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Introduction to Evidence-Based Practice (EBP)

Title: Barriers To Implementation Of Evidenc-Based Practice In Emergency Department

Evidence-based practice is important for improving overall patient care quality, improving nursing practice, and increasing the confidence of nurses in decision-making. Evidence-based practices refer to decisions made by the amalgamation of the best available research evidence with the choices made by persons receiving care and the detailed knowledge of those giving care. Evidence-based practices are important because it focuses on providing the most potent available care. It helps to minimize the gap between research and practice. The emergency department is an integral part of all healthcare systems. Situations that are handled in the emergency department often concern the life and death of patients. Maintenance of evidence-based practices (EBP) there is of utmost importance. However, there are complications in implementing the same in the emergency department. This paper will focus on the challenges and barriers that are faced in the emergency department in implementing evidence-based practices. It will also provide strategies to overcome those barriers.

There are several factors that can be potential barriers to the implementation of EBP which may be at the individual or organizational levels. One of the most basic barriers is the identification of the barriers so that they can be removed. The barriers discussed in this paper with respect to the emergency department include: time mismanagement, lack of knowledge, lack of resources and training, and negative attitude.

In an emergency department (ED), managing time is a crucial factor for the proper implementation of EBP. Effective time management will produce better work quality and help do more work. However, nurses working in the emergency department are always busy because of emergency activities in the department. They are often tired due to constant work and hence do not have time to research or read about the best EBP that can be implemented (Dagne & Beshah, 2021). Due to being tired they also lack the motivation to read and learn about new EBPs. Nurses in the emergency department have multiple tasks at once which makes it difficult for them to look for EBPs at that time. Focusing on multiple tasks leads to stress and none of the tasks being completed efficiently (Berg, 2018).  They therefore, simply follow the instructions they have or have followed for previous such situations. Learning new and advanced EBP requires time which in most cases is not adequate for nurses in emergency duties. To implement a particular EBP, the nurse must be well acquainted with it, but as they lack proper guidance and information EBP are often neglected. 

 It had been widely observed that EBP have positive responses from nurses and other healthcare professionals. However, oftentimes there is a lack in guidelines which are necessary for implementing the required EBP during academic education (Li, Cao & Zhu, 2019). Also, those nurses who do have appropriate academic qualifications did not have the knowledge to translate that theoretical knowledge into practical use (Yoder et al., 2022). Critical analysis of newer approaches is not easy or acceptable to deal with immediately. Most of the time nurses are not able to make a decision based on the available research and thus fail to implement EBP (Camargo et al., 2018). Nurses tend to avoid implementing EBP for fear of outcomes that may have a negative outcome. Hence, most nurses either use their own experiences or their senior’s advice to cope with and handle the situation instead of applying any EBP.

Challenges and Barriers in Implementing EBP in Emergency Department

The lack of appropriate training and resources is another barrier to the effective implementation of EBP. Most nurses do not get ample resources to learn about the new EBPs. Those who do learn them from the web or literary resources do not have the proper training that is necessary for implementing these EBP. Training sessions may not be given due to a lack of funds, staff or time. Thus, nurses who are new often are unable to implement EBP due to a lack of training (Alatawi et al., 2020). Also, they might have the fear that suggesting new EBP to seniors might be offensive or demeaning and hence they keep following the protocols as instructed by the seniors.

A negative attitude may also attribute to the lack of implementation of EBP. Negative attitudes may arise due to many different reasons in nurses. They can be individualistic like stress and tiredness or organizational like extra cost expenditure or devoting time to rewrite newer protocols (Qiao et al., 2018). Also, it might be possible that the practicing environment may not be ready to change the tried and tested methods in certain situations which then become an important barrier in trying newer EBPs. This may happen when people are reluctant to accept results of research over usually followed protocols that have proven results. The cost of implementation of new EBP can also lead to the lack of will for their implementation. Implementation of new EBP will mean that their guidelines and protocols have to be established such that future nurses can use these protocols. This may seem time-consuming, especially for the emergency department which is always busy.

