The Ability and Skills of Healthcare Practitioners - Case Study Example

Litеrаturе Review in Еvidеnсе-Bаsеd Рrасtiсе Name Institution Abstract The study aimed at conducting literature review on the existing evidences on EBP in Saudi. The topic of discussion was evidence-based practice (EBP) which is the ability and skills of the healthcare practitioners to integrate the best of up-to-date evidences in their practices. Additionally, the design of the study was systematic review majorly on the barriers, facilitators, knowledge, and attitude of EBP in Saudi. In the study, various methods were used to collect the information both manually and through the databases using keywords such as evidence-based practice, nursing, care, activities, and education. However, to ensure relevancy of the findings, the study combined such keywords with barriers, facilitator, attitude, prospective, practice, awareness, and Saudi. The used databases include Google scholar, MEDLIB, SID (Scientific Information Database), and CINAHL (Cumulative Index to Nursing and Allied Health Literature). The most important barriers as realized from the review were inadequate facilities, time, and skills required to undertake research methodology. The level of familiarity and knowledge of EBP was low at stood at 44.2% in Saudi. There are several of in using EBP and despite the efforts in place by the healthcare providers to ensure positive attitude. However, from the analysis, the practitioners registered low level of knowledge on issues relating to EBP. To remove the barriers influencing the use of EBP and increase the knowledge of the healthcare providers on the EBP concept, it is significant to have efficient planning and effective interventions. Keywords: Attitude, Awareness, Knowledge, Barriers, and Facilitators Litеrаturе Review in Еvidеnсе-Bаsеd Рrасtiсе Introduction In the recent years, there have been growing concerns on the quality of healthcare services provided in Saudi. As a result, new technologies and knowledge emerged, increased expectations of the patients and communities, and attitudes and professional expectations providing healthcare services increased. Such factors led to the Evidence-based practice (EBP) which is the ability of the healthcare professionals to use skills and integrate the best of up-to-date evidences, outcomes from reliable and valid healthcare researches, depending on the condition of the patient and preferences (Melnyk & Fineout-Overholt, 2011). Hence, along with the presentation of EBP in various study fields, several studies have been carried out in different fields including knowledge, attitude and practice, barriers and facilitators of EBP, understanding of different EBP concepts, and its other aspects across the globe. In Saudi, the concept of EBP attracted the attention of different fields of medical sciences in the past years. The studies conducted in Saudi indicate that the amount of knowledge, attitude, and performances of various groups of the service providers were at low levels. Inadequate facilities, shortage of time, limited skills in English language, and lack of authority to make adjustments were the major barriers mentioned in various studies carried out in Saudi (Alnahedh et al., 2015). Despite the numerous studies in the field of EBP in Saudi, the vision and exact information regarding the practice is not clear in medical sciences. Consequently, classification systematic presentation of the outcomes acquired through practical from various studies could play a significant role within the profession. The study aimed at performing a systematic review on the knowledge, awareness, barriers, facilitators, and performance of EBP in Saudi. The Concept of EBP in Saudi The evidence-based practice (EBP) within the healthcare profession is a concept that integrates the clinical expertise of individuals and commitment to being one of the leading sources of knowledge and the best available to the external healthcare evidences from the sources that improve the evidence-base practice systematic research. As a global culture, EBP allows the healthcare professions to consider naturally and consistently the evidences in each aspect of the practices (White & Dudley-Brown, 2012). In addition, the EBP decision-making process within the care systems involves the integration of the knowledge arising from one’s healthcare expertise, preferences of the patients’ actions, their clinical states, environment and situations, and research evidence within the contextual framework of the available resources. The main challenge faced by most healthcare professions is to offer appropriate weight to the research on the evidence (Wolfe, 2006). As a result, EBP plays a crucial role since it lends credence to the practitioners as knowledge workers and enhances their quality of leadership. It also improve the quality of the care and satisfaction of the patients since it recognizes that the patients are knowledgeable on matters relating to their health and seek to be active in the decision making process (Roffey, 2012). In 2003, the Sigma Theta tau International Honor Society of Nursing clearly indicated its position on the EBP specifically on the nursing profession and its commitment to ensuring it is the leading sources of knowledge and resources that aim to foster EBP globally. On the other hand, the Centers for Evidence-Based Nursing exist in many countries with the aim of providing educational sessions to assist the nurses learn methods of using evidence in clinical practice (Brodribb, 2011). Generally, the professions with the healthcare are increasingly being challenged by the changing expectation of the patients, their organizations, and those of the healthcare institutions to provide clearly measurable care systems of high quality. To achieve such goals, EBP is of significance and the roles of the practitioners in bridging the divide that occurs between research and practice through enhancement of the clinical care based on the evidence relating to the best practice (Bahammam & Linjawi, n.d). Consequently, several factors have been able to contribute to the ever-rising roles of the evidence in policy and practice (Alshimemeri, 2013). The major influence include increasing knowledge of the public, explosion of data, changing professional roles, emphasis on productivity, and cost-effectiveness in the delivery of healthcare services. Other factors are increased emphasis on scrutiny and accountability. Methods The aim of the study was to review the literatures carried out on EBP in Saudi. The review was carried out systematically during 2013-2014 using systematic review approach adopted from the book “A systematic Review to Support EBP.” The information required to ensure the achievement of the aims were collected using