Critical Analysis of Evidence-Based Practice - Literature review Example

Critical analysis of Evidence-Based Practice Evidence-Based Nursing is generally a kind of evidence-based medicine. It engages identifying solid research findings as well as implementing them ideally in nursing practices, sequentially to increase the patient care quality (Barnes 1999, p. 80: 280-285). The EBN goal is providing the highest quality as well as the most cost-efficient care possible. EBN is a process based on the interpretation, integration and collection of valid, applicable and fundamental research (Tiburi 2008, p. 185-191). Some describe EBN firmly, considering only the application of the research findings of randomized trials, while others also comprise the use of reports as well as expert opinions (Khoja 2002, p. 537-542). In practicing evidence-based nursing, practitioners should understand the research concept and know how to evaluate this research accurately. In summary, evidence-based practice is attributed commonly to the epidemiologist and physician Archie Cochrane who called for the maintenance, dissemination and preparation of systematic reviews in all the extensive fields of health care (Tiburi 2008, p. 185-191). EBP is "identifying, critically appraising and applying the best evidence in decisions making regarding the care of patients (Akobeng 2005, p. 837-840)”. In the recent times, there is all-purpose consensus that a wider definition of evidence-based practice must be considered that takes account of several forms of knowledge informing clinical practice (Nancy 2004, p. 6–10). For instance, Rycroft-Malone (2006, p. 95-108) reflects that evidence-based practice must encompass the inferred expertise of patients added to that of research and professionals - this move past taking account of preferences of patients to valuing the knowledge, which patients bring to the extensive nurse-patient interaction (Cooper 2003, p. 105-113). With the many definitions, at least in argument all have four steps in common namely (1) clearly identifying the problem or issue based on precise analysis of current practice and knowledge; (2) searching the literature for pertinent research; (3) evaluating the research evidence with the use of established criteria that regard scientific merit; and (4) choosing interventions and justifying the selection with the highly valid evidence (Tiburi 2008, p. 185-191). The first step is selecting a topic. Ideas come from diverse sources but are classified in two areas including Knowledge focused triggers and problem-focused triggers (Barnes 1999, p. 80: 280-285). In the process of topic selection, nurses must formulate questions, which are likely to acquire support from individuals within the organization. An interdisciplinary team must work together in coming up with an agreement regarding the topic selection (Akobeng 2005, p. 837-840). The priority of the selected topic must be considered including how severe the problem is. Knowledge focused triggers in creation are when health care staff listen to scientific papers, read research or encounter EBP guidelines done by organizations or federal agencies (Khoja 2002, p. 537-542). Knowledge based triggers must be new findings from research that enhances nursing further, or new practice guidelines (Rycroft-Malone 2006, p. 95-108). Generally, problem focused triggers are acknowledged by health care staff via quality improvement, financial data, benchmarking data, risk surveillance, or recurrent clinical problems. In this case, Hand hygiene is the topic selected. This is an approach as problem-focused triggers with the main problem being contagious diseases mounting from the laxity behavior of people not washing their hands. The other step is generally forming a team to work on the same. This might include the forming of a medical team to handle the problem arising from the behavior of not washing hands. Some might be snowed under when they find out first regarding EBP and applying the same for ideal reasons except patient care improvement (Tiburi 2008, p. 185-191). Forming a team augments the chance of EBP adoption (Rycroft-Malone 2006, p. 95-108). A team becomes dominant in implementation, as well as evaluation of the EBP. It is critical to have representatives of the developed team from authority members of the ideal organization as well as grassroots members (Akobeng 2005, p. 837-840). A third step includes evidence retrieval. In this case, it is evidence for the contagious disease surveillance emanating from diseases for not washing hands. One of the highly challenging issues in using Evidence Based Practice in the clinical setting is to learn how to frame a clinical question adequately so that an appropriate review of literature can be performed (Barnes 1999, p. 80: 280-285). In the formation, of a clinical question you should included among others the disease or disorder of the patient, the finding or intervention being reviewed, perhaps an assessment intervention, as well as the outcome (Tiburi 