Due to these barriers, there might be effective treatment approaches that will never get attention or be utilized to treat the patients. This therefore, may hamper not just the patients’ health but also the chance of learning a new skill. Thus, the strategies have to be implied that will help motivate nurses and healthcare systems to incorporate and implement EBP for the betterment of patient health and practitioner satisfaction.

To improve time management in nurses, nurses should focus on one task at a time. This will enable to focus much better on that task and finish it faster rather than applying their brains on multiple tasks at once. Planning out their day in advance will help them find time to read literature and analyze them to find ways of implementing EBP. They will also be analytical while treating patients by concentrating on one goal at a time. Nurses should be given effective time management courses so that they do not just keep repeating the same courses and try out the newer EBP. Patients in the emergency ward particularly require decisions and treatments that are quick and effective. Hence, proper time utilization and management will help to implement the EBP.

Lack of knowledge can be overcome by educators must incorporate teaching and implementing EBP beyond the classroom to clinical settings. If students are able to practice implementing EBP in clinical settings they acquire the confidence to apply them in actual emergencies (Fiset, Graham & Davies, 2017). The addition of educational lectures and skill training will improve the implementation rates of EBP (Zhao et al., 2022). It is also possible that multiple approaches like the incorporation of such courses will improve their overall knowledge and confidence.

Factors Contributing to the Barriers

Training sessions and various courses to teach how to effectively implement EBP should be provided to nurses. These can be done in a variety of ways and not just in a strict training session. Arranging journal clubs, clinical rounds and discussing case studies will also enable them to think critically and try to find ways of implementing newer and effective EBP (Fiset, Graham & Davies, 2017). Increasing the access to available resources also increases the chances of EBP implementation (Blackman & Giles, 2017). This eventually helps increase their zeal to try and treat patients.

A negative attitude is probably one of the most important factors that need to be dealt with for the effective implementation of EBP. To reduce negative attitudes of individuals, they must be appraised so as to boost positivity in them. When people are appreciated for their efforts they tend to improve more. This positivity will encourage them to implement EBP for increasing their efforts to be appreciated. On the organizational level, organization needs to understand the long term advantages of implementing EBP. It may seem that application of EBP will require extra workforce and cost initially but once the protocols are laid out and EBPs are being used effectively, it will reduce the costs that might be wasted in implementing different treatment methods. Also, EBP implementation will ensure client satisfaction which will improve the reputation of the organization.

Finally, the most important quality that healthcare professionals and nurses need to have to implement EBP effectively is the ability to think and question situation. This will help them to form a clear clinical question regarding the patient (Alatawi et al., 2020). If clinically relevant articles similar to the patient’s condition are found, they can then find a proper EBP. Also, an important step that needs to be kept in mind is the relevance of the article used for finding EBP because they might be outdated or irrelevant with regards to the patient. After evaluating all the points, the nurses can implement findings from the paper.

Conclusion

Thus, it can be concluded from the above discussions that even though implementation of EBP will reduce the burden on healthcare systems and improve the quality of patient health, there are many challenges as discussed that create hurdles in proper implementation of EBP. Thus, steps must be taken to ensure and encourage the implementation of more EBP in clinical settings. In the emergency wards, where patients are often very critical implementation of newer improved methods of treatment will help cure them faster and better. Thus, nurses should be given provisions to enable them to read and learn about EBP and then implement them in required situations. Being able to treat someone with a newer approach will boost their confidence and they will become better at decision making.

