Barriers to EBP
Introduction- Evidence-based practice (EBP) is a term that defines the conscientious usage of present finest evidences, with the aim of making critical decisions realted to patient care. In other words, EBP is a systematic approach that encompasses the critical analysis of most relevant and useful evidences for answering a clinical question that is under investigation. This process of EBP provides practitioners the ability to analyse and evaluate the research question, and other clinical guidelines that emphasise on high quality findings. These results are then applied to the medical practice (Hall & Roussel, 2016). Thus, the primary benefit of EBP is related to the fact that it entails decision making related to promotion of patient health, through the delivery of care services that integrate practitioner expertise and relevant findings. Owing to its potential in enhancing the health status among patients, EBP has recently been identified as a matter of priority in healthcare systems (Townsend & Morgan, 2017). Barriers to EBP generally occur at two levels namely, individual and organisational. While individual barriers encompass inadequate knowledge and lack of time management skills, organisational barriers are made up of patient factors, limited access to health facilities, leadership qualities, and updated technology. The thesis statement for the essay is:
Barriers to EBP- EBP has been found to be greatly dependant on a range of factors, apart from finding the evidence. These factors are responsible for influencing the extent to which the evidence gets translated directly into healthcare practice. Some of the barriers to the implementation of EBP are namely, (1) the ability to access and evaluate the collected evidences, (2) workplace culture, (3) Human Resources and Finances, (4) Clinical skills, (5) Values, expectations and concerns of the patient, and (6) Local environment (Laska, Gurman & Wampold, 2014). Introduction of EBP to clinical practice is largely dependent on the individuals who are in possession of the unique ability to locate and analyse the information that is relevant to the clinical question. Furthermore, introduction of EBP involves a great deal of change (Scurlock-Evans, Upton & Upton, 2014). There are a plethora of enables and barriers that are encountered on a regular basis, while attempts are taken for changing healthcare practice.
Individual barriers- Effective utilisation of evidence-based practice for healthcare related decision making is crucial in implementation of delivering care services that have already been proved effective by a thorough and rigorous appraisal of research results (Schmidt & Brown, 2014). However, the individual proficiency of the nursing professional is a major barrier in this process. Research findings have confirmed the fact that nursing professionals spent most of their time in activities that are related to direct or indirect patient care (Tucker, 2017). Hence, most nursing staff do not have adequate time to go to libraries and search for relevant evidences that can be implemented in practice. This can be attributed to the fact the boundaries of nursing practice are often blurred and are open to different interpretations in a range of circumstances (Gray et al., 2013). Thus, utilisation of EBP and its effective implementation by all staff nurses are a challenging task. Individual barriers also comprise of poor attitude and negative beliefs. Furthermore, a lack of awareness on research makes it difficult for the nursing professionals to gain a sound understanding of statistical terms, thereby creating difficulty in adjudging the quality of the research articles (Sadeghi?Bazargani, Tabrizi & Azami?Aghdash, 2014).
Individual barriers
Inadequate degree of familiarity of nurses with EBP also impedes the process of correctly defining the process (Khammarnia et al., 2015). There is mounting evidence for the fact that individual perceptions that all nursing staff hold for EBP play a crucial role in governing their clinical decision-making skills. Majority of the nurses have been found to report that they believe more on what they had been taught during the training programs and often trusted on traditional nursing practices, rather than EBP (Rodríguez-Soto et al., 2015). Frequency of the nurses in assessing relevant information is another barrier. Most of them access clinical evidences on an occasional basis, thus failing to effectively implement them. Additionally, lack of computer literacy, level of educational attainment and proficiency in English act as other individual barriers to EBP implementation.
Organisational barriers- In spite of the fact that nursing professionals form a major part of the clinical workforce, and are imperative in the delivery of healthcare services, there are a range of organisational factors that are perceived by the nurses as barriers to EBP implementation. Lack of authority for changing practice and unsupportive management and staff are some of the major organisational barriers (Lizarondo & McArthur, 2017). Management priority plays an essential role in governing the EBP owing to the fact that it considers several issues related to staffing, cost pressures, complaint responses, estate management, and meeting the targets of the Department of Health and the purchasers. EBP is an interdisciplinary practice. From the perspective of the operational management, the team members often get frustrated due to the continuous pressure imposed on them. Owing to the fact that the practice management groups (PMGs) are headed by non-nursing clinicians, the nursing staff are most commonly excluded from the clinical decision making process (Légaré & Witteman, 2013). There exist a lack of appropriate system to enhance personal and professional growth and development. Haphazard appraisals of the nursing staff in terms of quality and quantity also prevents them from participating in continuous education programs, thus creating major barriers in the application of EBP (Farokhzadian, Khajouei & Ahmadian, 2015). Leadership skills have also been identified as a critical element of EBP application.
