The Administration and Top Level Management in the Promoting Effective Evidence-Based Practice - Essay Example

Evidence Based Practice in Nursing Lecturer Evidence Based Practice in Nursing Introduction This report is on Evidence Based Practice with focus being on the study of the role of the Acute Care Unit in the provision of quality care to the elderly. The main reason for the selected topic is due to the continued increased acute care demand among the elderly and the continued need for the increase in the number of Acute Care for the Elderly Units to allow for the provision of specialized quality care for this group of patients (Jaipaul & Rosenthal, 2009; British Geriatric Society, 2012). With geriatric care being a key area of interest for me, focusing on this topic and conducting an Evidence Based Study on it will help me gain more knowledge and understanding on an area that I would like to further venture in. Reviewing the various studies related to this topic will be an effective way through which I will be able to through acquire up to date information on the selected study area, and to further enhance my ability to promote quality health care among the elderly as well as to enhance patient satisfaction (Bastin, 2009). According to Sacket et al. (2007), the professional practice of nursing through the use of obtained evidence through EBP has been found to improve patient care and provision of health services as compared to the convectional nursing practices. Through EBP, nurses are getting to actively take a role in the process of medical decision as they are able to make use of the most efficient and relevant information obtained through research to decide on the right course of action (Mantzoukas, 2007) This report will also appraise and critic the evidence or research studies available on the selected topic of study. Evidence-based practice Evidence Based Practice has been defined as a means through which clinical problems and questions are solved through the use of up to date evidence in addition to ones professional skills and proficiency as well as through the incorporation of nursing ethics and patient needs (Melnyk & Fineout-Overhault, 2010; Pierson & Schelke, 2009). EBP is based on the view that the development of clinical practices should be done with regard to the existing and most current evidence or facts, theory as well as research. The continuous transformation in the medical sector as well as the day to developments calls for more research to be done. The information collected through the conducted researches serves as evidence to use in practice. EBP is in this case aimed at enhancing the quality and adequacy of health care delivery and practice (Snyder, 2007). The information collected through EBP serves a huge role in implementing changes successfully. EBP allows nurses to make use of scientific researches to deliver quality health services and patient care that is not only beneficial to individual patients, but to the community as a whole (Majid et al., 2011). According to Fawcett & Garity (2009), Evidence Based Practice is a complete turn from the convectional nursing practice, and has been proven to promote a more improved client satisfaction as compared to the convectional approaches. Additionally, the modern approach to nursing plays a significant role in ensuring that nurses are able to take an active role in the making of clinical decisions through the use obtained information through reviewed researches (Munroe, Duffy & Fisher, 2008). Though EBP has be found to be a key means of promoting improved health care, the practice has not been successfully adopted by many nurses. A number of barriers to the successful implementation of this practice have been identified by different researchers. The barriers include the lack of sufficient time for nurses to undertake their expected roles and get engaged in evidence based research, the high number of health related literature that makes it difficult for the nurses to keep up with the most recent publications and the nurses’ lack of sufficient power to implement clinical changes (Manzoukas, 2007; OConnor& Pettigrew, 2009; Mclnerney P, Suleman, 2010; Solomons & Spross, 2010; Munroe, Duffy & Fisher, 2008). Locating and Appraising Evidence This part of the report describes the process through which the most appropriate and relevant literature for the study identified and collected. The process included undertaking an e search. All of the resources obtained for this study were gotten through an online search. The search strategy for this appraisal was done based on the selected research topic which was to assess the role of the Acute Care Unit in the provision of quality care to the elderly as is recommended by (Guyatt & AMA, 2008). The systematic review was done using primary and secondary sources. Primary sources are the literatures containing first hand information of the undertaken research. The use of these sources allows for original information to be collected. The systematic process of searching for the relevant literature was done using various databases that included the Pubmed database, Cochrane Library and the British Nursing Index. The search of the various literature online was preferred over the manual search because it is faster, allows one to get many different publications/ literature that may not be physically available in a particular library, and because the method is wide spread and all inclusive. The method has also been