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Discussion on the final position statement

Discuss about the Integration Of EBP In Clinical Practice.

Evidence based practice (EBP) is the critical use of best practice based evidence to influence decision making and plan patient care. The integration of EBP in clinical practice is done by systematic search and critical appraisal of relevant evidence according the clinical question or issues. It involves integrating clinical expertise and patient’s preference and values in the decision making process (DiCenso, Guyatt, & Ciliska, 2014). According to the standard 1 of the Registered nurse standards for nursing practice, registered have the responsibility to use critical thinking skill and use best available evidences in decision making and providing safe, quality nursing care (Registered nurse standards for practice, 2016). Although nurses face several challenges in integrating and implementing EBP in nursing practice, my individual position statement is that ‘nurses must be actively involved in implementing EBP during decision making and care delivery process’. The report provides a proper rational and discussion for taking this stand on the topic and also defends the individual position statement by refuting argument to finally make it clear why nurses should remain at the forefront of EBP implementation.

Health and medical care is a dynamic discipline where new medicines, medical equipments and clinical procedures are regularly invented. The main motive for new and advanced health care procedures and equipment is to support clinicians and nurses to provide the best standards of care to patients. Due to this perspective, there is great emphasis on using EBP in clinical decision making (Majid et al., 2013). Apart from clinicians, nurses are also expected to implemented research findings into their practice.  This is a professional obligation for nurses too as the Standard 1.1 of the Registered Nurse Standards for Practice states that nurses must access, analyze and apply the best available evidence for providing safe and quality practice (Registered nurse standards for practice, 2016). The importance of EBP in nursing practice is also seen due to its positive impact on clinical outcome of patient. Stevens (2013) has shown that EBP has great promise in achieving intended health outcome and nurse must employ EBP to deliver optimal care. The main rational for favoring EBP for nurses in daily practice is that it is the most appropriate method to cover gaps in patient care and achieve best outcome for patient by combining clinical experience and best evidence. It also has the advantage of enhancing patient’s experience in care as EBP considers patient values in care too (Steven, 2013). Hence, considering positive clinical outcome and patient’s experience associated with EBP, it is necessary that nurse use this opportunity to expand their skills in clinical practice and transform the delivery of care.  

Nurses responsibility in EBP implementation

In the current health care environment, special emphasis has been placed on EBP to promote excellence in health care.  However, the use of EBP as a routine patient care is very inconsistent among nurses because of the several barriers in integrating EBP in daily practice (Adamu & Naidoo, 2015). This points out to opposing arguments against the individual position statement. For instance, a study done to investigate the readiness of nurses in implementing EBP has revealed that although nurses had a positive perception about EBP, however they did use it in daily in clinical practice due to poor skills in using EBP. The common barrier expressed by nurses in implementing EBP was the challenges in finding and reviewing the research related to any clinical question. The research also showed that positive attitudes and required skills in identifying the best research was higher in experienced nurses compared to newly placed nurse (Ammouri et al., 2014). Based on the relevant barriers experienced by nurse in implementing EBP, it can be a relevant opposition argument to disapprove the individual position statement. However, the refuting argument against this evidence is that barrier to implementing evidence is found among nurse due to poor trainings and exposure to evidenced based information during the nurse education period. Hence, lack of resource and training to prepare the nurse in using evidence during their diploma programmes affects their ability to use EBP confidently. (Grant, Stuhlmacher & Bonte-Eley, (2012) also showed that nurses with masters degree can promote EBP use among other nurse colleagues as knowledge of research process promotes interpretation of scientific evidence. Therefore, if health management creates an environment that trains and educate nurse in analyzing and applying evidence, they can be at the forefront of EBP implementation and optimize positive outcomes for patient too.


Another study that defends the individual position statement of nurse’s responsibility to implement EBP in nursing care is that despite having skills related to EBP, lack of time act as a barrier for nurses in utilizing and applying research in clinical practice. A study done to explore barrier to EBP experienced by nurses revealed that nurses had insufficient time on the job to implement new research evidence and hospital administration did not support implementation of  EBP in routine clinical care (Shifaza, Evans, & Bradley, 2014). In addition, the system level limitation is that many hospitals lacks adequate human and fiscal resource to promote a culture of EBP. This means that lack of leadership support and lack of inclusion in decision making contributes to poor EBP implementation among nurses (Warren et al., 2016). Hence, lack of appropriate work culture to support and identify the importance of EBP has an impact on nurse’s perception of research importance too. The above evidences goes against the individual position statement because nurse alone are not responsible for implementing EBP, they also require the support of organization and adequate resource to increases the utilization of best evidence in practice.

Barriers to EBP implementation among nurses

Despite the above argument of not expecting nurses to implement EBP, the rebuttal against the argument is that nurses must use EBP in clinical care only when they get the training and support from health care organization in implementing EBP. A system of support and recognition for EBP along with reward system can act as facilitator to research utilization and address inconsistencies in the use of EBP among nurses. The leaders and management of health care organization need to play a role in creating a strategic climate for EBP implementation and sustaining the new practice in the health care system (Aarons et al., 2014). Apart from standard 1.1 of registered nurse standards for practice that directs nurse to use the best available evidence, the standard 5.1 also emphasize that nurses must use best available evidence to develop a plan of nursing practice. The professional obligation of using EBP among nurse is also necessary because it will support the nurse to fulfill other obligations in nursing practice such as providing safe and responsive quality nursing care and achieving improved health outcome for patient (Registered nurse standards for practice, 2016).


