Implementation of Evidence Based Practice (EBP) Challenges
With growth in research, there has been great changed experienced in the healthcare setting. The new environment in provision of healthcare has been modeled to cope with the ever changing nature of diseases and social life. New medical practitioners are facing great challenges as they transit from class to evidence based practices, which define new trend in nursing. Evidence-based practices environment is poising great challenges not only to new nurses but also to experienced nurse (Melynk, 2002). The new practice require nurses to apply clinical evidence to clients situations through the use of clinical judgment and considering the client values ant eh resources available in the healthcare system. The practice environment for nurses has greatly changed with the changing and increased focus on the evidence-based practice. Evidence based practice can be defined as well calculated, conscious and explicit employment of current evidence in the decision making process when providing care to individual patients. Evidence-based practice (EBP) is therefore understood to be a decision making approach through which clinicians tend to use best evidence available and also consult with patients to come up with best care option which suits the conditions of the patient (Ferguson and Day, 2007). In nursing, this approach has been emphasized but there is a great focus on participation of the client, the clinical judgment, and the resources available in the healthcare system. In the current environment where healthcare system is becoming more cost conscious, healthcare practitioners have to make rational decision. However, there are many challenges that are facing the implementation of this system especially for the new nurses who have not gained enough experience.
In light of the growing importance of evidence-based practice in healthcare provision, this paper looks into the importance of the evidence based practices in the new healthcare market. The paper will also focus on the challenges that have been encountered in strive to adapt evidence based practice.
Significance of evidence based practiced
Evidence-based practice has greatly changed the landscape of healthcare provision. It has made it possible for health care providers to use the best practices that have been greatly research in details while handling their patients. Evidence-based practice puts the client value at the center of the health care practices making sure that clients have a contribution to their healthcare. This is in the sense that EBP ensure that client values and practices are considered while providing healthcare (Ferguson and Day, 2007). This creates a patient-centered healthcare system in which patient preference, needs and values acts as guide to all clinical decision made by healthcare providers.
Clinical judgment is at the center of provision of healthcare. It is a critical aspect in EBP which is used to health nurses and other healthcare practitioners to make the best appropriate clinical decision that will result to least health effects on the patient. EBP decision making process need to be based on rational technical knowledge, best identified and researched practices, and patient contribution (Gerrish et al., 2007). EBP assist medical care practitioners to make the most appropriate clinical decision that takes care of all the above aspects. Therefore evidence-based practice is all about assisting healthcare providers to give the utmost best care that will assist patients to recover in the shortest time possible. It creates a consultative and involving process in which nurses make decision based on the best practice and client contribution.
Challenges of implementing evidence based practice
There have been reports of substantial improvement in health outcome for patients who are treated through evidence based practices. Well designed studies have shown that improved patient outcomes are more likely to be realized when nurses use research evidence in handling patients. However, there are many impediments which have made it difficult to implement EBP in healthcare settings especially for novice medical practitioners. There are many nurses who are struggling to implement EBP in their practice due to a number of reasons. There are eight factors that have been cited as impediments in implementation of EBP.
One of the greatest challenges facing implementation of EBP is lack of knowledge on use of evidence based practices. It has been shown that most nurses do not have enough knowledge to integrate research findings in their practices. Research findings shows that there is little evidence that shows that most nurses, especially novice nurses have knowledge on the implementation of EBP in their practices (Paramonczynk, 2005). A study by Bonner and Sandon (2008) that sought to examine the knowledge, attitude and nurses use of research found out that there was variance in EBP knowledge among nurse. The study concluded that in order to overcome knowledge barrier, nurses need to have specific research education, leadership and enabling work environment to effectively implement EBP in their practices.
The second factor that has been identified as a barrier to implementation of EBP is misperception and negative attitudes on research and evidence based practices. Most nurses have a negative attitude towards research and do not understand what entails EBP. This problem has persisted especially in old nurses due to fear of change of what can be identified as ‘practice culture’. It is a fear for change. However, a study by Bonner and Sandon (2008) found out that senior nurses were likely to have positive attitude towards research and implementation of EBP compared to younger nurses. In this study, only 44% of the nurses showed positive view of research and willingness to undertake extensive research.
The third factor inhibiting implementation of EBP is lack of knowledge on how to carry out search and appraise best practices (Tagney and Haines, 2009, p. 488). There has been identified problem on the knowledge of nurses on how to carry out research. It has been identified that three factors which determine nurse utilization of research include individual characteristics of nurse, characteristics of the organizations, and environmental characteristics. Most nurses are not well equipped to carry out research which leads to effective practice of EBP (Bonner and Sandon, 2008). In Bonner and Sandon (2008), it was found out that while 58.9% of the participants had gone through a research unit in their study, only a dismal 14.5% showed a good understanding of research design and only 10.8% understood statistics and date interpretation (p. 340). In this study, 36.3% identified lacks of skills as a barrier to implementation of EBP.
The fourth factor that has inhibited EBP is the overload of nursing work that leaves them with no time to carry out research (Tagney and Haines, 2009, p. 488). With increased shortage in nursing and in other areas of medical care, workload has become a major problem not only in implementation of EBP but also in provision of general healthcare. In a study by Bonner and Sandon (2008) lack of enough time to carry out the study, which emanates from work overload was identified as the third highest barrier (44.9%) after resources (55.2%) and support from peers (49.7%). With overload of works, nurses have not time to carry out research.
The fifth factor is constraints within the organization. For one to carry out extensive research there must be resources. There has to be adequate nursing journals, books, internet, and other resources with credible research findings. In Bonner and Sandon (2008) study, 55.2% identified resource constraint as one of the barriers to implementation of EBP which ranks it higher above all other constraints.
The sixth barrier is contradictory patients’ expectations. For example there are some patients who may demand to be given antibiotics for upper respiratory infection which may not be indicated in their physician’s prescription. Most patients who come to seek healthcare services come with preconceived ideas about the prescription they will received which has been contributed by wide scale dissemination of inaccurate medical information. Most nurses therefore feel they are not doing the right thing or simply avoid creating scenes with patients and hence restrain from implementing EBP.
The seventh factor is the fear for one to have different practice from what other nurses or medical peers are practicing which directly emanates from organizational culture (Tagney and Haines, 2009, p. 488). Most nurses have found out when they join a health care facility, there is culture of care that has been carried over. Nurses will therefore fear implementation EBP as it may deviate from the normal practices. Therefore lack of support from peers, as was demonstrated in Bonner and Sandon (2008) study is the second largest barrier identified by 29.7% of the nurse.
The eighth and last factor is large amount of information that can be found in nursing journals and books which sometimes may be confusing to practitioners. There is a large amount of information from different research findings and some of the information has been found to be inaccurate and hence confusing to most nurses. Nurses therefore find it difficult to identify the correct information to use in EBP.