Since the turn of the century, there have been increased calls for nurses and other healthcare professionals to increase the quality and effectiveness of services that they offer to their patients. One of the ways that could improve clinical effectiveness is by incorporating research-based evidence into the decision-making process instead of relying on what other healthcare professionals had done before or the knowledge possessed by the health professionals themselves. It is important for all the nurses to learn and understand all the steps of evidence-based and incorporate it into their practice. González-Torrente et al. define the evidence-based practice as a problem-solving approach that uses the best available resources, the preferences and values of the patients as well as the knowledge possessed by various healthcare professionals to come up with effective solutions (2012). With the ever-changing healthcare sector in the world and the new challenges that keep on arising, it is recommended that nurses incorporate evidence-based practice to improve the quality of services that they provide to their customers. This paper seeks to discuss the eight major steps that are commonly used in integrating evidence-based practice into the clinical environment as well as the challenges that might be faced by nurses while implementing a new practice.
The Main Steps of Integrating Evidence-Based Practice into the Clinical Environment
The eight main steps of integrating evidence-based practice into the clinical environment are creating a culture which allows the incorporation of EBP into the organization, integrating EBP into an institution, asking the clinical question, time-consuming, identifying a grade that will guide suggestions for incorporating findings into practice, applying the evidence into practice, evaluating the outcomes, and finally, disseminating the results ( Dadich, Abbott & Hosseinzadeh, 2015) .
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According to Dadich, Abbott, and Hosseinzadeh (2015), c reating a culture to incorporate EBP into an organization involves informing the nurses and other stakeholders of the advantages that come with EBP. Incorporating EBP into the organization lowers costs by reducing the lengths of hospital stays, and it also reduces hospital-acquired infection. Establishing EBP raises the quality of care within healthcare institutions and reduces costs associated with healthcare services. The knowledge of advantages of EBP can prepare the organization for the incorporation of EBP. The next step in the integration of EBP into a clinical environment is the selection of a framework that facilitates decision making. The application of science has over the years changed to a systematic approach which uses theoretical frameworks to aid in the integration of research into practice. Several frameworks exist, and it is important to identify the differences among them to come up with the best model for specific processes that are being implemented.
The next step involved is asking the clinical question. It is during this stage that a PICOT question is developed to help the nurses in identifying the clinical problem. After establishing the clinical question, the step that follows is the time-consuming phase which involves the evaluation of various studies to establish their reliability, accuracy, validity, and applicability ( Dadich, Abbott, & Hosseinzadeh, 2015) . Dadich, Abbott, and Hosseinzadeh note that e ven though it is an overwhelming process for most nurses, it is essential that they examine how much high-quality evidence was achieved during literature research. Subsequently, determining the grade that would direct recommendations for the implementation of the findings is the step that follows. Grade recommendation is based on how the team evaluates the strength of the evidence used for applying an intervention is. Examples of grading systems include the Grade Working Group and SORT. After grade recommendation, the nurses can go ahead and apply the evidence acquired into practice. The application of the evidence requires a well-organized plan and process to achieve the best results. After the implementation of the evidence acquired, evaluate the outcomes. It is at this stage that nurses establish whether or not the implementation of the evidence yielded any positive results or not. The Evaluation phase also involves identifying some of the gaps that exist in the procedure and process. The final step is the dissemination of the results. Dissemination of the results can be done through various ways such as the use of posters or presentations at conferences (2015).
Barriers Faced During the Implementation of a New Practice and Strategies to Overcome Them
According to Ogundele , there are several challenges which might be faced during the implementation of a new practice within a clinical environment. One of the major challenges is resistance. Resistance to the integration of evidence-based practice is most common among senior nurses and those with years of experience. The nurses always claim that things have worked perfectly by the application of their knowledge and experience and they see no need to change the way that they execute their functions. Another major challenge is the lack of time and knowledge. Most nurses claim that their busy schedules prevent them from implementing EBP (2011). It is important that the above challenges are resolved with urgency to make the implementation of EBP possible. As Ogundele (2011) notes, various strategies can be used to overcome the barriers to the implementation of EBP. The first strategy involves engaging the appropriate stakeholders to build trust and learn from their experiences. Stakeholders can also provide important input into the project by identifying the outcome measures. Another effective strategy is the seeking of the support of administrative support. Supportive administrations can be able to provide crucial information about other projects that used the same techniques and how they turned out. Organizations can also contribute towards the development of an organizational culture which supports EBP.
Sources of Internal Evidence
After integrating evidence-based practice in the clinical setting, it is important to monitor the progress and establish any positive outcomes. Dalheim (2012) identifies the main sources of internal evidence which provide the data that can be used to determine any improvement in the outcomes as scientific literature, practitioners, the organization, stakeholders, own experiences, and social interactions. Scientific literature acts as an important source of internal evidence which provides information through empirical studies which establish whether or not there have been improvements in the outcomes. Practitioners include the nurses and other professionals working in healthcare institutions. Since they are directly involved in the implementation of evidence-based practice, they can know whether it is achieving the desired results. Further, according to Dalheim (2012) , organizations are also critical in providing information about previous projects and how they performed together with providing the progress report on how the current projects are faring. Finally, stakeholders are important because they have great interests in the success of the project; hence they will be the first ones to provide accurate information.
Conclusion
In summation, the need for improving the quality and efficiency of service has forced many nurses to integrate evidence-based practice in their everyday activities. The eight main steps of integrating evidence-based practice into the clinical environment are creating a culture which allows the incorporation of EBP into the organization, integrating EBP into an institution, asking the clinical question, time-consuming, identifying a grade that will guide suggestions for incorporating findings into practice, applying the evidence into practice, evaluating the outcomes, and finally, disseminating the results. There are also various challenges that are faced during the integration of EBP into the clinical environment. It is important that such challenges are promptly solved to improve the quality of services offered by nurses.
References
Dalheim, A., Harthug, S., Nilsen, R. M., & Nortvedt, M. W. (2012). Factors influencing the development of evidence-based practice among nurses: A self-report survey. BMC Health Services Research, 12 , 367. doi:http://dx.doi.org/10.1186/1472-6963-12-367
Dadich, A., Abbott, P., & Hosseinzadeh, H. (2015). Strategies to promote practice nurse capacity to deliver evidence-based care. Journal of Health Organization and Management, 29 (7), 988-1010. doi:http://dx.doi.org/10.1108/JHOM-05-2013-0089
González-Torrente, S., Pericas-Beltrán, J., Bennasar-Veny, M., Adrover-Barceló, R., Morales-Asencio, J., & De Pedro-Gómez, J. (2012). Perception of evidence-based practice and the professional environment of primary health care nurses in the Spanish context: A cross-sectional study. BMC Health Services Research, 12 , 227. doi:http://dx.doi.org/10.1186/1472-6963-12-227
Ogundele, M. (2011). Challenge of introducing evidence-based medicine into clinical practice. Clinical Governance, 16 (3), 231-249. doi:http://dx.doi.org/10.1108/14777271111153859
