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Challenges in Implementing Evidence-Based Practice

This paper aims to explain the facilitators and barriers to the implementation of evidence-based practice within person-centred care including strategies to decrease non-compliance to policy, and recommendations for sustainable adherence to policy. The evidence-based practise improves the quality of nursing; however, there are some challenges that may affect the implementation of practice.

Evidence-based practise (EBP) is the application of best clinical evidence into clinical practise that can be used to solve the problems and improving efficiency; however, implementation of EBP depends on the knowledge of the nurse including the facilitator and barriers (Alatawi et al., 2020). Implementation of EBP is a complex process that required nurses to find out the best possible solution from the existing evidence; for example, a nursing medication error is one of the major clinical problems that affect the quality of care and patient outcome; hence, nurses use EBP such as single check or double nurse checking procedure to ensure to avoid the medication errors. However, implementation of this EBP cannot be possible without planning as the transition may be challenging due to factors that can be facilitators or barriers (Juckett et al., 2020). The most common barriers to implementation that are common in many EBP are lack of training, or education, management functions, staff behaviour, cost, and organizational culture (Mathieson, Grande, & Luker, 2019). While implementing a double-check procedure to reduce medication error; it is necessary to have additional nurses or the lack of staff can be challenging, furthermore, training and education of nurses are necessary prior to practice to ensure that they do check the prescriptions and amount of medicine given to patients. Similarly, organizational culture and, and staff behaviour may reduce the compliance to practise, therefore, EBP should be supported by policy or guidelines (Mathieson, Grande, & Luker, 2019).

Facilitators that can help to increase adherence or compliance to EBP are knowledgeable about nurse including their behaviour which helps them to develop a good nurse-person relationship. It has been found that when nurses are equipped with training and knowledge, they are able to perforce during the transition period of change while implementing EBP, knowledge of nurses also allows them to prepare for challenges (Duncombe, 2018). Another facilitator that increases the compliance is the cost effective, and easy-to-use EBP; for example, as discussed double-checking by nurses to reduce medication errors is an easy method that can be implemented and re-checking can detect and reduce the medication errors. Furthermore, strategic planning that focuses on the professional development and organizational improvement helps to increase the compliance; for example, an organization that provides the necessary information, train, and educate the professionals would be able to achieve a better outcome. In addition, ownership, flexibility, and autonomy also help to increase the compliance. The suggested EBP to reduce medication error is flexible and allows the nurse to take ownership which would increase the compliance (Howard et al., 2017).

The policy ensures the effective implementation of a practise and makes the transition process better; however, compliance with policy depends on the number of reasons, similarly, there are challenges that can increase the non-compliance. Therefore, it is necessary for organizations to make strategic planning to reduce non-compliance. A strategy that can improve compliance with the policy is the documentation of policy through policy planning and application to processes. A policy or guideline that applied immediately do not have an effective compliance rate due to the resistance and rejection, or lack of understanding of people. It is important to guide the people before making a policy and ask the stakeholders about their challenges and problems that could be included in the policy (Shah et al., 2015). Furthermore, there could be a time limit in the transition period that can help the people to become used to the new practise. In addition, it is necessary to use positive reinforcement consistent application of policies to ensure adherence; otherwise, it could create dispute or resistance that leads to non-compliance (Houghton et al., 2020).

Facilitators to Increase Adherence or Compliance to Evidence-Based Practice

Another strategy that can increase policy compliance is the training of employees related to policy, changes, or the implemented practise. Policy or change in organizational practises are implemented in every department that requires attention from every stakeholder to ensure that they know the purpose of policy; however, lack of knowledge and awareness leads to an increase the non-compliance. To increase policy adherence, it is necessary to increase awareness and make the people educated through training (Shah et al., 2015). A policy should be shown to individuals in training to ensure that they meet the organizational expectations. It has been found that if organizations allow their employees to learn about their policies during training it increases the chances of compliance and policy adherence. In addition, heads of every department should be asked to review the policy to ensure that the organizational requirement can be followed by the employees of every department (Shah et al., 2015). Houghton et al. (2020), found that policy training of one of the effects that may increase the awareness and decrease non-compliance to policy.