Absence of strong nursing leadership prevents the staff from drawing on best evidences for disease prevention and health promotion. Thus, nursing administrators are the prime personnel who can facilitate a culture of EBP in a healthcare setting (Tacia et al., 2015). Lack of adequate support from the leaders/managers and insufficient resources also prevent the nurses from adopting EBP strategies. Other frequently encountered organisational barriers are a lack of human resource, absence of academic library with relevant nursing journals, no internet access at the workplace and huge workload. Huge workload commonly occurs due to shortage of nursing staff. Further features of the organisation that impede EBP implementation are that the administration often disallows the implementation, of which other staffs are not supportive. Physicians most often fail to show a cooperation during the implementation.
Organizational barriers
Strategies to implement EBP- In recognition of the necessity of integration of relevant research findings into nursing practice, a variety of strategies have been identified by the nursing faculty for assimilating concepts of EBP in their clinical practice. One of the major strategy is cultivating inquiry. EBP usually begins by fostering and encouraging a spirit of inquiry, in association with the healthcare domain. This promotes critical analysis and intellectual curiosity about the nursing g practice in different levels of the education. Owing to the fact that nursing undergraduates often have less exposure to real time clinical settings, they often ask different questions (Warren et al., 2016). Efforts taken by the nursing faculty to encourage such questions will foster the intellectual curiosity of the nursing graduates and provide them with the opportunity to think beyond their ideas of traditional medicines and therapies. This in turn would enable them to identify the benefits of alternative medications, in relation to patient scenarios. Teaching the nurses to frame their research question in the format of a PICO question is another effective strategy. This can be facilitated by formulation of a mnemonic that will describe the essential components of the clinical question. This in turn will allow the nurses to clarify the essential elements of the question being investigated. To effectively use clinical evidences and put them to practice, a strategic plan that encompasses appropriate communication, funding and collaboration is required (Yahui & Swaminathan, 2017). Educators often encounter a plethora of challenges and opportunities while teaching nursing students about EBP. Thus, fostering an excitement about the research and communicating its utility or applicability will help in growing a liking towards the subject. EBP must be incorporated across different nursing curriculum.
Furthermore, gaining access to relevant databases that will allow searching critical knowledge about the required evidences is crucial. Another critical strategy that can help in promoting use of clinical reasoning encompasses reflective analysis and -case-based pedagogies. Evaluating the skills of the nurses in relation to retrieval and evaluation of relevant research material for the presenting complaints of a client will also help in the implementation of EBP (Melnyk et al., 2014). Other useful strategies comprise of conducting small journal clubs and evidence-based projects. Formulation of an educational prescription will largely help in the identification of the clinical problem being investigated (Nixon et al., 2014). This can be attributed to the fact that educational prescriptions will allow PICO question development, searching for correct evidence, and promoting its applicability in practice. Assertively asking all the healthcare employers to create the provision of internet access in the workplace and gain subscriptions to different electronic databases that contain relevant articles on healthcare such as, PsycINFO, Medline, CINAHL will also help in the implementation procedure. Additionally, the nursing professionals and physicians should also join some professional organisations that provided training on use of EBP resources. Other implementation strategies should focus on the need of holding department or in-service meetings that will allow gaining a sound understanding of the ways by which nurses can investigate answers to clinical questions, while being a part of the group that comprises of members having different levels of clinical expertise and research (Schaffer, Sandau & Diedrick, 2013). Furthermore, clinicians should also take efforts to hold brainstorming sessions with the managers and peers regarding the ways by which clinical evidence can be appropriately documented and incorporated into nursing practice. These sessions will prove greatly beneficial in modification of protocols, use of electronic documentation, and appropriate toolkits. Ideal ways to facilitate EBP implementation would be to use a case study for demonstrating EBP values. Administrators and managers should support EBP by allotting adequate time and providing the necessary resources for access of the internet and library (Ubbink, Guyatt & Vermeulen, 2013). Creating provisions for clinical promotions and ladders that offer incentives or reimbursements will also encourage EBP practice. Incorporating functional outcomes and cost analyses in the research questions will prove effective in eliminating the organisational barriers. Further efforts can be associated with building a strategic time-plan for setting goals and implementing the changes.
Strategies to implement EBP
Conclusion
To conclude, the delivery of consistent and high-quality services in healthcare settings is a major challenge. EBP has rightly been defined as a problem-solving method that focuses on delivering patient-centred care in the best way. The primary aim of EBP is to enhance the quality of life of the patients, reduce healthcare costs, and promote professional development. However, there exist several barriers to the appropriate implementation of EBP in medicine. Most common individual barriers that are encountered in EBP are inadequate English proficiency, lack of adequate computer and internet literacy skills, and less time to read relevant scientific literature. Furthermore, certain organisational barriers are shortage of human resources (nursing staff), huge workload, no internet access at work, and inadequate access to nursing journals in the library. Thus, these aforementioned barriers can be reduced or eliminated by promoting an awareness of innovation strategies, creating an understanding, changing the practice, developing positive attitude to these changes, and integration of new practices into the daily healthcare routines.
References
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