different methods through searching based on the keywords in the review. The keywords used to acquire the information-included evidence based practice, care, medicine, nurse, education, and learning. These were integrated with other keywords such as knowledge, attitude, barrier, facilitator, practice, prospective, and Saudi in collecting the data from various databases such as SID (Scientific Information Database), SaudiMedex, Magiran, Google scholar, MEDLID, PubMed, and CINAHL (Cumulative Index to Nursing and Allied Health Literature). The chosen articles were published during different periods. To identify and increase the scope of reviewing the published papers, upon conducting the search on the databases, there was manual search of the valid journals. Upon exclusion of the articles that were considered to hardly relate to the aim of the study and selecting the major articles, to enhance the reliability of identifying and evaluating the articles, the study listed the selected references from the articles chosen. The inclusion criteria for the study involved the articles studied recently on the evidence-based practices. The excluded articles were those presented at the seminars and other educational articles. Moreover, the reviewing process involved a series of activities with exclusion of the articles that failed to relate to the aim of study. Of the 1043 found in the databases, only 28 papers were found to closely relate to the topic of review. Upon careful study and retrieval of the required information, the study summarized the findings in the table and conducted an analysis manually. The graphs were drawn using excel while in organization the study used EndNote X5 software. Besides, the software assisted in reading the titles, abstracts, and identification of the duplicates. Results The selected papers had different characteristics with most of them having the studies based on the barriers of EBP. Hence, in the review, the identified barriers from the articles will be stated. Of all the frequently appearing barriers as noted from the reviewed articles, lack of suitable facilities was the most significant barrier. Other major identified barriers as mentioned in the literatures were low motivation, negative attitudes towards EBP, inadequate confidence in the research outcomes, failure to provide effective training in EBP, resistance to changes, and few benefits realized from the EBP by the practitioners. In the other papers, besides the assessment of the barriers involved in EBP, the study also assessed the facilitators of EBP in a sequential manner to create several opportunities Figure 1: Main barriers to evidence-based medicine stated in the published papers Figure 2: Main facilitators of evidence-based medicine stated in the published papers Figure 3: Mean of acquaintance and familiarity with specific terms of evidence-based practice in the published papers From the identified results, it is clear that the acquaintances and understanding of the CBP concept majorly related to the relative risks and absolute risks. Both the acquaintance and the knowledge stood at 44.2%. Figure 4: Mean scores of attitude, knowledge, usage, and awareness of evidence-based practice in the published papers Discussions The results of analysis of the various studies conducted in Iran showed that it lacked adequate facilities, time, and the practitioners were unfamiliar with the research methods. Additionally, there is lack of authority among the healthcare practitioners in Saudi to effect their desired changes, which also contribute to the EBP barriers. Within the country, there are several facilitators of EBP including the creation of the many opportunities, the teaching research methods, and holding various training methods to improve the level of understanding of EBP. However, various health practitioners in Saudi have limited information on the EBP concept and the reference books used for acquiring the relevant information of EBP (Centre for Evidence-Based Medicine, 2016). From the study, several issues represented the weaknesses relating to the level of performance and utilization of the concept. These issues are awareness, knowledge, utilization rates, and practice. Perceived major barriers and facilitators Studying and focusing on the most important barriers to EBP show similar results like in other countries. The major barrier in the case of Saudi is lack of adequate facilities that allow effective and efficient practice of evidence-based healthcare. Whereas, the study carried out on the negative attitude and inadequate level of education reflected to the significance of ensure proper understanding of the practice (Ashria et al., n.d.). The study conducted in Canada showed that the major barrier to practicing the EPB was time. Creation of the ample opportunity to the study, effecting the teaching of the research methods, and holding the training courses on the EBP concept are the main facilitators of the practice in Saudi. Besides, there is need for understanding the presented information and encouraging transparency could be the best methods of improving the integration of EBP concept (Abt, 2004; Steelman, 2006). Therefore, the results of various literatures conducted in Saudi are similar to those in the other places. In most cases, to improve the application and importance of EBP certain activities are inevitable. The activities include provision of appropriate facilities for implementing the concept of EBP, ensuring there is adequate time to study, and encouraging the performances based on the evidences by reducing the workloads (Filieri, 2010). Furthermore, there is need to increase the human resources, training the practitioners on time management, teaching the concept of planning and research methods, and ensuring utilization of the findings from the study. More importantly, there is much requirement to train the practitioners on the principles and EBP standards while at the same time establishing the legal and administrative structure that would assist in providing the possibility of making the changes (Famili, 2006). From the collected information, the healthcare providers in Saudi have relatively low awareness on the matters relating to EBP. The lowest issues on familiarity and understanding in Saudi are confidence interval (CI), evidence level, and the meta-analysis that matched the previous studies. Additionally, the knowledge on the relative and absolute risks are often confusing than other terms such as the clinical trial and systematic review due to their outward meanings (Poell & Woerkom, 2010). Besides, they appear simple but with reference to statistics and methodologies, these concepts are a bit complex and require further studies. Generally, the acquired results on knowledge and perception of some