Evidence-based practice (EBP) refers to a paradigm and an approach to life-long problem solution to clinical verdicts that entails a diligent application of the best available evidence. An example is a methodical search for and critical assessment of the most relevant evidence to address clinical issues. EBP is based on an individual's clinical experience and the values and preferences of patients to enhance outcomes for groups, individuals, systems, and communities (Reeves, Pelone, Harrison, Goldman, & Zwarenstein, 2017).
According to Black et al., (2015) studies certify that outcomes of patients are enhanced when nurses practice apply evidence-based approaches in their practices. An evidence-based method has been described as increasing the safety of the patient, improving clinical outcomes, reducing the cost of healthcare and lowering differences in patient outcomes. The need for EBP is significant, though there are barriers to the widespread adoption of existing research evidence such as the level of knowledge and fluency of clinical nurses (Reeves et al., 2017).
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There are many individual and organizational barriers to the application of research among nurses. Some individual barriers are lack of awareness of investigation, nurses feeling not empowered to change practice, and colleagues, not in support of the change of practice. Barriers due to the organization include inadequate time to adopt new concepts, lack of awareness of accessible tools of education linked to research, and lack of access to research. Most significant features linked to nurses' EBP are derived from their organization's support to adopt and carry out research. Other enablers comprise the existence in the clinical environment of research mentors, educators equipped with knowledge about research, advanced practice nurses, internships in nursing research, as well as chosen nurse researchers. There are various recommendations for reducing barriers to evidence-based practice including the development of reciprocated relations with academics, contributing to research concern groups and application of research role models.
There is a lack of thorough intervention research aimed at establishing organizational barriers to strengthen nurses' involvement in EBP. The gap must, therefore, be addressed by decision-makers at tertiary healthcare establishments through training program focused on the point of care research. The training program should target nurses and clinicians to lower barriers of EBP while strengthening contribution in research.
Evidence-based Interventions for the Problem
The proposed evidence-based interventions are intended to cover the gaps in care of the patient for better results and a healthier population by mixing clinical experiences alongside evidence. Evidence-based intervention considers the value of patients thus promoting better patient experiences. Since there is an increase in demand for improved outcomes of EBP, there will be the need for more educated nurses (Peters, De Bruin, & Crutzen, 2015). Thus, nurses will adopt critical thinking, assessment and decision-making skills and will successfully scrutinize research to establish its applicability to a specific patient. Also, there will be the increased safety of the patient, enhanced quality of life and better patient outcomes through enhanced treatments. Besides, there will be a standardized practice to provide more liable outcomes. A systematic strategy of evidence-based intervention will lead to treatments with improved chances of efficiency. The foundation of evidence-based practice will depend on research that offers dependable information regarding treatments since information will be analyzed based on the patient situation to establish the chance of positive outcome. An evidence-based intervention will be patient-focused and will address the needs of patients with the objective of more effective and efficient treatment. Moreover, an evidence-based intervention will incorporate cost-effective healthcare and decreased medical complications throughout the diverse clinical specialties.
Barriers and Resistance to Change That Might Come From the Organization, Patients, And/Or Colleagues
Availability of sufficient time appears to be the most significant aspect for nurses to learn and adopt evidence-based practices. Since evidence-based practices is a process of multistep, nurses require adequate time to establish clinical problems where evidence-based practices can be adopted, and translate the problems into clinical questions. Thus, nurses can locate outstanding evidence based on literature searching (Abidi, Oenema, Nilsen, Anderson, & van de Mheen, 2016). Besides, nurses can carry out a critical assessment of recovered evidence, formulate as well as utilize an intervention, and analyze the effectiveness of the applied intervention. Lack of time is a major barrier to evidence-based practices. Therefore, the management of the hospital must make the needed adjustments in nurses' work schedules to ensure adequate time for learning and implementing EBP.
