Evidence-based practice is the scientific proof obtained after thorough research combined with integrated clinical experience while taking into consideration patient’s advocacy values and administering nursing care. It is a vital part in enhancing critical care nursing practice and to provide quality healthcare to patients (Blais, 2015). Additionally, adopting EBP improves patient outcomes, reduces cost and risk of harm as well as unnecessary tests and procedures (Rousseau & Gunia, 2016). There are several steps of integrating EBP process in the healthcare environment.
Eight steps of integrating EBP in the clinical environment
The first step to applying evidence-based practice in reference to Communication Errors with EMS and ED in nursing entails cultivating the spirit of inquiry by selecting a framework where decisions are arrived at by the patient and the healthcare provider under the preferred healthcare setting (Mattila & Melender, 2016). Step number two involves asking clinical guiding question which involve a PICOT question that is crucial in identifying the patient’s problem. P stands for the type of Patients or population involved in particular to healthcare problems. The letter I stand for the Interventions of specific methods of interest while C is the Comparison of treatment (Black, Garossino & Qian, 2015). Letter O is the desired Outcome that is precise and brief while T is the Timing that is relevant to approach a particular problem. The third step for a clinician is to search for the best evidence through acquiring information from the database and other resources that are likely to solve the patient problem.
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The fourth step enshrines evaluating strength and weakness of the evidence to determine reliability and validity of the research to apply it to the patient's problem. The step number five involves integrating evidence found to arrive at the best clinical decision after reviewing biologic and socioeconomic factors (Blais, 2015). The sixth step is where the health provider evaluates the outcomes from the decision made after applying the new practice. The step number seven involves circulating the outcome of EBP to the other healthcare professionals (Rousseau & Gunia, 2016). Lastly, the healthcare provider recommends the need to integrate EBP in all aspect of healthcare to give accurate results.
Barriers faced in implementing a new practice to address increasing communication errors between Paramedics and ED Staff
The first obstacle to implementing EBP in a clinical setting is the culture of nursing practice that articulate nurses as caregivers but not researchers. According to Warren, Bardsley and Risch (2016), ED nurses have been trained to provide care to patients but not indulge themselves in research-related activities to solve patients' problem. The nurses apply the knowledge acquired and the available interventions to provide safe, efficient and quality care. There is little time between work and training (Rousseau & Gunia, 2016). Additionally, time management is a barrier to implementation of EBP as it is not realistic for a nurse to make follow up on research while providing nursing care at the same time.
There is limited access to user-friendly computer technology that can be used to undertake research and give faster accurate results that can be relied upon to make the correct judgment. Mattila et al., (2016) asserted that differing views between patients and paramedics on research-based evidence may hinder implementation the new practice. There is usually slow adoption of EBP since management fails to support physicians and nurses to transition to evidence-based practice. Resistance from nurses to advance to medical research in the course of their job becomes a norm in healthcare which is hard to overcome.
Strategies that could be used to increase success including overcoming barriers
Healthcare organizations are introducing short programs that promote integration of EBP in healthcare practice. Black et al., (2015) added that efforts to integrate the current competency with a new field of the competency-based curriculum to address the needs of EBP program in healthcare are being introduced through attending workshops and tutorials. Ideal mechanism of teaching EBP concepts through a full staff approach is also considered to expand areas of knowledge that contain high-quality content that can be understood on time. Such materials could be internet-based tutorials, the formation of clinical question and application-based diagnostic concepts. Students’ nurses are encouraged to focus on randomized control trials associated with outcome-based research involving questions posed to clinicians. Educators of clinical medicine should enlighten ED nurses with a practical application of EBP as part of the work assignment for them to get used to it (Mattila & Melender, 2016).
Six sources of internal evidence that could be used in providing data to demonstrate improvement in outcomes
Clinical research record is one of the sources of evidence that demonstrate improved outcomes of the new practice where changes are noted every time a new methodology is used. Another source is patient medical history that reveals quality of health extended to the patient after incorporating a new practice based on clinical research (Rousseau & Gunia, 2016). The third source of internal evidence is questionnaires that consists of clinical questions posed in course doing scientific research. Statistical analysis is the fourth source of evidence where several tests are made with variables on sources of knowledge in finding, and reviewing research evidence (Blais, 2015). Randomized control trial is the fifth source of evidence that aims to reduce bias when testing the effectiveness of evidence-based research through the random allocation of units and comparing them through experimental and control group (Warren et al., 2016). The sixth source is systematic reviews that critically evaluate evidence-based practice both quantitatively and qualitatively to provide a complete summary of relevant evidence under the research question.
Conclusion
The current educational program in nursing is supposed to include concepts of evidence-based practice to prepare the clinical nurses for current and future healthcare environment. Adopting the culture of EBP would create competent based professionals who incorporate research with caregiving to improve the quality of health for the patients. The research would keep nurses updated thus overcome new healthcare challenges.
References
Black, A. T., Garossino, C., & 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.
Blais, K. (2015). Professional nursing practice: Concepts and perspectives . Pearson.
Mattila, L. R., & Melender, H. L. (2016). Educational interventions on evidence-based nursing in clinical practice: a systematic review with qualitative analysis. Nurse education today , 43 , 50-59.
Rousseau, D. M., & Gunia, B. C. (2016). Evidence-based practice: The psychology of EBP implementation. Annual Review of Psychology , 67 , 667-692.
Warren, J. Bardsley, J. & Risch, S. (2016). The strengths and challenges of implementing EBP in healthcare systems. Worldviews on Evidence ‐ Based Nursing , 13 (1), 15-24.
