**** please comment to each response, add citations and references :)***
Response one: Evidence-based practice (EBP) is undoubtedly invaluable to quality improvement, patient care, and outcomes. EBP is responsible for numerous quality improvement initiatives that resulted in positive enhancements to patient care delivery processes throughout the years. Therefore, evidence-based practice holds great promise for moving healthcare to a superior level of care, globally. However, despite all the evidence obtained through research, a huge gap still exists between all this knowledge and its implementation in patient care delivery. Although it comes naturally to nurses to do good and they have a genuine desire to care for others, nurses face multiple barriers to integrate and apply these well-known best practices.
For instance, nurses prepared at the associate-degree level frequently have limited knowledge about evidence-based practice research, and don’t fully understand its importance and value. Therefore, they do not engage in such practices or do it only unintentionally as a result of their prior school and job training. However, they do not purposefully or knowingly look for evidence-based practice interventions when researching for new knowledge. The best way to eliminate this barrier is to encourage these nurses to pursue higher levels of education and attain a minimum of a baccalaureate degree. Nursing shortage and heavy workloads have also stood out among nurses as strong barriers to EBP implementation. As reported by nurses, these two elements make it nearly impossible for them to have enough time to carry out best practices that require a significant amount of time or to have any downtime to read recent advancements or literature (Khammarnia, Mohammadi, Amani, Rezaeian, & Setoodehzadeh, 2015). Besides the current national interventions to increase the nursing workforce, nursing managers also attempt to provide satisfactory staffing levels by offering incentives for staff that are willing to work extra and by the utilization of external staffing agencies.
Khammarnia, M., Mohammadi, M. H., 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, 1–5. doi: 10.1155/2015/357140
Response two: Evidence-based practice helps healthcare professionals provide high-quality and safe patient care through the use of evidence-based research and knowledge (Jyothi, 2012). With the push to provide safe, high-quality care to improve outcomes and reduce healthcare costs, the Institute of Medicine has set a goal for 90% of practice be evidence-based by the year 2020 (Lehane et al, 2019). Despite the research that emphasizes evidence-based practice as the best standard of care, the United States still falls behind in meeting that goal. This is because there are barriers present that impede the process of implementing evidence-based practice.
One barrier that is faced is individual barriers to research utilization (Black, Balneaves, Garossino, Puyat, & Qian, 2015). This is because there is often a lack of knowledge on how to do evidence-based research or how to implement it. There may be a lack of support or reluctance from nurses to change processes. To address this barrier, nurses should be encouraged to be part of the decision-making process to implement evidence-based practice. This can be done by encouraging nurses to address problem areas and to participate in quality improvement committees. Nurses should be provided with educational opportunities to allow them to gain knowledge on evidence-based research which the nurse can then use to provide comply with evidence-based nursing practice. Nurses should also be encouraged to further their knowledge base by obtaining higher levels of certifications or degrees.
Another barrier to implementing evidence-based practice are organizational barriers. As with the individual barriers, many organizations may be reluctant to make changes in processes. Organizations may lack the finances, resources, or tools needed to implement the recommended changes (Altin et al., 2015). It is often time-consuming to do the research and implementation process. This can become costly to organizations who are fighting to be profitable in today’s struggling healthcare market. To address this issue, organizations should be mandated to follow evidence-based practice. They must be educated on the importance of providing high-quality, safe care to patients. Evidence-based practice benefits not only the patient, but the organizations as well. When patients receive evidence-based care, patient outcomes are improved. In a time when reimbursements are often tied to patient safety and outcomes, organizations should want to use the best practice to improve outcomes. It should become the gold standard for organizations.
Altin, S., Passon, A., Kautz-Freimuth, S. et al. (2015).A qualitative study on barriers to evidence-based practice in patient counseling and advocacy in Germany. BMC Health Services Research 15, 317. Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-0979-9#citeas
Black, A. T., Balneaves, L. G., Garossino, C., Puyat, J. H., & Qian, H. (2015). Promoting evidence-based practice through a research training program for point-of-care clinicians. The Journal of nursing administration, 45(1), 14–20. doi:10.1097/NNA.0000000000000151
Jyothi, N. (2012). Evidence-Based Practice-The Future of Nursing and the Role of Nurse. International Journal of Nursing Education, 4(2), 82-84., Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/lo…
Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., … Hegarty, J. (2019, June 1). Evidence-based practice education for healthcare professions: an expert view. Retrieved from https://ebm.bmj.com/content/24/3/103.
Response three: The lack of implementation from evidence based research to practice is multifaceted.No one factor sits alone. Facility readiness to embrace evidence based practice is a prime example of this. It can affect if, how, and when nurses use evidence based research by influencing the environment in which they practice.Nurses are by nature of profession often very good at identifying a problem. Yet lack of support, understanding/education, and staffing can shortchange utilization of evidence based research, even though it has been verified to improve outcomes.
Aside from facility/environmental readiness, time has been identified as a major barrier. These are again tied together.It takes additional time and work to remain up to date on current research. In many areas nurses are shorthanded, caring for an increasingly complex demographic.Among barriers to initiating and utilizing evidence-based practice, time is one of the most common identified (Yoo et al., 2019). Even nurses who feel they have good access to research in an electronic form, identify time as a major restraint (Yoo et al., 2019). Through a lack of support and education, nurses are left asking themselves if the current “good” care is worth risking, in the HOPE of providing “great” care. Many nurses will hold firm to the established ways due to the continuity they see for themselves and the patient.
Facilities need to foster an environment that helps nurses understand not only what evidence based practice is, but how to utilize it (Johnston et al., 2016). Training and educational grants would be an option to broaden the nursing staffs understanding (Johnston et al., 2016).Also, mentors would be a tangible way to breech the gap so that nurses feel that they can consult their peers, yet get the education needed to use EBR effectively to improve patient care. Decreasing nurse to patient ratios would drop stress so that nurses could provide less hurried care and find time to truly utilize research opportunities for their patients.
Johnston, B., Coole, C., Narayanasamy, M., Feakes, R., Whitworth, G., Tyrell, T., & Hardy, B. (2016, August). Exploring the barriers to and facilitators of implementing research into practice. British Journal of Community Nursing, 21(8), 392-398. doi:10.12968/bjcn.2016.21.8.392
Yoo, J. Y., Kim, J. H., Kim, J. S., Kim, H. L., & Ki, J. S. (2019, December 26). Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PLoS ONE, 14(12), N.PAG-N.PAG. doi:10.1371/journal.pone.0226742