Professionalism and Issues in Nursing
Evidence-based practice (EBP) refers to the judicious and conscientious utilization of the latest best-evidence together with the clinical knowledge and patient values during care delivery. Evidence-based health care practice has been shown to improve the quality of patient care, patient safety, and healthcare outcomes for many healthcare conditions such as diabetes, cardiovascular conditions, obesity, asthma, among other conditions. Evidence shows that healthcare organizations using the latest best-evidence report better health outcomes, improved patient safety, low readmission rate, low rate of hospital-acquired infections, low mortality rates, and reduced healthcare costs (Correa-de-Araujo, 2016). This indicates the benefits associated with evidence-based practice in healthcare organizations. To realize the full benefits of EBPs in healthcare, the healthcare providers, and particularly nurses need to understand strategies effective in promoting evidence-based practice. Similarly, evidence shows that the implementation of EBP is hindered by numerous barriers that may restrict the effective application of best evidence in practice (Charif et al., 2017). Nurses are the frontline workers in healthcare organizations and thus they are actively involved in integrating new research into current practice to promote evidence-based practice. This paper will discuss effective strategies and mechanisms in promoting evidence-based practice and the associated challenges. The paper will conclude by discussing how the implementation of evidence-based practice affects professionalism in nursing.
Strategies used in Promoting Evidence-Based Practice
According to Kueny et al (2015), the support from the leaders in healthcare organizations and nursing units is very effective in promoting evidence-based practice (EBP). Therefore, the leaders, including nurse leaders should establish and build a supportive culture that values EBP and provide a collaborative environment that creates processes necessary to implement evidence-based changes. Leaders should also focus on providing all the necessary resources required to implement EBP and also provide mentorship and immediate feedback, and empower the nursing staff to make effective EBP changes in their units (Kueny et al., 2015). Kueny et al (2015) further add that a supportive organizational culture and an established procedure through which EBP is initiated and implemented can be complemented further by contextual factors such as accessible information, provision of ample resources, and the availability of skilled staff to drive and implement EBP. According to Kodama & Fukahori (2017), leaders in healthcare organizations and nurse units ought to create working and supportive environments that enable nurses to effectively participate in EBP.
Another strategy is to model behaviors and practices that promote EBP. For example, nurse leaders in nursing units can consider becoming actively involved in implementing EBP changes in order to encourage and motivate the nurses to embrace EBP. Nurse leaders can use leadership styles that inspire and motivate followers to support EBP. For instance, a transformational leadership style can be used by nurse leaders to model EBP, create a supportive atmosphere that encourages nurses to provide evidence-based care and inspire and motivate nurses to adopt EBP changes. According to Kueny et al (2015), strong leadership is a catalyst when implementing EBP. Nursing staff identifies administrative support as essential during the implementation of EBP. Therefore, nurse managers should advocate for a culture that supports EBP. A culture supporting the implementation of evidence into practice a major motivational factor for utilizing research-based evidence. Studies show that collegial and administrative support highly influence the use of research-based evidence (Black et al., 2015).
In addition, training is an essential strategy during the implementation of EBP because change normally requires staff members to adapt to new responsibilities and roles. Therefore, when implementing EBP, a training program relevant to the specific EBP change should be developed to increase the knowledge and abilities of the clinicians, and also to provide the clinicians with a sense of confidence and motivation about the EBP. For instance, a study conducted by Kueny et al (2015) indicated that an educational program about an EBP that was being implemented was successful in guiding nurses through the process of implementing the change. Nurses reported that the educational program was effective in educating, increasing knowledge, mentoring, and supporting the engagement of clinicians when generating evidence. Training and educational programs for nurses before implementing EBP have been shown to provide nurses with an opportunity to learn and participate in research as well as knowledge translation activities that are very essential during the implementation of EBP.
Another strategy is to use change champions to advocate and promote the EBP within the organization. Change champions believe in the change and passionate about the change and therefore they persistently drive the vision to ensure the staff support and accept the proposed EBP. During the implementation of an EBP, a change champion can be used to act as a role model to the other nursing staff to implement a shared vision for embedding the EBP in the organization (Miech et al., 2018). The activities of change champions during the implementation of EBP include tenacious advocation for the EBP within the work setting; facilitating reflection; acting as a team leader during the implementation of the EBP; taking part in planning activities; training and education the nursing staff about the EBP initiative; presenting the proposed change to the organizational leadership; persuading the staff about the significance of the proposed EBP change; developing and distributing posters, stickers and pamphlets to educate the staff about the change; and persuading peers using data (Miech et al., 2018). Champions are the driving force when implementing innovations and changes within healthcare settings and thus champions are can significantly influence the adoption of EBP within healthcare settings.
