Evidence Based Practice
Quality and patient-centered medical and nursing practice is depended on a combination practice knowledge and expertise, critical thinking and evidence-based practice. Due to the shift of medical practice from a patient care system to patient as customer service model, the need for quality, affordable and efficient clinical practice has made the use of evidence based practice a basic requirement in hospitals during nursing and medical procedures (Melnyk & Fineout-Overholt, 2010). Evidence based practice incorporates research and empirical outcomes that support quality health care delivery in departments of nursing, medical, physiotherapy and nutrition. Evidence Based Practice have been applied in the nursing profession in an attempt to improve the healthcare delivery. However, there are various challenges that are often faced during the process of applying evidence based practice in the ICU. Therefore, the essay will discuss some of these challenges that hinder the implementation of EBP and the strategies that can be employed to overcome them to ensure quality service delivery is achieved.
According to Whitehead, LoBiondo & Haber (2012), clinical and nursing decision making processes should rely on empirical evidence as generated by methodical research processes that support he evidence based practice model of health care. From the experience in practice, evidence-based practice is essential. For example, development and adoption of direct observation of urinary catheter insertion, where the procedure is recommended-using best evidence to reduce the rates of nosocomial urinary tract infections in Intensive care unit patients, requires the availability of two nursing professionals where one is doing the procedure while the other is observing to ensure satisfaction of the endorsed aseptic techniques (Biggs, 2017).
The implementation of evidence based practice in nursing and medical care provision has been faced by multiple barriers and challenges relating to the four pillars of principles guiding the sources of evidence that are patient prevalence, organizational factors, scientific literature and professional expertise (Wilson, Sleutel& Newcomb, 2015).
The greatest barrier of evidence based practice is the behavior of nurses with regard to research utilization. In most cases, nurses lack the authority to change the patient care procedure which may result from low levels of hierarchy and age. The nurses also have a tendency of consulting colleagues who in most cases have inadequate knowledge on the latest and best evidence based practice. Isolation from knowledgeable colleagues, unclear implications of the practice and insufficient facilities are the reasons that contribute to the behavior of nurses (Oranta, 2002). According to Stavor, Zeddreck-Gonzalez and Hoffmann (2017), nurses need sufficient information on the evidence-based practices in order to fully implement and adopt the practice. To address this challenge, health providers such as the government, hospitals and community-based organizations need to provide the intensive care specialists with sufficient information through education on the most suitable evidence-based practice through offering training, lecturers, tutorials, continuous medical education (CMEs) programs and Grand rounds to disseminate knowledgeto encourage the utilization of the latest recommended evidence based practices (Dang and Dearholt, 2017).
Barriers and facilitators of evidence based practice
Secondly, even though the information on latest and current practices can be accessed online, the nurses may not have enough time, skills or technology to find the information for purposes of learning, comparison or confirmation (Wilson, Sleutel and Newcomb, 2015). This is provided for by availability of smartphones, tablets, computers and internet services to enable online, real time access to the best recommended forms of care in the ICU. With little time due to emergency procedures, inadequate information on the best scientific e-libraries such as Pub-Med and unavailability of cheap, fast and reliable internet, access to the online data is hindered, severely. The recommended remedy to this challenge is that the hospitals and health care organizations should provide computers connected to the internet with direct links to subscribe online libraries to the nursing stations to encourage continuous medical education for better patient management through evidence-based practice (Stavor, Zeddreck-Gonzalez and Hoffmann 2017).
Besides, misconception on research utilization is another barrier that affects evidence based practice. Some of the misconceptions among the health care providers state that evidence based practice are beyond clinician experience and expertise and they are only about numbers and figures (Stokke, Olsen and Espehaug, 2014). In order to address these challenges, Wilson, Sleutel and Newcomb (2015) suggest that organization systems need to develop guidelines that would support clinical decision making processes based on the evidence based practices available. Such guidelines should be enforced through staff and medical handbooks, notice-board reminders and wall charts.