described as being a more organized technique of identifying and accessing the right literature (Larrabee, 2009). The keywords selected for use in the search were; Elder care, acute care, acute care unit, quality care and acute care for the elderly. The selection of these key words was based on what would bring out the most relevant literature to the topic of study. According to Williamson (2009) the selected keywords during critical appraisal should be based on the main research question and topic. The search was narrowed down to publications not older than five years; hence, all the selected sources were between the years 2007 to 2013. The selected number of years was to ensure that only the most up to date information was obtained, as well as to reduce the number of sources from which the most relevant. After collecting the relevant literature from the e-search the next main thing was to identify which of the collected publications were actual research projects and which ones were not. This was done through the reading of the abstract which in most cases provides actual information on whether the research is a real study or not. According to Huett & MacMillan (2011) the abstract in any given report will always give the statement problem, which will help in identifying if the study is real. Actual studies will also always include an abstract that briefly describes the study objectives, methodology used, findings obtained and the conclusion (Melnyk & Fineout-OverHolt, 2010; Sanders & DelMar, 2007). The final result yielded about 40 articles through which all the relevant evidence would be easily collected through a deep exploration and analysis of each of the collected source. The selected critiquing tool for this appraisal was the Critical Appraisal Skills Program (CASP). The selected tool is easy to use as it provides a checklist through which the most efficient evidence and information can be obtained and interpreted during a critical appraisal process (CASP, 2012). Findings – General overview The search for the various literatures produced both empirical and non empirical researches. The main results of the searches conducted produced both research and non research papers. Because this research study required the use of actual research papers, the research papers were identified by reading through the abstract and also having a brief and quick overview over the report. The research design used for the various researches varied from one research to the other. The selected research studies varied in terms of the research techniques; some were quantitative, others qualitative, while others also combined both the methods of research. Most of the selected papers were however qualitative. Data collected in the different research studies was both from primary and secondary sources with the most rampant sources being primary. With most data being primary, then the information obtained was first hand and of importance in the construction of robust evidence. Primary research studies are identified as being rich in terms of providing quality clinical evidence, with systematic reviews being rated the least in the hierarchy of the quality of medical evidence obtained (Bahati, Guy & Gwadry-Sridhar, 2010). With regard to the selected topic; identifying the role of Acute Care Units in the provision of quality care to the elderly, most of the studies sought to answer the questions of how effective the Acute Care Units are in providing quality care to the elderly patients and on the level of patient satisfaction with regard to the care provided. From the findings obtained and on the basis of the main questions raised by the research studies, there is need for improvement of the quality of care provided in the Acute Care Units especially in the UK, with elderly reporting less satisfaction in the various services and level of care provided. According to the findings, acute care units reduced the number of admission days in hospitals as well as the costs of acquiring treatment, but the quality of services provided in the general care of the patients, during their stay at the units was wanting. The first search produced 116 hits. These entailed different publications from different regions. At the first search most of the researches obtained were non UK with most of them being from the USA. Accessing more UK sources was done by keying in the words UK to the main key words. The keying in of UK, to allow for sources from the UK produced 81 results. The various publications included, clinical guidelines, text books, websites, reports and journal articles that contained information related to the key words keyed in. The results obtained were further reduced to about 60. The elimination criteria at this point entailed identifying the peer reviewed journals and scholarly books that would be used for the research. All the selected articles were in the English language. The most relevant and most rich sources of information included journal articles that contained undertaken research studies related to the topic. Scholarly books were also another rich source of information. The selected materials for this particular appraisal were mainly peer reviewed articles. The evidence obtained from the various sources can be said to be valid and strong, hence, beneficial to geriatric care especially with regard to acute care. The use of peer reviewed articles is one way through which the evidence can be said to be useful as it is from academic sources. The