Evidence-Based Health Care And Challenges In Implementation

Evidence-Based Approach

Evidence-based practice is a conscientious, explicit and judicious use of clinical evidence to make decisions about how to care for patients in the clinical environment. This means that the practitioner integrates individual clinical experience with other available evidence from systematic research to make better informed decisions. Thus practitioners need to make care decisions based on the existing facts that have been gathered in practice (Jordan, Bowers, Cur, & Morton, 2016). This is thus the link between what practitioners have learned in class to the existing facts in the practice. Proponents of this approach argue that it has changed the healthcare environment since it is based on best practices that put client value at the center of the practice and ensuring that patients contribute to the clinical practice and the value that they receive (Duffy, Fisher, & Munroe, 2008). It has been further argued that evidence-based practices allow practitioners to go beyond their preferences and biases thus improving the effectiveness and quality of clinical outcomes. This practice has to be done based on the environmental and organizational context that the practitioner operates. However, most practitioners have struggled with this approach since they find it difficult integrating this approach in their study. This is due to the barriers and challenges that they experience in their field of practice.  

One challenge faced by practitioners is the lack of adequate resources that are allocated to evidence-based practices. For every activity or initiative to take place, there must be adequate resources that are allocated to meet the requirements of the initiative. Organizations need to provide adequate resources that they can use to implement evidence-based practices (Solomons & Spross, 2010). This means that organizational barriers to resources have to be removed so that practitioners can apply the method well. For example, some organizations do not support their practitioners in applying evidence-based approaches since they lack adequate resources for allocating to the practitioners. As such most practitioners do not implement evidence-based approaches but rather use their knowledge and skills to address the issues in the organization.

Despite the lack of adequate resources, poor organizational culture has been cited as one of the difficulties in implementing these approaches. Most organizations lack appropriate organizational culture strategies that create an environment that allows practitioners to easily practice evidence-based approaches. Grimm & Shoo (2005) argue that strong organizational cultures lead to a string internal focus and stability which shape the way evidence-based approaches are implemented within the organization. This means that when the organizational culture is strong, it creates better conditions for the practitioners to apply the approach since it increases or reduces the ability to achieve the approach. Poor organizational culture leads to disparities in practices and poor values or priorities for achieving the approach. Hannes, Vandersmissen, De Blaeser, Peeters, Goedhuys & Aertgeerts (2007) study identified a lack of organizational support as the major barrier to implementing evidence-based approaches in clinical settings. This is seen in difficulties accessing information, insufficient staffing and lack of management concern for the issues affecting practitioners.

Challenges in implementing evidence-based practices

Further, some practitioners have failed to apply these practices due to lack of adequate knowledge and skills that relate to the practice. This is because evidence-based practice skills need to be acquired through education when one undergoes education. Some researchers have pointed out gaps in education that have limited the ability of practitioners to develop adequate skills for applying the method (Rickbeil & Simones, 2012). The nursing transition from class to the field is entirely based on the knowledge that the practitioner has acquired and the ability of the practitioner to transfer this knowledge to clinical practice. Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan (2012) study sought to asses the perception of evidence-based approaches in nursing students in the US which reported that there were educational deficiencies in the learning process that limited the abilities of the practitioners to apply evidence-based approaches. It is widely known that most practitioners lack appropriate knowledge and skills for example the novice nurse which makes it difficult for them to apply evidence-based approaches (Melnyk, Gallagher-Ford, Fineout-Overholt, & Kaplan, 2012).  This is because the students lacked access to knowledgeable mentors, resources and tools needed to apply the EBP approaches within the clinical settings. Thus the deficiencies in education are transferred to practice which in turn makes it difficult for the practitioner to develop appropriate competencies for the approach. In addition to that Gale & Schaffer (2009) argue that educators spend more time teaching students how to collect clinically related information rather than how to apply the same information in clinical settings. This means that when such practitioners enter the clinical field they lack proper abilities that can be used to sustain evidence-based practices within the area of work.

Mercer & Pignotti (2007) suggests that other studies have attributed the challenge of implementing evidence-based approaches to resistance within teams in implementing these approaches.  This is due to the misperception and negative attitudes on the importance of evidence-based approaches in clinical practice. This is seen from the fact that most practitioners get resistance from clinical managers and other staff in implementing the approach. This is because most practitioners argue that using the approach in clinical practice requires a lot of time to gather and analyze different information before making a decision. Resistance can be a result of lacking knowledge of defiance by some practitioners who are not willing to use the approach.