Moreover, the barriers to the implementation of evidence-based practice are lack of sufficient human resources and inadequate work load responsibility shouldered by the few nurses available at the individual work stations. Varaei, Salsali and Cheraghi (2013) reported that the shortage of human resources was a huge hindrance to adoption of evidence based approach to nursing care. The increased workload therefore denied the nurses the time to consult online journals or offline libraries to collect evidence for best care. In regard to the issues, organizational support should increase the number of nurses and provide easily accessible libraries to the nurses at their work stations through reliable internet connections or handbooks.
Some challenges are clinical set and organizational generated (Melnyk, Gallagher-Ford and Long 2014). These barriers are due to the cultures, less or no tools that support evidence based practice and supervision failure. Despite of medical and nursing professionals being trained on the use and interpretation of scientific literature on evidence based practice, their knowledge is not reinforced through supervision in the hospital environment (Rindal, Rush and Boyle, 2008). Hence, the nurses use the most convenient practices to manage the patients without observing the standards encouraged by the EBP. Health systems need to provide stringent measures and supervision to encourage the adoption of the evidence-based nursing practices in the ICU. Such measures include departmentalization of functions into small manageable units with assigned nurses in charge, a proper reward-punishment mechanism for good/bad practices and surveillance.
Behavior of Nurses
Furthermore, the medical and nursing environments are conservative fields that are too slow to adapt to new changes due to the patient safety theories. The slow adaptation makes implementation of evidence based practice difficult in hospital settings. Although the barriers and challenges to implementation of evidence based practice are identified, the reinforcement from the health care organizations remains weak (Saunders and Vehvilainen-Julkunen, 2016). Additionally, previous research on challenges of implementing evidence based practice was basically based on opinions instead of empirical study and therefore serious problems affecting the implementation process are a priority in future researches.
According to Farokhzadian and Khajouei (2015), the most downplayed but serious task in implementing evidence based nursing practice is judging and little or no trust in the quality of the research papers and academic journals. Provider satisfaction and trust need to be achieved through quality research and dissemination of reports through tutorials, lectures and conferences. Furthermore, the nurses in the different institutions should be encouraged to participate in the clinical researches to acquire primary knowledge on the advantages of evidence-based practices over the traditional practices. Regarding this, it is hence obligatory to equip the nurses with knowledge and skills for evidence-based practice (Farokhzadian and Khajouei 2015).
Changes all through the system are required to encourage the nursing and medical professionals to design procedure plans based on the up-to-date scientific evidence to reduce nosocomial infections transmission, morbidity and mortality. Described challenges are however, based on opinions, beliefs and myths rather than empirical research knowledge on the evidences supporting the new health care practice of direct observation.
In their participatory research, Friesen-Storms & Moser (2015), these barriers apply to all the medical and nursing practices such as intravenous lines insertion, vitals monitoring and patient care. Regarding this article and clinical experience based on evidence based practice; health care organizations need to ensure effective and widespread translation-use of scientific knowledge to design and implement evidence based practice guidelines (Hall &Roussel, 2016). This process would involve development of guidelines specific to each evidence based practice process, dissemination of information on the outcome to service providers to fill knowledge gaps regarding the effective interventions and encourage adoption and commitment by the clinical providers to practice evidence-based practices such as direct observation of catheter insertion, infection control through hygiene, protective clothing, hand washing and correct oxygen use in COPD and asthma patients(Harvey &Kitson, 2015).
Conclusion
From this paper, it is can be concluded that nurses and health care professional are not familiar with evidence based practice in ICU. As much as the hospital has information resources, few nurses have participated in research. This shows that they have insufficient time to research and implement new ideas. The behavior of nurses is also among the barriers that have affected evidence based practice. As much as nurses have no appropriate research skills to support the role of their profession, to update themselves they should integrate evidence based practice in their activities. Administrators should support nurses by permitting them to learn skills related to evidence based practice by providing bibliographic databases that will help them to learn how to critically evaluate research studies. On the hand, nurses should also be given time to be informed with the current research during work hours. Ultimately, evidence based practice is a new field for clinicians and nurses and therefore there is need to evaluate the best strategies that can used for its implementation.
Access to Information
References
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