DNP 820 Topic 7 DQ 2 What are some reasons why evidence-based approaches might not yet be standard practice for certain sectors of the health care industry? What do you suggest for overcoming these barriers to achieve a widespread and universal evidence-based culture? Provide examples and relevant literature to support your response.

DNP 820 Topic 7 DQ 2 What are some reasons why evidence-based approaches might not yet be standard practice for certain sectors of the health care industry? What do you suggest for overcoming these barriers to achieve a widespread and universal evidence-based culture? Provide examples and relevant literature to support your response.

The Institute of Medicine (IOM) report to Err is Human converted an issue of growing professional awareness to one of substantial public concern in a manner and pace unparalleled in modern experience with matters of health care quality. Evidence-based assessment is a formal method of literature analysis that uses standardized techniques and places heavy emphasis on data from randomized controlled trials. Advocates of evidence-based practice argue that medical decisions should be based, as much as possible, on a firm foundation of high-grade scientific evidence, rather than on experience or opinion. The motivation for EBP stems from the observation that many widely used practices lack supporting evidence and are therefore of questionable value. Utilizing research findings at the top of care delivery is fundamental in increasing healthcare processes and patient outcomes. Due to increased expectations of high-quality nursing care in our society, it is no longer acceptable for nurses to give care based on experience and textbook information only; many clinicians report difficulties in implementing EBP of this approach due to lack of familiarity. Nurses’ understanding in the performance of EBP and the barriers they face is important to facilitate the successful implementation for the strengthening of EBP in care settings (Mahmoud & Abdelrasol, 2019).

Nursing has a strong history of using evidence-based research in practice. For evidence-based practice (EBP) care to be the favored standard of practice, EBP barriers must be overcome. Existing barriers in implementing evidence-based nursing exist at both individual and organizational level including inadequate time to read literature, intense workload, shortage of staff competent in EBP, deficiency of resources, lack of knowledge and skills, resistance to EBP, inadequate knowledge of EBP principles or how EBP will enhance patient outcomes and unfamiliarity with how to implement EBP, heavy patient caseload, family obligations, negative beliefs toward it and limited academic skills, and inability to employ recommending EBP research studies into clinical practice (Mallion and Brooke, 2016). Several strategies can be implemented to overcome barriers to EBP implementation which include the use of change agents, who can report potential difficulties in implementing EBP, conducting the change in one particular care area of the organization before disseminating it throughout and using multidisciplinary implementation teams to help cementing innovations into ongoing organizational processes. Training nurses on how to use the EBP change before implementing it, also using a bottom-up approach as opposed to a top-down approach will help to overcome some of the barriers as in this approach there is no ownership of the frontline staff. Changing practice takes substantial effort at both the individual and organizational level (Mathieson, Grande & Luker, 2019).

References

Mahmoud, M., & Abdelrasol, Z. (2019). Obstacles in employing evidence-based practice by nurses in their clinical settings: a descriptive study. Frontiers of Nursing, 6(2),123-133. doi: https://doi.org/10.2478/FON-2019-0019

Mallion, J., & Brooke, J. (2016). Community-and hospital-based nurses’ implementation of evidence-based practice: are there any differences? British Journal of Community Nursing 21, 148-154.

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary health care research & development, 20, e6.

I agree with you that the motivation for EBP stems from the observation that many widely used practices lack supporting evidence. Therefore, these practices are prone to failing in achieving their ultimate goals. Therefore, EBP provides factual information that can support practices that were previously lacking supporting proofs. Evidence-based assessment is an important routine in EBP. This assessment is a formal method of literature analysis. Different criteria are deployed in examining the data to be used in evidence-based practice. Using accurate research findings improve the accuracy of healthcare practice. Therefore, healthcare professionals are involved in research and other fact-finding activities. EBP is credited for reducing medication errors (Braun et al., 2019). Therefore, healthcare professionals are expected to embrace evidence-based practice. Due to increased expectations of high-quality nursing care in our society, nurses are expected to be accurate when making clinical decisions. At the same time, healthcare organizations have a duty of helping their nurses in implementing and using EBP.

References

Barker, J. H., Kane, R., & Linsley, P. (2019). Evidence-based practice for nurses and healthcare professionals. Evidence-based Practice for Nurses and Healthcare Professionals, 1-264.

Braun, T., Ehrenbrusthoff, K., Bahns, C., Happe, L., & Kopkow, C. (2019). Cross-cultural adaptation, internal consistency, test-retest reliability and feasibility of the German version of the evidence-based practice inventory. BMC health services research, 19(1), 1-17.