objectives in many of the researches obtained were clear precise and the findings made were based on them. The selected sources for this review as mentioned earlier on entailed those not older than five years. This means that only the most recent publications were used, hence the results of these studies are applicable in the current clinical practice, and can be used to answer arising clinical problems today. Findings – review of a single research report This part of the report is a review on a UK based research study by Bridges, Flatley & Meyer (2010). The research topic for this study was, Older People’s And Relatives’ Experiences In Acute Care Settings: Systematic review and synthesis of qualitative studies. With regard to the clarity and appropriateness of the set objectives and aims, the authors clearly state the objectives both in the abstract and in the introduction of the paper. The researchers identify the main objective of the study as being; ‘To explore older people’s and their relatives’ views on and experiences of acute health care’. The objective is clear, brief and in line with the research topic as is recommended by Kothari (2009).This makes up a key success factor in the research study (Farrugia et al., 2010). The study, however, only presents one objective to guide the research process a factor which may serve as a weakness of the study. A successful research study requires that the researcher formulate a main objective and specific objectives through which the research process is to be undertaken. The general objective of research projects identifies what researchers expect to achieve by the end of the research (Babbie & Benaquisto, 2009). Specific objectives are the small parts of the general objective. These are important as they procedurally address the various research questions and specify what will be expected by the end of the project (Kothari, 2009). With regard to the research design, the research study made use of systematic reviews. The focus was on qualitative researches. The review was made up of 42 primary research projects and 1 secondary study. The authors made use of comparative thematic models to analyse the data collected. The choice of a systematic review is stronghold considering that there are no identified research studies related to acute care that have taken this approach in the UK. Systematic reviews have however been identified as not being a rich source of evidence for clinical practice (Bridges, Flatley & Meyer, 2010). Despite describing the research design used, the authors do not give a justification for the choice of design. They do not give a reason for the selection of their data collection and analysis method, an aspect that is important in the formulation of any given research project. This has, however, been found to be a common trend in the case of qualitative studies. The selection of 42 primary studies was an effective way of promoting the collection first hand information. In the sampling procedure, the authors describe how they acquired their various literatures with this being a systematic review. The collection of the relevant literature was done through both online and hand searches, with the main source databases being the British Nursing Index, CINAHL, Medline among others. The researchers focused on publications between 1999 and 2008. This was for the reason that research would be used to update the National UK guidelines whose publication was between the year 1997 to 2000 (Bridges, Flatley & Meyer, 2010). This was an effective of not only promoting relevance, but also of ensuring that evidence collected was up to date and could be used to solve the most recent problems . The identified researches for review were those that were qualitative in that they used face to face interviews and open ended as well as semi structured questionnaires. The authors again fail to give a justification for the choice of the search techniques as well as the databases selected. As another weakness, the authors do not mention the key words for the search process. The analysis and findings section of the research have been clearly presented. According the findings the elderly patients were found to disregard the quality and value of provided technical care. The elderly were found to belittle themselves and view themselves as worthless to take charge of any situation. The research identified the creation of communities, promoting a sense of identity among the elderly and shared making of decisions as the 3 main ways through which the negativity can be dealt away with. The authors identify their main gap in the research as the failure to include the experiences of nurses in acute care for the elderly. This would have been an important aspect in the promotion of a relationship based model, which looks out for the best interest of both the patients and the nurse or health care giver as well. There is, therefore, need for further studies to focus on the experiences of nurses in the provision of cute care to the elderly. Can this evidence inform practice? The uptake of the evidence obtained from the above critique is one that will be highly beneficial in the improvement of the quality of health in acute care units and in the provision of service delivery to the elderly. The evidence is an excellent means through which patient satisfaction among the elderly patients receiving acute care can be increased. There is however barriers to the successful implementation of evidence