Farley, et al. (2009) suggest that organizational policies can be one of the barriers to implementing evidence-based practices. This is because the practice can be implemented well if the organization has a set of policies that define the way issues need to be approached. Most healthcare organizations lack proper policies that define the way the approach needs to be used in organizations and whether it is mandatory or optional. Further, the policies lack strategies for addressing organizational challenges like resistance which makes it difficult for practitioners to work. This means that most practitioners work in an environment that is challenging and sometimes depressing thus increasing the ability to use shortcuts rather than use the tidious evidence-based approach.

Strategies for Addressing Barriers to Evidence-Based Approach

Strategies for Addressing Barriers to Evidence-Based Approach

Researchers have argued that the best way to improve the ability of practitioners to use evidence-based approaches is through proper education. In most cases, education programs have been criticized as lacking proper standards that empower practitioners on the importance of evidence-based nursing approaches. This means that such individuals encounter challenges when using the approach especially in analyzing data and other statistical terms that relate to the approach (Manspeaker & Van Lunen, 2011). Further, some practitioners have little understanding of the jargons or even applying the data gathered in patient situations. Therefore, this calls for integrating the issues related to the evidence-based approaches in education where clinical education includes training practitioners on how to use the approach. This means that practitioners need to understand how to apply the information that they have gathered into clinical practice to inform decision making (Middleton, 2016). Proffesional bodies like the Nursing and  Midwifery Board of Australia need to further address these challenges by offering training programs and even publishing relevant information that practitioners can use in the field. Thus proper education and training empowers practitioners with different models of using the approach in clinical settings. By learning how to ask the right questions, gather information, appraise the information and then act on it, the approach can be easy to implement if the practitioner has proper education and clinical skills.

Another strategy that needs to be put in place to improve evidence-based approaches is to carry out research on how the clinical environment can be improved. In their study, Gale & Schaffer (2009) reported that most practitioners felt the need to address environment-related issues which affect the ability of nurses to apply evidence-based approaches. This means that the challenges that practitioners face in everyday life need to be identified so that strategies can be put in place to address them. Challenges relating to the evidence-based approach have been based on the lack of clear evidence on the cost of achieving the approach and the actual benefit of the results of the study. The clinical environment plays an important role in the ability of the practitioner to apply the approach to the clinical process.

One way that organizations can increase the ability to apply evidence-based approaches is through creating a better organizational culture that increases the ability for practitioners to work and relate well within the clinical environment. Since each professional group has a unique perspective rooted in the values that they hold that create a strong commitment to change (Farley, Feaster, Schapmire, D’Ambrosio, Bruce, Oak & Sar, 2009). There is a need to develop systematic approaches to evidence-based thinking which can be used to create an environment that allows practitioners to practice this method. this entails working on the structural elements of the organization to align them with the requirements of evidence-based approaches. In most cases, implementing any policies in an organization requires an adequate organizational structure that is used to develop system capabilities for achieving the process. Organizational culture can thus be a barrier or an enhancer of evidence-based approaches within clinical settings.

Further, Fitzsimons & Cooper (2012) argue that organizational culture plays a role in ensuring that there is innovation diffusion within the organization thus allowing the practitioner to use the evidence-based approach to develop solutions for new situations that they face. This means that managers have to ensure that change driven by clinical evidence is supported in practice. This leads to increased quality of care since the use of evidence-based approaches becomes a norm in the organization. The role of organizational culture and structures is to ensure that proper mechanisms are put in place to support the practitioner at the individual and organizational level pertaining to the use of evidence-based approaches.

Evidence-based practices in clinical settings are slowly growing thus the need for practitioners to understand how to apply them in clinical settings. This means that different stakeholders need to be involved to develop policies, programs, and strategies for ensuring that the practices are applied by practitioners. This calls for the need to address individual and organizational challenges which hinder the ability to apply the approach in clinical situations. Gambrill (2006) argus that evidence-based practices can only be fully implemented if agency policies are properly developed to inform practitioner intervention by directing how practitioner wisdom and client preference interact to influence decision making. In addition to that, the policies need to be open to the practitioner and client input thus increasing the flexibility of their application. This will increase the ability of practitioners to apply the practice since once individual and organizational barriers have been addressed the practitioners are forced to follow relevant policies when dealing with organizational related challenges.

The resource-based view suggests that that the solution to the evidence-based approaches is the shift in priorities and resourced so that enough resources can realigned and reallocated to the approach.  This calls for the need to balance between the needs of the population, clients, the institutions and the practitioners. The practitioner-workload issues have been adequately discussed in most articles especially those related to nursing. In addition to that, the nursing education programs need to be revisited to ensure that the curricula have evidence-based education approaches that practitioners can learn. Empowered learners can then translate the same information to real life practice that they get engaged in. This means that to adequately apply this approach, enough resources have to be allocated to allow practitioners fully research topic areas thus increase the autonomy and efficacy of the practitioner to engage in complete EBP cycle (Santelli, 2006).  this means that healthcare organizations have to ensure that evidence-based approaches become a priority and proper resources are allocated to all levels of practice. The needs of the organization, the practitioner and the population have to be balanced for the benefits of evidence-based approaches to be realized.