There is also an insufficient understanding of the technical phrases and statistical terms applied in research articles. The terminologies are unfamiliar to diploma and certificate nurses who have limited exposure to the terms. Thus, there is the need for a well-designed program for training to counter the problem. Also, there is a lack of enough coverage given to data-associated competencies with the highly growing literature on medical and healthcare. Nurses, as well as associated healthcare specialists, need to have good skills of searching to retrieve current, applicable and accurate data. Insufficient skills in searching often lead to missing important information or getting excess information that is likely to lead to overload and anxiety of information (Abidi et al., 2016).
Strategies to Overcome Barriers and Resistance to Change
Strategies to counter barriers, as well as resistance to change, must be assessed to establish their impacts on changing nurses' beliefs, attitudes and knowledge about evidence-based practice and their impacts on modifications in practice. With regards to evidence-based care to advance hastily in nursing, people and systems must be committed to strengthening evidence-based practice as well as allocating resources for the purpose (Melnyk, Gallagher ‐ Ford, Long, & Fineout ‐ Overholt, 2014).
Graduate and basic nursing programs should teach the foundations and value of evidence-based practices for nursing to create a culture where evidence-based programs are the norm. There is the need for researchers to unite so that they design and carry out studies to address high-priority burning clinical issues as there are many areas in which evidence lack of supporting current nursing practices. Adoption of sources of information for nursing care is essential for nurses to maintain their knowledge and evidence-based practices. It is desirable to investigate how regularly nurses use different sources of information to fulfill their information requirements (Melnyk et a., 2014).
A Plan to Implement Evidence-Based Interventions
A plan to implement evidence-based interventions should be programmatic in its concepts. There are many social interventions including policies, practices, and programs that have significant impacts on outcomes of life, educational achievement, criminal activity, substance use, employment, depression, health, and earnings. How evidence-based interventions should be applied is also essential, since minor changes in the application can usually lead to a difference in the size of the effect of an intervention. This plan informs program advisors and policymakers on the steps to take to make sure there is an effective application of evidence-based intervention so that they achieve the impacts similar to those identified in the research proposal. The following steps should be observed:
Step 1 : Selection of a suitable evidence-based intervention;
In this step, the resources that might be of need can be retrieved from:
U.S. Education Department’s Institute of Education Sciences, Identifying and Implementing Educational Practices Supported by Rigorous Evidence: A User-Friendly Guide , http://www.ed.gov/rschstat/research/pubs/rigorousevid/rigorousvid.pdf
Standards of Evidence as Outlined by the Society for Prevention Research. http://www.preventionresearch.org/StandardsofEvidencebook.pdf
Creteria used to identify evidence-based programs on the Social Programs that Work website. http://www.evidence-basedprograms.org.Default.aspx?tabid=138
U.S. Office of Management and Budget, What Constitutes Strong Evidence of Program Effectiveness, http://www. whitehouse.gov/omb/part/2014programeval.pdf
Step 2 : Identification of resources that can assist with an effective application;
Step 3 : Identification of suitable application sites;
Step 4 : Identification of strategic aspects of the intervention that need to be observed and scrutinized;
Step 5 : Implementation of a scheme to ensure observance of the strategic aspects.
Other Health Care Professionals to Enlist As Team Members to Help Drive Change In the Organization
Associated health care specialists to include as members of a team to assist drive the change in the organization should include doctors, physicians, surgeons, nursing students on internships as well as the executive management of the organization.
References
Abidi, L., Oenema, A., Nilsen, P., Anderson, P., & van de Mheen, D. (2016). Strategies to overcome barriers to implementation of alcohol screening and brief intervention in general practice: a Delphi study among healthcare professionals and addiction prevention experts. Prevention Science , 17 (6), 689-699.
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.
Melnyk, B. M., Gallagher ‐ Ford, L., Long, L. E., & Fineout ‐ Overholt, E. (2014). The establishment of evidence ‐ based practice competencies for practicing registered nurses and advanced practice nurses in real ‐ world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence ‐ Based Nursing , 11 (1), 5-15.
Peters, G. J. Y., De Bruin, M., & Crutzen, R. (2015). Everything should be as simple as possible, but no simpler: towards a protocol for accumulating evidence regarding the active content of health behaviour change interventions. Health Psychology Review , 9 (1), 1-14.
Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. The Cochrane Library .