Other strategies that are effective in facilitating the smooth implementation of EBP include recruiting research role models to guide the staff members regarding the implementation of the EBP, including advanced practice nurses and research mentors in the implementation process. More importantly, it is very important to engage suitable stakeholders. Engaging all stakeholders provides an opportunity to seek the input of all the relevant stakeholders and seek buy-in from the initiation of the EBP project, and throughout the implementation process.
Challenges in Implementing Evidence-Based Practice
Studies show that various organizational and individual factors hinder the implementation of evidence-based practice. The most common challenges when implementing EBP include lack of human resources, especially lack of adequate nurses; heavy workload, and resistance to changes by the staff members.Professionalism and Issues in Nursing
According to Tappen et al (2017), lack of adequate facilities due to the limitation in human and financial resources is a major challenge when implementing EBP. The limitation of the fiscal resources complicates the process of implementation of the research EBP results; this may result in a lack of supplies and equipment necessary to effectively implement EBP findings. These findings are supported by previous studies that show that lack of resources such as hospital library poses a challenge when it comes to retrieving the appropriate research evidence. Moreover, the lack of up-to-date textbooks and nursing journal articles hinders the effective implementation of EBP in healthcare organizations. When nurses lack adequate time to read and conduct research, they may feel they lack the required competency and authority to implement new care procedures and they also feel that the research findings may not be applicable in practice settings (Tappen et al., 2017). Lack of adequate time to participate in research and implementing EBP is attributable to the shortage of nursing staff, heavy workload, and intensive nursing activities. A study conducted by Kodama & Fukahori (2017) indicates that in most cases nurses lack adequate time to search, read, and review research articles to support EBP. This is supported by Tappen et al (2017) who found out that lack of adequate time and inadequate knowledge on EBP are among the key factors that hinder the application of EBP.
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Lack of support from the management and other organizational staff is also a major challenge when implementing EBP. Implementation of research findings into clinical practice requires effective collaboration and teamwork between managers, quality improvement personnel, and healthcare practitioners. For example, to successfully implement an EBP initiative, the management in an organization should provide the required resources in terms of the staff and funding. Failure for the management to release the necessary personnel and other resources to partake the implementation of the EBP initiative may pose a major challenge. Tappen et al (2017) found out that lack of support from the management adversely affected the implementation of EBP initiatives.
Resistance by staff members is a major challenge when implementing EBP initiatives. Changing a culture or practice can be a key challenge and uncomfortable and thus staff members may resist the proposed change. Nurses may resist changes such as EBP because they are so much used to certain practices and also, they may be uncomfortable with the uncertainty that comes with new practices (El-Sayed et al., 2017). Moreover, lack of skills and knowledge may be a major reason for nurses to resist a proposed EBP initiative. For example, when nurses feel that they lack the necessary skills and competency to handle the proposed EBP, they may resist such a change. Resistance to change by the staff may be a major hindrance because the staff may deliberately refuse to accept and adopt the proposed EBP. Therefore, a nurse leader needs to help the nursing staff to manage the change in a manner that allows the staff to cope with the change. Nurse leaders steering EBP should engage and involve staff members throughout the process of implementing EBP, rather than imposing the EBP to the nursing staff (Tappen et al., 2017).
Lack of skills to implement EBP practices also poses a major challenge to EBP. There are various components of EBP that includes the selection of the best relevant information, retrieving research articles and other resources, asking appropriate questions, and integrating the patients’ preferences and research findings during clinical decision-making (Kodama & Fukahori, 2017). Moreover, nurses require skills to integrate evidence and critically research skills such as searching for information, understanding statistical terms, and data analysis. Without these critical skills in EBP, the implementation of EBP faces serious challenges.