based practice and that may, therefore, pose as a great challenge to the effective adoption of the obtained evidence. The one common barrier that has been described by many researchers as being a key challenge to EBP implementation is the aspect of time. Nurses have reported to have very tight schedules, with so much to do at work, and little free time on which they can venture into EBP. According to findings obtained, most of the time during the day is spent attending to patients and other hospital duties, with any free hours being spent on family and personal responsibilities (Thompson et al., 2009). Another reported major challenge is that a high number of the nurses lack the efficient knowledge to be able to effectively undertake an EBP. The nurses lack knowledge on how to search and analyse the right reports and on how they would access information to promote change in the nursing profession (Bertulis, 2008). Another huge barrier to effective EBP adoption by nurses is the lack of enough support from the administration and top authority. Nurses have reported have problems in terms of mentoring as well as resources to take part in EBP. The nurses have no ready access to information and resources mainly because these do not exist, or due to the high logistics involved in accessing them. The organizational culture is also another key barrier to EBP implementation. According to the various research studies undertaken, nurses have been found to have difficulties in accepting the role of promoting in their health setting. Many of the nurses believe that they have no power to implement any form of change in their practice and only associate that role to the top management. Resistance to change both among the nurses and among those in the top level is also another affecting factor to Evidence Based Practice (Cummings et al., 2007). Another major barrier to successful EBP is the lack of the nurses’ understanding of how research is likely to improve patient satisfaction and outcome. Adults as stipulated by Neville & Horbatt (2008) will always want to know why they need to know and understand the reason why they need to learn or get trained on a particular issue. In this case, nurses will in most cases disregard EBP, if they cannot get a connection between the evidence obtained and the promotion of improved patient care and satisfaction. In addition to this, adult learners have always been found to prefer providing immediate solutions to an arising problem (McEwen & Wills, 2011). This will therefore, mean that when faced with a situation that can best be solved through EBP, nurses will prefer to have the fastest and simplest means of solving the situation. Such means may include consulting their colleagues or other specialists. A quick and workable solution to this barrier would be to provide easy access to research evidence that can be accessed fast enough and that can provide an immediate solution to common medical problems. The materials providing such evidence should be readily available to all nurses. Another success strategy would be to motivate the nurses into taking part in EBP and assuring them that though the process may seem hard and complex during the first times, continued undertaking of the process will enhance proficiency, and that they will eventually find the practice easy, beneficial and interesting. The organization of education campaigns is one effective way through which such information can be spread. This same view is supported by Neville & Horbatts (2008) and Oh (2008). Implications for practice From the above parts of this report, Evidence Based practice is an important part of the nursing practice and to the medical profession as a whole. EBP provides evidence through which the ever occurring challenges and problems in medical practice can be solved and through which change in the practice can be implemented. With the major role that EBP is playing in the promotion of quality health and improved patient outcomes, its complete successful implementation is necessary. This, therefore, calls for immediate solutions to the existing barriers to its successful implementation to be obtained. There is need for educational and training programs to be implemented with the aim of educating the nurses on the need to engage in EBP, its benefits to the nursing practice and in the promotion of positive patient outcomes. The nurses need to know on how to effectively undertake the EBP process, and in a way that they enjoy. The administration and the top level management the various health care settings have a major role to play in the promoting effective EBP. One way through which they can do this is by promoting motivational programs and strategies through which the nurses will be encouraged into taking part in EBP. The administration needs to also provide the required resources needed for EBP and to make them easily and readily accessible to the nurses. There is need for more studies to be undertaken, with the focus being on strategies through which the many identified barriers to EBP can be eliminated. References Babbie, R. & Benaquisto, L. (2009). Fundamentals of Social Research. Scarborough, ON: Nelson Education Limited. Bahati, R., Guy, S. & Gwadry-Sridhar, F. (2010). Crictical Appraisal. Ontario: University of Western Ontario. Bastin, H. (2009). Personal views: learning from evidence based mistakes. British Medical Journal, 329 (7473):1053 Bertulis, R. (2008). 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