Discuss about the Evidence Based Practice in Nursing for Clinical Expertise.
Evidence-based practice is a dynamic process that entails deliberate integration of a nurse’s cumulative clinical expertise, the best and current available scientific evidence and patient’s preferences and values in providing the highest possible quality care (Felice 2014). To ensure the success of this practice, the nurses mandated in its execution should acquire the requisite competency and skills. This is in line with the Nursing and Midwifery Board of Australia (NMBA) that has propounded stringent professional and competency for registering nurses (Australia, 2015). In contemporary health care practice, nurses have the mandate of using evidence based practice (EBP) however, it is expected that they are not in the frontline during its implementation because of many substantiated reasons. In this regard, nurses have a right to defend themselves as far as underutilization of EBP is concerned (Seers, Crichton, Martin, Coulson, & Carroll, 2008). This paper explores this position, that nurses are not able to fully implement EBP even though it is the most effective approach in care of patients. Furthermore, it will discuss some ways in which EBP improves patient outcome, how it is applied and some barriers towards its uptake.
The widespread utilization of evidence-based practice in nursing care has had a positive impact on the outcome of the patients and their families according to a randomized controlled trial done in Southern Melbourne by Dr. Melnynk and group (Melnynk &Fineout, 2015). One of the core aspect championed by this practice is a collaborative approach to care. In this approach, a forum whereby different professionals with different expertise work in close collaboration to ensure optimal care of the patient is created. Each professional in this team comes on board with a different approach to tackling a given menace. The net result of this collaboration is the better patient outcome. Also, this partnership ensures that there is no duplication of services. Apart from seeing that the institution’s meager resources are properly utilized, it also relieves the patient and family from unnecessary additional costs (Melnynk &Fineout, 2015). Evidence based practice has been proved to be underutilized by the profession of nursing (Glasziou, 2015) as Paul Glasziou puts it after conducting a randomized controlled trial in 2015 on 200 nurses in a period of three years. Their use of EBP in patient care was substandard throughout the study (Glasziou, 2015).
The evidence-based practice embraces the integration of the best and presents available scientific evidence in the planning and during the discharge of care. This aspect of the practice attempts to ensure that the entire healthcare is standardized and that all discharged care has a scientific backup.This will hinder nurses from executing illogical nursing interventions with unknown and unpredictable results. When this aspect is critically upheld in the clinical area, patient ‘s safety will be protected thus an improvement in the outcomes of care (Watt & Snowdon, 2013).
Another promising aspect of this practice is that, during the entire process of planning and giving care, patient’s preferences, values, attitudes, and beliefs are taken into consideration. It is a patient and family-centered process. The nurse and the patient work collaboratively during the coming up of the plan of care to ensure that it is relevant to the patient and his/her family. This aspect also ensures that the care is discharged in the culturally safe environment. Consequently, this will go a long way in creating a trusting and understanding environment where patients will express themselves freely. All these will culminate in proper nursing assessment thus improving patient’s outcome (Stevens, 2014)
The evidence-based practice comes into practicability when the nurse encounters a patient. The critical thinking skill is paramount in the utilization of this practice. This engagement generates questions about the entire or some parts of the treatment and culminates in the nurse coming up with the clinical problem, for instance, a nurse who has just met a patient with a wound, may identify the clinical problem to be the management of a wound. After identifying the case or clinical problem, the nurse then develops a well-structured clinical question out of the case e.g. how to manage a chronic wound (Kim &Mallory,2014)
Afterward, the nurse critically selects the proper resources and tools and thoroughly conducts research to tackle the pre-determined clinical question(s).This is a time-consuming stage whereby the nurse is required to be accustomed to a wide range of current published literature. For this to materialize, the institutions should endeavor to see that relevant resources are at the disposal of the staff to engineer learning and for easy search (Sansee, Johnson &Welch, 2014). In addition, proper working environments should be created for nurses. This includes adequate staffing to ensure that there is manageable workload. This will offer nurses sufficient time to conduct research for their clinical questions thus furthering their professional development (Fink, Thompson &Bones, 2013).
Before putting the gathered evidence into clinical practice, the nurse keenly, scrutinizes the evidence to determine its proximity to the truth and whether it can have a positive impact if applied in the clinical practice. This entails cultivating interprofessional and consultative avenues. In addition, this also involves being flexible and ready to accept, and value inputs from other professionals who, in one way or another are involved in the management of the patient. The appraisal of the evidence is paramount as it promotes quality of care and ensures that patient safety is enhanced (Pravikoff & Pierce, 2016).
After appraising the evidence and determining its usefulness in the clinical practice, the nurse returns to his/her patient for implementation. Here the nurse exercises flexibility by listening and taking into account the patient ‘s preferences. The nurse and the patient work collaboratively in the development of the plan of care. Afterward, the nurse integrates his /her acquired expertise in practice, patient values and beliefs and the scientifically proven evidence in managing the patient’s condition. In addition to this aspect, all interventions and evidences should be clearly documented for accountability (Emerson, 2015).
