should focus on patients’ mobility, delirium risk, and falls risk. Also, scholars note that it is necessary for nurses to perform a daily examination of patients under the threat of developing patient falls.

In my experience, there was a case when patient-centered care helped to promote an elderly female patient’s well-being and reduced the risk for patient falls. The woman was 75 years old, and she spent several weeks at the hospital. During that time, I instructed her on safe walking habits and self-care measures. As a result, the patient moved around the ward and corridors with cautiousness and attention. No fall incidents were recorded, and she left the hospital with new skills that would help her remain more alert at home. Thus, the patient-centered care model can be successful in reducing the risk for patient falls.

References

Aydin, C., Donaldson, N., & Aronow, H. U. (2015). Improving hospital patient falls: Leveraging staffing characteristics and processes of care. The Journal of Nursing Administration, 45(5), 254-262.

Delaney, L. J. (2018). Patient-centered care as an approach to improving health care Australia. Collegian: The Australian Journal of Nursing Practice, Scholarship & Research, 25(1), 119-123.

Fox, M. T., Sidani, S., Persaud, M., Tregunno, D., Maimets, I., Brooks, D., & O’Brien, K. (2013). Acute care for elders components of acute geriatric unit care: Systematic descriptive review. Journal of the American Geriatrics Society, 61(6), 939-946.

Article: APA Format

Reid, J., Briggs, J., Carlisle, S., Scott, D., & Lewis, C. (2017). Enhancing utility and understanding of the evidence-based practice through undergraduate nurse education. BMC Nursing, 16(58), 1-8. Web.

Brief Discussion

The selected article offers meaningful insights that can empower nursing educationists and practitioners to embrace the power of evidence-based practice (EBP). The authors describe a new course (Evidence-Based Nursing 1) that was implemented as part of an undergraduate nursing program. The researchers observed that the targeted learners were willing to make evidence-based practices part of their nursing philosophies after completing the course. The practice can encourage practitioners to integrate EBP into their respective care delivery models (Reid, Briggs, Carlisle, Scott, & Lewis, 2017). The judicious use of emerging or current evidence in care delivery and health decision-making processes can result in improved patient outcomes and support advanced practice nursing. This article describes the meaning of EBP and how it can be implemented in nursing institutions to ensure that advanced practice nurses (APNs) are prepared to meet their patients’ health needs. The use of emerging evidence and concepts from research studies can guide nurses to offer advanced care. When APNs embrace the power of EBP, they will achieve their potential and offer quality and equitable health services.

EBP Discussions

The concept of EBP revolves around the use of best evidence to improve patient outcomes. Mackey and Bassendowski (2016) indicate that external clinical findings, results from systematic studies, and personal nursing expertise constitutes “best evidence” for EBP. Nurses should combine such concepts to develop appropriate care delivery models and make desirable decisions to support their patients. EBP is a powerful approach that can be used at the point of care. Proficient nurses can diagnose and educate patients depending on their conditions. Such practitioners will identify signs and symptoms, offer timely patient education, and empower individuals to engage in disease management practices. These tasks at the point of care will be informed by every nurse’s current evidence and information backed by the latest research findings.

Informatics can bring the best available evidence to support AGPC practice. Modern technologies empower nurses to use standardized terminologies that can result in desirable health outcomes. Digital sources of timely or latest evidence can also be used to meet patients’ needs. Practitioners can use informatics processes to acquire and apply evidence to different clinical situations (Reid et al., 2017). Informatics competencies empower nurses to minimize sentinel events and meet patients’ needs.

I am planning to embrace the future by using EBP in my practice. I will incorporate the concept using a powerful strategy. The approach will be implemented using the notion of lifelong learning. I will also undertake numerous researches and use modern informatics to improve my nursing philosophy. Unfortunately, some barriers can affect the implementation and development of an EBP culture. The first one is the existing gap in education and practice. This limitation affects nurses’ ability to use evidence accurately and efficiently. The lack of appropriate policies to support the use of EBP is the second challenge (Mackey & Bassendowski, 2016). The third obstacle is that many institutions and practitioners have failed to embrace the power of informatics. These gaps affect patients’ health outcomes negatively.

EBP is expected to impact advanced nursing practice positively. The concept can sanction practitioners to make informed decisions and offer desirable care depending on their patients’ expectations. The approach results in improved care delivery systems. It also encourages practitioners to improve their nursing philosophies using emerging ideas (or concepts) and their competencies (Reid et al., 2017). EBP empowers nurses to make informed decisions, develop superior care delivery models, and update their skills. APNs using the concept will, therefore, offer safe, affordable, and sustainable care to their patients.

References

Mackey, A., & Bassendowski, S. (2016). The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing, 33(1), 51-55. Web.

Reid, J., Briggs, J., Carlisle, S., Scott, D., & Lewis, C. (2017). Enhancing utility and understanding of evidence based practice through undergraduate nurse education. BMC Nursing, 16(58), 1-8. Web.