Clinical question: How can evidence-based practice be used to improve quality of care in the elderly population with high blood pressure.

Question
Type of patient	intervention	Comparison intervention	outcome
elderly with blood pressure	Therapeutic intervention	Therapeutic intervention	Patient response from intervention
Key words Blood pressure Elderly	Key words Phamarcological interventions	Key words Pharmarcological intervention	Key words Treatment challenges Allergies reactions

Population/problem	The population under study was the adult population with high blood pressure.
Intervention	The study sought used nonsystematic literature review to analyze literature on evidence-based practices from 1966 to 2009 to determine the trend and research that has been done and documented on the topic.
Comparison	The data was compared from different articles and research done on the topic to determine how the approach has been changing and the current trend that is being applied. To refine the results better, the study addressed the following issues; blood pressure measurement, patient evaluation components, adherence to regimes, secondary hypertension and hypertension in special populations.
Outcomes	The study recommended that 140/90mm Hg definition of JNC 7 is still the reasonable therapeutic intervention for patients with high blood pressure.

References

Duffy, P., Fisher, C., & Munroe, D. (2008). Nursing knowledge, skill, and attitudes related to evidenced based practice: Before or After Organizational Supports. MEDSURG Nursing, 17(1), 55-60.

Farley, A. J., Feaster, D., Schapmire, T. J., D’Ambrosio, J. G., Bruce, L. E., Oak, S., & Sa, B. K. (2009). The Challenges of Implementing Evidence Based Practice: Ethical Considerations in Practice, Education, Policy, and Research. Social Work and Society Internationl Journal, 7(2).

Farley, A. J., Feaster, D., Schapmire, T. J., D’Ambrosio, J. G., Bruce, L. E., Oak, S., & Sar, B. K. (2009). The Challenges of Implementing Evidence Based Practice: Ethical Considerations in Practice, Education, Policy, and Research. Social Work & Society, 7(2), 246-259.

Fitzsimons, E., & Cooper, J. (2012). Embedding a culture of evidence based practice. Nursing Management, 19(7), 14-19.

Gale, B., & Schaffer, M. (2009). Organizational readiness for evidence-based practice. Journal of Nursing Administration, 29(2), 91-97.

Gambrill, E. (2006). Evidence-Based Practice and Policy: Choices Ahead. Research on Social Work Practice, 16, 338-357.

Grimm, N. A., & Shoo K. Lee. (2005). How Do Organizational Culture and Strategy Influence Implementation of Evidence-based Practice? AMIA Annual Symposium Proceedings Archive, 970. 

Hannes, K., Vandersmissen, J., De Blaeser, L., Peeters, G., Goedhuys, J., & Aertgeerts, B. (2007). Barriers to evidence-based nursing: a focus group study. Journal of Advanced Nursing, 60(2), 162-171.

James, P. A., Oparil, S., Carter, B. L., Cushma, W. C., Dennison-Himmelfar, C., Handler, J., . . . Tow, R. R. (2013). 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). Journal of American Medical Association, 311(5), 507-520.

Jordan, P., Bowers, C., Cur, M., & Morton, D. (2016). Barriers to implementing evidence-based practice in a private intensive care unit in the Eastern Cape. South African Journal of Critical Care, 32(2), 50-54.

Manspeaker, S., & Bonnie Van Lunen. (2011). Overcoming Barriers to Implementation of Evidence-Based Practice Concepts in Athletic Training Education: Perceptions of Select Educators. Journal of Athletic Training, 46(5), 514-522.

Melnyk, B., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: critical implications for nurse leaders and educators. Journal of Nursung Administration, 42(9), 410-417.

Mercer, J., & Pignotti, M. (2007). Shortcuts cause errors in systematic research syntheses: Rethinking evaluation of mental health interventions. Scientific Review of Mental Health Practice, 5(2), 59-77.

Middleton, J. (2016). The impact of accurate patient assessment on quality of care. Nursing Times.

Rickbeil, P., & Simones, J. (2012). Overcoming Barriers to Implementing Evidence-Based Practice. Journal for Nurses in Staff Development, 28(2), 53-56.

Santelli, J. (2006). Abstinence-Only Education: Politics, Science, and Ethics. Social Research, 73, 835-858.

Solomons, N. M., & Spross, J. A. (2010). Evidence?based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review. Journal of Nursing Management, 19(1), 109-120.