The last phase of this process is the evaluation of the effectiveness of care discharged or if the clinical question was answered. It is the nurse’s responsibility to see that the pre-determined goals are achieved. If the goals are not achieved and since this is a continuous process, the process starts over again but with a different approach. This phase of the practice also entails sharing the finding with others through writing. (Steven, 2014)
Although nurses in Australia have demonstrated a positive attitude towards the implementation of evidence-based practice, still numerous roadblocks are curtailing its smooth implementation. These hindrances are partly related to institutional structure and individual nurse factors. A systematic review on the impediments of nursing implementation of EBP done by PubMed Central (PMC) found that the nurses involved did not practice EBP for at least five days in a week. It concluded that many of them do not have preliminary knowledge and skills. A blame was put on the system of education (Dizon, 2009). Despite the endeavors of NMBA to ensure that all health institutions have enough nurses, still some have not met the required threshold (Australia, 2015). Daily, numerous literatures are discharged from different sources. Consequently, nurses need a lot of time daily to keep updated with present evidence. Unfortunately, due to this inadequacy of workforce, the nurses stay engrossed in their work for long hours, and this denies them a chance to stay abreast with the current evidence. Moreover, some health facilities in the country, especially in remote areas,are not endowed with the requisite facilities that are crucial for the implementation of this practice. Such incentives include a well-equipped library and internet connectivity. Furthermore, some institutions’ policies do not mandate nurses to alter the patient’s care procedure (Felice, 2014).
As aforementioned, sound education background, skills, professional and competency standards are crucial in the implementation and success of this core practice. Lack of these key aspects can pose as a barrier to its growth according to Vivian Coates’ finding on EBP utilization on diabetic patients (Schultz, Harmsen, & Spronk, 2010). Nurses did not understand the evidence behind administration of glucose when a diabetic has hypoglycemia. Failure of some nurses to comprehend and interpret statistical terms and the language used in research has been the core impediment in fishing out the valuable evidence glued in many kinds of literature. Moreover, wanting IT skills and searching expertise among nurses has deeply curtailed the sourcing of appropriate information to enhance better patient care. Furthermore, most nurses lack proper communication skills and this has hindered the mushrooming of the evidenced based practice. Coates concluded that more than 50% of the nurses did not document patient information in the standard way thus covering less details about diabetes. This is due to the inability of some nurses to clearly deliver the acquired evidence to patients (Emersion, 2015).
Consequently, for the sake of making this practice a success, Bergstrom strongly advocates that only thoroughly trained and people who have sound knowledge of the EBP principles to be involved in its championing and implementation (Bergstrom, 2008). This is based on a randomized controlled trial carried out in California which found that nursing trainers have less research knowledge (Bergstrom, 2008). Unfamiliarity with the principles of the evidence-based practice may result in its impartial utilization. Also, this practice requires that the nurse sorts and critiques the literature to acquire the best evidence that will result in high-quality service. Lack of training may lead to using inappropriate evidence in clinical practice that will jeopardize the patient’s safety and health (Emersion, 2015).
In conclusion, evidence-based practice is a life changing practice if properly executed. The Australian Health Practitioner Regulating Agency, The NMBA, and government should collaborate to see that all barriers to its success area averted. This includes proper training of nurses while incorporating its principles early in their career. Various randomized controlled trials and systematic reviews have presented evidence about the challenges that nurses have in EBP implementation.
References
Australia. (2015). Nursing in Australia. Canberra: A.G.P.
Bergstrom, N. (2008). The gap between discovery and practice implementation in evidence-based practice. International Journal Of Evidence-Based Healthcare, 6(2), 135-136. https://pt.wkhealth.com/pt/re/lwwgateway/landingpage.htm;jsessionid=YHnGvTPrRvbBTNY9Y5pFSLJNXQyt2xngSFM6ThYHTGjW9QJWnMgv!-1552860756!181195628!8091!-1?sid=WKPTLP:landingpage&an=01258363-200806000-00001
Dizon, J. (2009). A systematic review of the effectiveness of evidence based practice (EBP) educational programs in enhancing knowledge, skills, attitudes and behaviour of allied health practitioners. International Journal Of Evidence-Based Healthcare, 7(3), 207. https://pt.wkhealth.com/pt/re/lwwgateway/landingpage.htm;jsessionid=YHnpwhLWJ2F2hRk1xr6hmzqs2ymTt5nqy4bGL8y25PbxDkRpCl3Y!-1552860756!181195628!8091!-1?sid=WKPTLP:landingpage&an=01258363-200909000-00019
Emerson, T. S. (2014). Barriers to Evidence practice. Albany, state university of New York
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Fink, R., Thompson, C. J., & Bonnes, D. (2005). Overcoming barriers and promoting the use of Research in evidence-based practice. Journal of Nursing Administration, 35 (3), 121–129.
Glasziou, P. (2015). The paths from research to improved health outcomes. Evidence-Based Nursing, 8(2), 36-38. https://ebn.bmj.com/content/8/2/36
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Seers, K., Crichton, N., Martin, J., Coulson, K., & Carroll, D. (2008). A randomised controlled trial to assess the effectiveness of a single session of nurse administered massage for short term relief of chronic non-malignant pain. BMC Nurs, 7(1). https://bmcnurs.biomedcentral.com/articles/10.1186/1472-6955-7-10
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