Effects on Nursing Professionalism
Strategies that promote successful implementation facilitate the integration of EEBP in nursing and ensures that nurses use scientific research to make clinical decisions. EBP enables nurses to remain updated regarding new medical procedures and protocols for patient care. By searching and implementing interventions that are evidence-based and fit the profile of the patients, nurses are able to promote recovery for the patients (Gagnon et al., 2015). Moreover, through EBP, nurses can examine research and understand the efficacy or risks associated with certain treatments or diagnostic tests. The use of EBP enables nurses to integrate patients in the care plan and thus patients are proactively involved in their own care. EBP integrates research evidence with clinical expertise and promotes personalization of care by integrating the preferences of the patients (Gagnon et al., 2015).Professionalism and Issues in Nursing
More importantly, successful implementation of EBP improves the quality of care, care coordination, the efficiency of care, improves patient outcomes, and reduces healthcare costs (Black et al., 2015). For example, implementation of electronic health records in healthcare organizations has been shown to improve care coordination, efficiency, improve workflow and reduce medical errors, while implementation of EBP that aims to reduce and prevent the rate of hospital-acquired infections (HAIs) can reduce the rate of HAIs, the associated complications, reduce the mortality rate, and also reduce the healthcare costs associated in treating the HAIs.
Moreover, the successful implementation of EBP leads to the implementation of high-quality policies, protocols, and procedures in healthcare organizations. Evidence-based policies, protocols, procedures, and guidelines should be developed and implemented using the best available evidence to ensure that the research is incorporated in clinical practice. Implementing guidelines, policies, and procedures based on the best-available evidence ensures that organizational staff uses the latest and updated guidelines during care delivery. Stevens (2015) further adds that strategies promoting the use of EBP motivate nurses to develop innovative programs and quality improvement initiatives and this improves the quality of care, patient safety, and health outcomes. Evidence-based practice guides nurses to make sound and studious clinical decisions founded on research, clinical experience, cost-effective treatment, and patient preferences. Uncountable treatment breakthroughs, policies, and strategies for nursing care have led to significant milestones in the healthcare system.
Challenges that hinder effective implementation of EBP hamper the benefits associated with EBP such as improved patient care and reduced health care costs. Despite the numerous major advances, nurses have a lot to do to attain EBP. According to Maloney (2016), whereas nurses may be willing to adapt EBP and gain the essential skills and knowledge, they face major obstacles that hinder them from applying EBP in practice. Therefore, such challenges hinder nurses from adopting interventions and measures that improve patient safety and healthcare outcomes.
Moreover, challenges that hinder EBP prevent nurses from developing superior nursing skills necessary to improve care delivery. Integrating EBP in the clinical experiences of nurses facilitates the development of more advanced decision-making skills, problem-solving skills, and critical thinking skills (Maloney, 2016). Nurses who utilize EBP are able to adapt better to situations and changes, use informatics, participate in quality improvement initiatives, and work in interprofessional teams. Therefore, challenges preventing the use of EBP prevents nurses from developing nursing skills important in the nursing profession.
Furthermore, professional standards require nurses to integrate research findings and evidence into practice. Nurses are required to evaluate their nursing practice using the latest evidence and use the suitable resources to plan and provide evidence-based nursing care to ensure the provision of safe, effective, and high-quality care (Nkrumah et al., 2018). Therefore, challenges that hinder effective implementation of EBP prevent nurses from adhering to the required nursing professional standards and the appropriate quality nursing practice.Professionalism and Issues in Nursing
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Conclusion
Evidence-based practice improves the quality of patient care, patient safety, and healthcare outcomes for many healthcare conditions. Strategies that can be used to promote the implementation of EBP include support from the organizational management when implementing EBP, modeling the behaviors and practices that promote EBP, providing training to the nursing staff about EBP, using change champions to persuade staff members to embrace the proposed evidence-based practice, having adequate nursing staff to prevent heavy workload, and engaging/involving nurses throughout the implementation process of EBP initiative. Factors that hinder effective implementation of EBP include resistance to change by the staff, lack of adequate nursing staff, heavy workload and burnout, inability to access library with relevant nursing and medical journals, lack of the required EBP skills, inadequate time to conduct research, lack of support from the organizational leaders and management. Successful implementation of EBP improves nursing care and promotes better health outcomes and patient safety. Seeing factors that affect EBP either through promotion or hampering the implementation of EBP, the organizational and unit leaders need to provide continuous education to nurses to improve their skills and knowledge for use EBP; create an inquiry culture; and provide nurses with adequate time to learn more about EBP and whole participate during the implementation.
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