While many organizations, units, and nurses understand the value of evidence-based practice (EBP), it can be challenging to incorporate it into practice. There are various barriers to initiation on an individual level or organizational level. While many nurse professionals agree that EBP is an important component to practice, a discrepancy exists between implementation. When surveyed, nursing students believe EBP is important yet implementation scores were significantly lower (Abu-Baker et al., 2021). This same concern extends into professional practice. When surveyed, Chief Nurse Executives stated they valued EBP yet did not support EBP by allocating resources, including financial resources, to back this practice (Melnyk, 2018). Identified barriers included a limited amount of time, lack of leadership support, and lack of understanding are barriers to evidence-based practice (Melnyk, 2018).

To overcome these barriers, as discussed in the first discussion, the culture of a unit or organization needs to support EBP and have a spirit of inquiry. This supports the importance of EBP and builds acceptance of this practice. Leadership needs to support practice through a few different methods. The first is staff need to have access to resources, such as journal articles or a librarian to help search for references. Additionally, to build support for EBP, a clinical ladder or career advancement program can support nurses who employ EBP and those who are higher up on the ladder tend to have a more positive outlook on EBP (Weng et al., 2015).

Leadership needs to embrace a culture of inquiry. This can be done by supporting and encouraging EBP. Nursing leaders need to understand EBP in order to support this practice. This enhances the culture of inquiry. Staff may not understand how to perform EBP and struggle with implementation and sustainability. If leaders understand EBP and implementation science, they can better support appraising articles and evidence application (Majers & Warshawsky, 2020). Having a mentor can assist in incorporating EBP into practice as well as selecting an EBP model to guide staff in the EBP process. As schools lay the foundation for EBP, healthcare organizations need to continue developing EBP competencies and having EBP as a standard of professional practice.

References

Abu-Baker, N. N., AbuAlrub, S., Obeidat, R. F. & Assmairan, K. (2021). Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students. BMC Nursing, 20(13). Doi: http://doi.org/10.1186/s12912-020-00522-x.

Majers, J. S. & Warshawsky, N. (2020). Evidence-based decision-making for nurse leaders. Nurse Lead, 18(5), 471-475. Doi: 10.1016/j.mnl.2020.06.006.

Melynk, B. M. (2018). Why choose evidence-based practice? American Association of Nurse Practitioners. https://www.aanp.org/news-feed/why-choose-evidence-based-practice.

Weng, Y. H., Chen, C., Kuo, K. N., Yang, C. Y., Lo, H. L., Chen, K. H. & Chiu, Y. W. (2015). Implementation of evidence-based practice in relation to a clinical nursing ladder system: a national survey in Taiwan. Worldviews on Evidence-Based Nursing, 12(1), 22-30. Doi:10.1111/wvn.12076

healthcare organizations are at a hurry to implement evidence-based practice. Healthcare institutions that have successful implemented EBP has reported improvement in positive patient outcomes. Also, EBP has been credited for promoting patient safety (Flodgren et al., 2019). Despite many benefits, significant percentage of healthcare institutions are struggling to implement EBP. There are various barriers to initiation on an individual level or organizational level. Most nurse professionals have agreed that EBP is an important component to practice, but some have shown little support towards the practice (Qiao et al., 2018). Limited support from these experts have troubled the implementation of EBP. The resistance has also been attributed to incompetence among some nurse professionals. Therefore, other healthcare institutions have went ahead to introduce training programs for their workers. These nursing programs aim at sensitizing healthcare professionals about EBP. Similarly, successful completion of these training programs will improve workforce competence levels. Nursing leaders need to understand EBP in order to support this practice. Thus, leaders can also join staff members in these training sessions.

References

Flodgren, G., O’Brien, M. A., Parmelli, E., & Grimshaw, J. M. (2019). Local opinion leaders: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, (6). https://doi.org/10.1002/14651858.CD000125.pub5

Qiao, S., Li, X., Zhou, Y., Shen, Z., & Stanton, B. (2018). Attitudes toward evidence-based practices, occupational stress and work-related social support among health care providers in China: A SEM analysis. PloS one, 13(8), e0202166. https://doi.org/10.1371/journal.pone.0202166