Many nurses also excuse themselves from using EBP by stating that they do not have the skills or they have not got the required education in their nursing education programme to implement EBP. However, nurses cannot escape from this responsibility because it is also a professional obligation of nurses to maintain their capability for practice and engage in professional development (Registered nurse standards for practice, 2016). The above argument strengthens the fact that EBP is essential for nurse to facilitate professional development. Hence, it will be important for nurses to attend training programs to develop their skills in asking the clinical question and searching and critically appraising best available evidence. Winters & Echeverri, (2012) explains that nursing faculty or the nursing preceptor are the important person who can train the nurse in step-by-step implementation of EBP. There training programs should focus on addressing the common barrier faced by nurse in using research in practice such as challenges in interpreting research evidence and lack of confidence in evaluating the evidence. Therefore, this means nurses need to be taught about the all steps in EBP implementation such asking clinical question, searching for best evidence, integrating the evidence into practice and evaluating the outcomes.

Based on the individual position statement, the first step towards implementation of EBP in nursing practice is to develop spirit of inquiry and intellectual curiosity among all nursing students. Teaching nursing students to frame a clinical question in PICOT format can also help them to use appropriate search term and find empirical evidence (Nielsen, Lasater & Stock, 2016). Many nurses are competent in framing the clinical questions, however they fail to critically appraise the evidence. In this case, nurse preceptor’s guidance is critical in teaching the nurses the method to analyse the validity and the applicability of the study (Ryan, 2016). In addition, collaboration with clinical managers can also support nurse in determining the applicability of the evidenced based practice in real setting (Aasekjær et al., 2016). A study also revealed that undergraduate education program should focus on building the attitude, skills and uptake of EBP among nursing students to increase their confidence in adapting evidence (Leach, Hofmeyer, & Bobridge, 2016).

Role of health care organization in EBP implementation

Conclusion

The report summarized and supported the use of EBP in nursing considering better clinical outcome, patient satisfaction with care, lesser complication and improving patient safety and quality of life. Several studies also gave opposing argument regarding the use of EBP by discussing about individual and organizational barrier in implementing EBP. Despite the barrier, the final position statement is also again the same which is to promote implementing EBP in nursing practice. This is mainly because of professional obligation to promote patient safety as well as professionally develop in nursing practice. Currently EBP is used inconsistently by nurses and role of hospital management or clinical managers is important in providing the right resource and knowledge in using EBP confidently.

References

Aarons, G. A., Ehrhart, M. G., Farahnak, L. R., & Sklar, M. (2014). The role of leadership in creating a strategic climate for evidence-based practice implementation and sustainment in systems and organizations. Frontiers in Public Health Services and Systems Research, 3(4), 3.

Aasekjær, K., Waehle, H. V., Ciliska, D., Nordtvedt, M. W., & Hjälmhult, E. (2016). Management Involvement—A Decisive Condition When Implementing Evidence?Based Practice. Worldviews on Evidence?Based Nursing, 13(1), 32-41.

Adamu, A., & Naidoo, J. R. (2015). Exploring the perceptions of registered nurses towards evidence-based practice in a selected general hospital in Nigeria. Africa Journal of Nursing and Midwifery, 17(1), 33-46.

Ammouri, A. A., Raddaha, A. A., Dsouza, P., Geethakrishnan, R., Noronha, J. A., Obeidat, A. A., & Shakman, L. (2014). Evidence-based practice: Knowledge, attitudes, practice and perceived barriers among nurses in Oman. Sultan Qaboos University Medical Journal, 14(4), e537.

DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences.

Grant, H. S., Stuhlmacher, A., & Bonte-Eley, S. (2012). Overcoming barriers to research utilization and evidence-based practice among staff nurses. Journal for Nurses in Professional Development, 28(4), 163-165.

Leach, M. J., Hofmeyer, A., & Bobridge, A. (2016). The impact of research education on student nurse attitude, skill and uptake of evidence?based practice: a descriptive longitudinal survey. Journal of clinical nursing, 25(1-2), 194-203.

Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y. L., Chang, Y. K., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers. Journal of the Medical Library Association: JMLA, 99(3), 229.

Nielsen, A., Lasater, K., & Stock, M. (2016). A framework to support preceptors’ evaluation and development of new nurses’ clinical judgment. Nurse education in practice, 19, 84-90.

Registered nurse standards for practice. (2016). Retrieved 28 October 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Ryan, E. J. (2016). Undergraduate nursing students’ attitudes and use of research and evidence?based practice–an integrative literature review. Journal of clinical nursing, 25(11-12), 1548-1556.

Shifaza, F., Evans, D., & Bradley, H. (2014). Nurses’ Perceptions of barriers and facilitators to implement EBP in the Maldives. Advances in Nursing, 2014.

Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. OJIN: The Online Journal of Issues in Nursing, 18(2), 1-13.

Warren, J. I., McLaughlin, M., Bardsley, J., Eich, J., Esche, C. A., Kropkowski, L., & Risch, S. (2016). The strengths and challenges of implementing EBP in healthcare systems. Worldviews on Evidence?Based Nursing, 13(1), 15-24.

Winters, C. A., & Echeverri, R. (2012). Teaching strategies to support evidence-based practice. Critical Care Nurse, 32(3), 49-54.

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