Training and education of employees can ensure the smooth transition, implementation, and adherence to policy; however, for a long-term adherence beyond the initial implementation period there is a need for strategic planning including gentle reminders to ensure effective adherence. Below are recommendations that can improve the policy adherence beyond the initial period (Koohang et al., 2020).

  • Regular education of employees: after the initial education there are different ways an organization or employers can educate employees or re-communicate them about the policies to increase long-term compliance. To stay at the top of their minds organizations can conduct seminars, and workshops to highlight the policies. Similarly, they can be games and quizzes at the organizational level to know to assess the level of understanding of policy and increase their knowledge. In addition, regular HR sessions can be conducted within the different departments to remind them of the importance of policy (Koohang et al., 2020).
  • Sending Gentle Reminders: Some organizations have resources and technologies that can be utilized to improve the compliance training; for example, online compliance training, it is an effective way to educate employees and remind them about the policy as they have received the opportunity and freedom to self-educate and convenience. Technologies such as email communication can be used to increase policy compliance. Organizations can guide the people through email communication and send reminders if they have read the policy document and following the same. Similarly, it also helps an organization to stay connected with the employees (Koohang et al., 2020).
  • Implementing provision of strict action: organizations need to take action when policies are misused to avoid further resistance and non-adherence. When individuals misuse a policy, they open the door of risk for the organization as many people may follow the same path and case misuse the policy; however, if they have given the punishment or strict actions are taken it restricts the people to follow the same path; hence, strict rules and consequences of non-adherence should be educated to people to ensure long-term adherence (Bargain & Aminjonov, 2020).
  • Being transparent: Transparency is an effective tool that can increase policy compliance. The organization needs to maintain transparency by showing the purpose of policy, goals, and demands ad show faith in employees (Wayant et al., 2018).

Conclusion

Based on the above analysis it can be concluded that EBP in nursing improves the clinical outcome; however, successful implementations of EBP required strategic planning and policy support as there are various barriers and facilitators that can affect the implementation of practise.

References

Alatawi, M., Aljuhani, E., Alsufiany, F., Aleid, K., Rawah, R., Aljanabi, S., & Banakhar, M. (2020). Barriers of implementing evidence-based practice in nursing profession: A literature review. American Journal of Nursing Science, 9(1), 35-42.

Bargain, O., & Aminjonov, U. (2020). Trust and compliance to public health policies in times of COVID-19. Journal of public economics, 192, 104316.

Duncombe, D. C. (2018). A multi?institutional study of the perceived barriers and facilitators to implementing evidence?based practice. Journal of Clinical Nursing, 27(5-6), 1216-1226.

Houghton, C., Meskell, P., Delaney, H., Smalle, M., Glenton, C., Booth, A., ... & Biesty, L. M. (2020). Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database of Systematic Reviews, (4).

Howard, B. N., Van Dorn, R., Myers, B. J., Zule, W. A., Browne, F. A., Carney, T., & Wechsberg, W. M. (2017). Barriers and facilitators to implementing an evidence-based woman-focused intervention in South African health services. BMC Health Services Research, 17(1), 1-9.

Juckett, L. A., Wengerd, L. R., Faieta, J., & Griffin, C. E. (2020). Evidence-based practice implementation in stroke rehabilitation: a scoping review of barriers and facilitators. The American Journal of Occupational Therapy, 74(1), 7401205050p1-7401205050p14.

Koohang, A., Anderson, J., Nord, J. H., & Paliszkiewicz, J. (2020). Building an awareness-centered information security policy compliance model. Industrial Management & Data Systems.

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary health care research & development, 20.

Shah, N., Castro-Sánchez, E., Charani, E., Drumright, L. N., & Holmes, A. H. (2015). Towards changing healthcare workers' behaviour: a qualitative study exploring non-compliance through appraisals of infection prevention and control practices. Journal of Hospital Infection, 90(2), 126-134.

Wayant, C., Moore, G., Hoelscher, M., Cook, C., & Vassar, M. (2018). Adherence to reporting guidelines and clinical trial registration policies in oncology journals: a cross-sectional review. BMJ Evidence-Based Medicine.

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