2008, p. 185-191). An acronym is commonly in use to remember normally called the "PICO" model. The P stands for who is the Patient Population is in this case being the population where the contagious diseases is under surveillance. I stand for what is the potential Intervention or relatively the area of Interest. In this case, it represents the intervention for how to handle the contagious disease spread (Akobeng 2005, p. 837-840). C stands for a Comparison intervention or relatively Control group. This is the sample population in the community that is not affected by the contagious disease resulting from washing hands. O is the desired Outcome in this case being reducing the contagious diseases and improving the behavior of people in accepting washing of hands. Applying the Evidence is the other step. After the determination of the external and internal validity of the research study, a decision is made at whether the data gathered does apply to the initial question. It is critical to address questions that relate to therapy, harm, diagnosis and prognosis (Barnes 1999, p. 80: 280-285). The data gathered should be interpreted as per to many criteria and must always be shared with respective nurses and/or other researchers. In the application, in this context, the evidence of contagious diseases is applied to come up with the better solution. The EBP benefits are well demonstrated and described in the international literature. Therefore, most managers in the modern days in the health system are demanding a practitioner approach, which explicitly pursues and values practice based on ideal evidence of appropriateness, meaningfulness, feasibility, cost effectiveness and clinical effectiveness (Tiburi 2008, p. 185-191). O'Rourke (1998) believes that Evaluation Based Practice is a way of keeping patients safe from futile and at times dangerous interventions as well as in maximizing limited resources. Crane (1995) reflected that, if EBP is entrenched in practice, the ideal, available information (derived from appropriate quality research) will advance practice, reduce inconsistency in practice and progress the care delivery cost effectiveness. Modern demand is for health care interventions, which demonstrate dependability that is, for practice that has been established to reliably and positively effect desired health, economic and social outcomes (Akobeng 2005, p. 837-840). The increased development of health and medical science over the past fifty years has practically led to a considerable growth in knowledge. Because of this, development in the range of knowledge and interventions available to assist professionals of health in their clinical decision-making is exceptional. This mushrooming of knowledge has not, though, led to an augment of its accessibility to clinical practitioners (Barnes 1999, p. 80: 280-285). The need to insert evidence in clinical settings is now taken as a significant challenge for service professionals in the health medicine. The nursing profession has taken up the model of EBP taken to be as evidence-based nursing (EBN) (Tiburi 2008, p. 185-191). The EBP development in nursing, including the research utilization, has developed an extensive deal of interest in the profession of nursing during the most recent decade (Mullen and Bellamy 2008, p. 325-338). Studies have demonstrated consistently that nurses are more and more recognizing the research role and EBP in their practice on a daily basis (Akobeng 2005, p. 837-840). In spite of this recognition, the definite application of Evidence Based, Practice is not established widely in nursing practice (Tiburi 2008, p. 185-191). Development of professional status and policy over the past 15 years has positioned unprecedented pressure on professionals to be more responsible for their actions. In addition, they are expected to practice increasingly under a system of health care, which embraces the EBP ideals (Barnes 1999, p. 80: 280-285). Rycroft-Malone (2006, p. 95-108) reflects that, as more information is generated via new information and research is transmitted through the media, for instance the direct broadcast or Internet, professionals in nursing will come under pressure to show that they are side by side of current knowledge (Hall berg 2003, p. 3-22). It will be predictable that they show signs of this newly obtain knowledge via delivering services that are in line with the rigorous and most recent evidence. As similar perceptions of EBP are shared between diverse health care professions, the respective nurses have come to utilize the terms evidence-based practice to describe their ideal practice (Akobeng 2005, p. 837-840). Even though, the idea of EBP has been approved as critical for professional nursing practice, the ideal application is not widespread (Tiburi 2008, p. 185-191). However, there are factors that impede the active participation of nurses in evidence based practice (Rycroft-Malone 2006, p. 95-108). To date research study, which regards perceived barriers and nurses' attitudes