Practice-based on evidence (EBP) is the conscientious and judicious use of the best current evidence, the clinical experience, and the patient’s values to guide decisions in health care (Melnyk et al., 2022). Unfortunately, despite much research to inform clinical practice, many patients still fail to receive evidence-based care. In addition, researchers have identified other barriers to the acceptance, adoption, and implementation of EBP (Brownson et al., 2017). The most common barriers to implementation are difficulty changing the current practice model, resistance and criticism from colleagues, and lack of trust in evidence or research (Brownson et al., 2017). Disadvantages of evidence-based practice include lack of evidence, common sense oversight, and the length of time and difficulty finding valid, credible evidence (Brownson et al., 2017). Another significant barrier that was pointed out was the need for more time to search for, understand, and interpret research findings. Other challenges in adopting EBP include insufficient access to information technology (IT), limited IT skills, and lack of information searching skills (Brownson et al., 2017). Due to its broader adoption in today’s medical fields, the barriers to implementing EBP have received more and more attention in recent studies. These barriers include nurses’ insufficient knowledge and skills in EBP, misperceptions that EBP requires too much time, organizational culture and policies, inadequate support from nurse leaders and managers, and lack of resources and investment in EBP (Brownson et al., 2017). When sufficient research evidence is available, the practice should be guided by research evidence, clinical experience, and patient values.

Making an evidence-based change in practice involves a series of action steps and a complex, nonlinear process. Implementing the change will take several weeks to months, depending on the nature of the practice change (Clark et al., 2019). Increasing staff knowledge about a specific EBP and passive dissemination strategies are likely to fail, particularly in complex healthcare settings (Clark et al., 2019). Strategies that were identified to have a positive effect on promoting the use of EBPs include audit and feedback, use of clinical reminders and practice prompt, opinion leaders, change champions, interactive education, mass media, educational outreach/academic detailing, and characteristics of the context of care delivery (e.g., leadership, learning, questioning) (Clark et al., 2019). Senior leadership and those leading EBP improvements must be aware of the change as a process and continue to encourage and teach peers about the change in practice (Clark et al., 2019). The new practice must be continually reinforced and sustained, or the practice change will be intermittent and soon fade, allowing more traditional care methods to return (Clark et al., 2019).

Moreover, a significant proportion of the organization’s education, training, and support for EBP is directed toward direct care nursing staff (Clark et al., 2019). There is an expectation in the organization that the nurse manager of an area (i.e., units or clinics) will be an active team member to facilitate practice change (Melnyk et al., 2022). If the manager does not support it, the project will go nowhere. Nurse managers make or break an EBP project and maintain a local climate that supports EBP (Clark et al., 2019). In addition, clinicians identified that influential leadership roles share an EBP vision for the area, committing to developing their and their staff’s EBP competency, communicating the expectation of EBP, recognizing staff for their EBP, and hiring staff that value EBP (Melnyk et al., 2022).

References

Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2017). Dissemination and implementation research in health: translating science to practice. Oxford University Press.

Clark, L. T., Watkins, L., Piña, I. L., Elmer, M., Akinboboye, O., Gorham, M., … & Regnante, J. M. (2019). Increasing diversity in clinical trials: overcoming critical barriers. Current problems in cardiology, 44(5), 148-172.

Melnyk, B. M., & Fineout-Overhold, E. (2022). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.

it is true that Practice-based on evidence (EBP) is the conscientious and judicious use of the best current evidence and the clinical experience. The practice has a defined procedure that guarantee accurate clinical decisions. EBP also considers patient’s values in decision-making process (Wieringa et al., 2018).  Most healthcare organizations desire to improve their patient positive outcomes. At the same time promote patient safety. Evidence-based practice assures healthcare institutions with best clinical decisions that will later on be useful in improving patient positive outcomes and promote patient safety. Unfortunately, despite much research to inform clinical practice, many patients still fail to receive evidence-based care. Barriers at individual and organizational levels have denied patients from accessing evidence-based care (Melnyk et al., 2018). A successful implementation of EBP rely on different internal and external stakeholders. However, nurse professionals are critical players in implementing evidence-based practice.  Incompetence levels among nurse professionals have challenged the efforts of implementing EBP. Other healthcare institutions have established training programs for their staff.

References

Melnyk, B. M., Gallagher‐Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A. (2018). The first US study on nurses’ evidence‐based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews on Evidence‐Based Nursing, 15(1), 16-25.  https://doi.org/10.1111/wvn.12269

Wieringa, S., Engebretsen, E., Heggen, K., & Greenhalgh, T. (2018). Rethinking bias and truth in evidence‐based health care. Journal of evaluation in clinical practice, 24(5), 930-938. https://doi.org/10.1111/jep.13010