Integration of Evidence-Based Practice Into Professional Nursing Practice

Evidence-based practice (EBP) can be seen throughout history dating back to the mid 19th century when Florence Nightingale gathered research to improve the quality of care provided to patients while analyzing hospital data (Miller, Ward & Young, 2010). EBP has been defined as “using current best evidence in making decisions about the care of the individual patient” (Ervin, NE. 2002. p. 11). Integrating EBP into nursing practice poses its own set of difficulties and barriers.

To bridge the gap from literature and the evidence gathered through research into bedside nursing, there must be a clear and thought out strategy for implementation (Pipe, T. , Wellik, K. , Buchda, V. , Hansen, C. , & Martyn, D. 2005). There are many strategies to the implementation of EBP into nursing. Due to the varying levels of education and exposure, there is no right or wrong avenue for implementation. While there are barriers to the use of EBP; the outcomes from EBP include, but are not limited to, reaching the goal of better patient outcomes, decreased use of resources, and increasing revenue by decreasing cost.

EBP is the culmination of the best research practices to achieve a patient directed goal while minimizing the resources needed and maximizing financial gain (Menez, J. 2007). EBP has produced many necessary changes throughout nursing and has provided safer patient outcomes. With the utilization of the best research modalities, integration and teaching of EBP, and the use of EBP in nursing, many necessary changes throughout nursing have been initiated and safer patient outcomes have been documented (Pipe, T. , Wellik, K. , Buchda, V. Hansen, C. , & Martyn, D. 2005).

EBP has been a source of nursing medical change which benefits the nursing profession as well as the patient. Integrating EBP into Nursing Practice The initiation of change while integrating EBP into nursing practice poses many obstacles. To initiate change into any situation, there must be a climate willing to accept change. Many units encounter resistance and resentment when forced into change. When there is a climate that fosters change, the resistance felt will be less throughout the department.

When staff is encouraged to participate in the change process and feel their voices are heard and they are supported by the upper management, the change will be better accepted (Bouckenooghe, D. , Devos, G. , Van den Broeck, & Herman. 2009). When changed is forced, the barriers encountered to the acceptance of the change may include rejection, hostility, negativity, sabotage, or lack of interest by those expected to change (Bouckenooghe, Devos, Van den Broeck & Herman. 2009). When integrating EBP into nursing, the educator must realize the skill and knowledge level of all the participants.

In an associate degree program, there isn’t a course dedicated to research within the curriculum. (Spencer, J. 2008). The bachelor degree nurse has been exposed to research and may be more willing to accept the change (Spencer, J. 2008). With the use of outcomes and evidence used in research, the obstacles with integrating EBP may be diminished. To better facilitate the process change stemming from the research and evidence gathered, the research team must be comprised of staff at all levels within the department (Bouckenooghe, D. , Devos, G. , & Van den Broeck, Herman. 009).

The research team should include the ancillary staff, nursing support, both ADN and BSN nurses, management, physicians and the quality department. Implementation Strategies There is not a clear, concise, or “right” way to implement EBP (Austin, M. J. , & Claassen, J. 2008). To change the ideas and format of nursing and the thought process of both experienced and new nurses with the “right” method of implementation would be the same as saying that everyone who presents with chest pain is treated with the same interventions and has the same outcome.

Barriers to implementing EBP into nursing focus around lack of knowledge; (Ervin, NE. 2002) knowledge in both the research process and the ability to use critical thought process when deciphering the evidence gathered from the research (Ervin, NE. 2002). As stated by Dawes, M. , Summerskill, W. , Glasziou, P. , Cartabellotta, A. , Martin, J. , Hopayian, K. (2005), “learning has three components: knowledge, skills, and attitudes” (p. 4).

To foster a learning environment that will maximize resources and provide the learner with tools to retain the information and utilize what is learned, the educator must also look at the best learning modalities for each participant (What’s Your Learning Style?. 2009). Learning is as individual as ones fingertips. The educator must provide hands on, auditory, tactile, and verbal presentations (What’s Your Learning Style? , 2009). When the learner feels they are interactive with the education being presented, they are more likely to retain and implement what is taught (Hudson, K. Duke, G. , Haas, B. & Varnell, G. 2008).

Outcomes of EBP Bridging the gap between theory, research, and practice is essential in the continuation of learning and practice improvement in the medical field. With the use of EBP, this gap has become smaller (Hanberg, A. , & Brown, S. C. 2006). There have been many positive outcomes to the use of EBP. The outcomes produced by bridging the theory gap include drastically improved patient outcomes and care, and the decrease in unnecessary healthcare costs healthcare cost.

When the staff nurse is involved in the decision making and critical thinking involved in producing better patient outcomes, this provides self confidence and improved decision making skills. (Hanberg & Brown, 2006) With improvement in these areas, nurses are armed with the knowledge to recognize when and where a change should occur, the ability to seek out the research necessary to create the change, and the evidence to back up the change to promote an improved outcome.

Clinical Example of EBP By bridging the theory-practice gap, many patient improvements have been introduced. These improvements include decreased infection rate with the use of chlorhexidine swabs when changing the dressing on central or peripheral access lines, the decrease use of normal saline to “liquefy” secretions in the artificially ventilated patient, and the decreased rate of pressure ulcers noted to the inactive fragile patient.

Institutions have also benefited from the use of EBP. There has been reduction in cost, implementation of policy and procedure, and increased patient satisfaction (Sammer, C. E. , Lykens, K. , & Singh, K. P. 2008). EBP in Action “Effective evidence-based practice requires defining an answerable, well-built question, systematically searching for the best current evidence, and appraising that evidence for validity (Barzilai, Weinstock & Mostow, 2007, p. 23).

The acronym PICO, P-patient or problem, I-intervention, C-comparison intervention, )-outcome, is a great tool when formulating a question to initiate EBP (Evidence Based Practice) An example of EBP in action may stem from the question, “In a patient with sudden onset of shortness of breath and diffuse chest pain, what is the best method for ruling out pulmonary embolism (PE), chest angiography or a ventilation perfusion scan? As a result of research and data analysis, it was shown that the use of CT through chest angiography provided the best modality in the diagnosis of a PE. However, due the vast differences in machinery through the country, this modality for diagnosis has not yet been established as the “norm”. (Segal, J. B. , Eng. J. , Tamariz, L. J. , & Bass, E. B. 2007). Conclusion In conclusion, with the use of EBP, critical thinking skills are heightened, the gap between theory and practice is decreased, and the skill to provide an evidenced bases process through research is attained.

By formulating a plan to implement EBP in a climate that fosters learning and change, policies and procedures can be produced to benefit the patient and provide safe quality patient care while reducing the institutions cost (Sammer, C. E. , Lykens, K. , & Singh, K. P. 2008). The recipient of health care should feel their care is beneficial to the healing process and that the method of their care has been devised through research and evidence to support this care. Algase. 2009). EBP is essential in providing patients with care that has been proven by research and data collected to support the research. Nursing is a profession that is geared to healing and saving lives. With this ever changing world of medicine, research must be initiated in order to promote the change. Nursing research is not forced on all nurses, it is simply expected that the nurse will apply the research gathered intelligently to their practice. (Menez. 2007).

To summarize Ervin (2002) and his strategies for EBP education, the push to make nursing a more EBP focuses profession begins in the classroom, before the nursing student practices in the clinical setting, and continues post graduation while in the clinical setting as continuing education. The student must develop their own hypothesis, test this hypothesis, and implement their findings. This can be accomplished in a course designated to research and research utilization.

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