to the adoption of EBP in respective hospitals has been predominantly conducted across the globe (Murray and Coleman 2005, p. 912-916). Additionally, there is inadequate literature existing, which explores this subject in inhabited aged care facilities (RACFs), chiefly nursing homes, across the globe (Akobeng 2005, p. 837-840). Studies directed towards the explanation of why EBP has not been adopted widely in nursing have acknowledged three main factors including the attributes of individuals, for instance attitudes towards research as well as lack of adequate research knowledge; organizational context, that includes lack of ease of access to research findings, inadequate time, inadequate support from others as well as lack of authority; and the research nature that includes the gap between practice and research and the intricacy of the research articles presentation (Tiburi 2008, p. 185-191). For the individual attributes, it has been a significant barrier to the participation of nurses in Evidence Based Practice. The individual attitudes holds towards research have been recognized as the foremost attributes of the individual in barriers to implementation of the EBP (Barnes 1999, p. 80: 280-285). Theorists have recognized attitudinal variables as critical predictors of individual behaviour (Akobeng 2005, p. 837-840). For instance, Bowie (1981) had a belief those nurses' unenthusiastic attitudes towards research, which is presented as a barrier to its implementation in ideal clinical settings (Rycroft-Malone 2006, p. 95-108). There has also been extensive debate that regards to individual characteristics and the environment at the workplace in influencing individual attitudes toward EBP (Barnes 1999, p. 80: 280-285). A lack of ideal research knowledge has also been acknowledged as an individual attribute, which creates an ideal barrier to the EBP implementation (McQueen 2001, p. 1536-1546). Negative attitudes with regard to research together with its insight as a low-priority factor are cited frequently as attitudinal barriers to implementation of the same (Lacey, 1994). Lack of research knowledge is also profoundly a barrier to the participation of nurses in Evidence Based Practice. The references made to nurses' inadequacy of knowledge show the deficit of skills and knowledge to conduct research that is an enormous barrier to the lack of EBP implementation (Barnes 1999, p. 80: 280-285). A large number of research studies have exposed that nurse’ inadequacy in knowledge as well as the confidence to conduct research or apply the findings in practice with a study of 765 nurses from a hospital in the UK revealing that only 40.5% of the nurses understood the term EBP and 68.9 % having only a basic knowledge of the process (Tiburi 2008, p. 185-191). Conversely, there are arguments that organizational context pose as a huge barrier to participation of nurses in Evidence Based Practice (Rycroft-Malone 2006, p. 95-108). Conclusion EBP is generally identifying, critically appraising and applying the best evidence in decisions making regarding the care of patients. In this case, Hand hygiene has been outlined with the advantages of participation of nurses in this case being, understanding the community more, easy handing of the treatment and educating on preventative measures among others. However, the nurses face barriers including the inadequate knowledge on research, time constrains and the rigid organization structure. References Akobeng, K 2005, Principles of evidence based medicine, Archives of Disease in Childhood, 90: 837-840 Barnes, J 1999, Evidence based medicine and evaluation of mental health services: methodological issues and future directions, Archives of Disease in Childhood, 80: 280-285 Cooper, B 2003, Evidence-based mental health policy: a critical appraisal, British Journal of Psychiatry, 183: 105-113 Hall berg, I 2003, Evidence-Based Nursing, Interventions, and Family Nursing: Methodological Obstacles and Possibilities, Journal of Family Nursing, 9: 3-22 Khoja, T 2002, the place of evidence-based medicine among primary health care physicians in Riyadh region, Saudi Arabia, Family Practice, 19: 537-542 McQueen, M 2001, Overview of Evidence-based Medicine: Challenges for Evidence-based Laboratory Medicine, Clinical Chemistry, 47: 1536-1546 Mullen, E. and Bellamy, J 2008, Implementing Evidence-Based Social Work Practice, Research on Social Work Practice, 18: 325-338 Murray, I. and Coleman, S 2005, how evidence based is the management of two common sports injuries in a sports injury clinic? Commentary, British Journal of Sports Medicine, 39: 912-916 Nancy, 2004, Global Health Issues and Challenges, Journal of Nursing Scholarship 36 (1), 6–10 Rycroft-Malone, J 2006, the politics of the evidence based practice movements: Legacies and current challenges, Journal of Research in Nursing, 11: 95-108 Tiburi, M 2008, Evidence-based medicine as viewed by key decision-makers of health plans in southern Brazil, Health Services Management Research, 21: 185-191 Read More