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.doi: 10.11648/j.ajns.20200901.16

Strategies to Overcome the Barriers

Blackman, I. R., & Giles, T. M. (2017). Can nursing students practice what is preached? Factors impacting graduating nurses' abilities and achievement to apply evidence?based practices. Worldviews on Evidence?Based Nursing, 14(2), 108-117.https://doi.org/10.1111/wvn.12205

Berg, L. (2018). Patient safety at emergency departments: Challenges with crowding, multitasking and interruptions (Doctoral dissertation, Karolinska Institutet (Sweden)).https://www.proquest.com/openview/99141624e9fbe39a2298696c04af9029/1?pq-origsite=gscholar&cbl=2026366&diss=y

Camargo, F. C., Iwamoto, H. H., Galvão, C. M., Pereira, G. D. A., Andrade, R. B., & Masso, G. C. (2018). Competences and Barriers for the Evidence-Based Practice in Nursing: an integrative review. Revista brasileira de enfermagem, 71, 2030-2038.https://doi.org/10.1590/0034-7167-2016-0617

 Dagne, A.H. & Beshah, M.H. (2021) Implementation of evidence-based practice: The experience of nurses and midwives. PLoS ONE 16(8): e0256600. https://doi.org/10.1371/journal.pone.0256600

Fiset, V. J., Graham, I. D., & Davies, B. L. (2017). Evidence-based practice in clinical nursing education: A scoping review. Journal of Nursing Education, 56(9), 534-541.https://doi.org/10.3928/01484834-20170817-04

Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses—systematic review. Medicine, 98(39). 10.1097/MD.0000000000017209

Qiao, S., Li, X., Zhou, Y., Shen, Z., & Stanton, B. (2018). Attitudes toward evidence-based practices, occupational stress and work-related social support among health care providers in China: A SEM analysis. PloS one, 13(8), e0202166.https://doi.org/10.1371/journal.pone.0202166

Yoder, L. H., Cengiz, A., Hinkley, T., Hertel, R. A., Gallagher?Ford, L., & Koshy Thomas, B. (2022). Medical?surgical nurses' EBP beliefs and competencies. Worldviews on Evidence?Based Nursing.https://doi.org/10.1111/wvn.12567

Zhao, J., Bai, W., Zhang, Q., Su, Y., Wang, J., Du, X., ... & Hu, J. (2022). Evidence-based practice implementation in healthcare in China: a living scoping review. The Lancet Regional Health-Western Pacific, 20, 100355.https://doi.org/10.1016/j.lanwpc.2021.100355 

PICO analysis helps in developing critical thinking that is crucial for implementation of EBP. PICO is an acronym that helps form a question addressing the population (P), issue of interest or intervention (I), comparison group (C), and outcome (O).  

a). Research Question: For people having high cholesterol levels, what is the effect of having a restricted diet along with physical activity like walking or cycling in comparison to those with no restricted diet or physical activity?

PICO elements

Keywords

Search terms

P (Patient or Population)

People having high cholesterol

People with cholesterol

I (Intervention)

Restricted diet and physical activity

Restricted diet, physical activity

C (Comparison)

No diet or activity

No diet or activity

O (Outcome)

Reduction in cholesterol levels

Cholesterol reduction

The selected article that reflects all the points of the research question 

In the United States, obesity has become a major non-communicable chronic disease which can lead to other serious diseases like cardiovascular diseases. Exercises and physical activity have shown a positive result in reduction of cardiovascular diseases by ensuring weight loss through creation of a negative energy balance. Clinicians are required to educate patients with obesity about the advantages of physical activity and exercise training. Through this paper, evaluations of only exercise training, based on aerobic training and resistance training and exercise training in combination of diet are observed. Also, the role of physical activity in short term and long term goals of weight management were analyzed through the paper.

The paper identifies with the selected PICO in the following manner:

The population of the paper (P) is people who suffer from obesity. People who have obesity have fat accumulation in their bodies and thus have high cholesterol as well.

The paper discusses the importance of physical activity alone and then combined with diet (I).

Those who did not perform any activity had higher chances of cardiovascular disease (C).

The resultant outcome of weight loss and maintenance is also reviewed (O).

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[Accessed 02 March 2024].

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