terms used in EBP reflect the low levels of awareness among the practitioners (Alsanea, 2006). Therefore, it is significant to train them on the statistical and methodological concepts to assist them improve on their application and implementation on the EBP. However, it is important to improve the level of awareness, attitudes, and utilization of evidence approaches within the healthcare by providing adequate training, provision of incentives (financial and non-financial), and provision of the most appropriate culture-making process. Integrative EBP From the literature reviewed, it is clear that globally, the healthcare professionals including those in Saudi welcome the concept of EBP. However, factors such as awareness and knowledge levels tend to bedside the application of the concept in actual practice, which leaves room for application. Based on the identified barriers that limit the application of EBP in Saudi, it is significant to focus on structural implementation of the EBP within various healthcare institutions and focus on cultural change across various institutional levels including the patient care, education, management (Almeedani & Old Dominion University, 2014). The policy frameworks recommended in Saudi need to encompass a wide array of possible entries of implementing the EBP concept in a multifocal and sustainable manner. Although most of the healthcare professionals seem to appear to be quite EBP-minded, the uptake of the concept is progressing while important barriers still obstruct the full implementation in the practice. Such findings occur consistently at various healthcare professional levels. Nonetheless, the analysis from the multiple regressions indicates that the perceived barriers only predict a fraction of the practice, knowledge, skills, and attitude associated with EBP. Apparently, the frequently reported barriers are not the major reasons behind the poor implementation of the EBP (Metcalfe & Mimouni, 2011). Moderately, the change of mindset among the practitioners seems to indicate the reasons behind such perceptions with the additional barriers to implementing EBP lying with the organizations. As a result, an integrative approach that involves the practitioners with support from across different organizational levels might offer the best solutions to some of the challenges. Several literatures suggested the integrative method of overcoming the barriers especially in Saudi. In addition, some of the authors also argued that the best implementation method needs to multifocal and a comprehensive program involving the professionals tailored with their desires and perceptions. The systematic review on the multifaceted guideline of implementing various methods resulted in imperfect evidence supporting the decisions relating to dissemination and implementation methods are like to show efficiency under different circumstances (Abu-Gharbieh et al., 2015). However, in nursing, leaders play a vital role in implementing EBP. The evidence from various studies suggests that strategies on the level of leadership, organization, and culture play significant role in implementing EBP in nursing. The available evidence of research particularly on the effectiveness of institutional infrastructure in promoting evidence-base nursing is limited. Generally, in the medical profession, such literatures are scarce. There are several multidimensional programs initially proposed to improve utilization of research and encourage the use of EBP by the nurses. Other proposed strategies include dedication to research agenda, integration of the EBP concept in education, and implementation of EBP on the specified medical professions (Rayess, 2016). In Saudi, over the last decade, the clinically integrated instead of stand-alone EBP teaching practices have been able to show improvement in EBP behaviors and might assist in implementing the concept of EBP within the clinical practice. Knowledge Level and EBP in Saudi There is a great discrepancy on the existing amount of evidence based research and utilization of such evidence within the healthcare profession. In Saudi, studies show that approximately 10-40% of the adult patients seeking care services do not receive evidence-based care. Additionally, the research also indicates that more than 20% of the provided care systems are unnecessary and to some extend might potentially harm the patient (Ateef, 2015). However, such problems associated with knowledge on EBP do not affect the Saudi practitioners but also their counterparts in Europe. For example, from the study conducted by the National Board of Health and Welfare in Sweden in 2008 show that only 8.6% of the patients acquired injuries while in hospital care. However, from the analysis, the findings stated that such were avoidable if the actual knowledge of EBP was applied in the scenario. To reduce the injuries on the patients due to lack of knowledge, it is significant to implement effectively and efficiently the concept of EBP (Richardson, 2005). Generally, the EBP concept originated from evidence-based medicine (EBM) which involves conscientious, explicit, and judicious application of the recent evidence while making decisions on the care about the patients. In addition, the practice of EBM means integration of the practitioner’s expertise with the best available external clinical approach from the researches considered systematic. To improve the knowledge-based practices, one method of ensuring integration of the evidence into the practice is through evidence-based clinical guidelines. The factors that influence the implementation of evidence-practice remains poor understood in many countries including Saudi (Aveyard, 2009). Studies reveal that factors associated with learning processes associated with implementation of EBP guidelines, attitudes and beliefs of the healthcare provider, leadership support, constraints of resources, and integration of the recommendations at institutional level influence the implementation process. Hence, it is critical to identify and understand the activities associated with specific barriers and facilitators through theoretical framework to allow the development of effective implementation of the strategies. Within a systematic review of utilization of the concept, attitude is the main factor that relates to the EBP. However, education is often used in influencing attitudes (Washington & Washington State Library, 2008; Straus, Tetroe, & Graham, 2009). Besides, there is a possibility of using the skills and knowledge to influence the integration of the research into the practice. Most of the existing researches on EBP focus on the nurses and physicians with limited analysis on the manner in which the dieticians, occupational therapists, and physical therapists utilize the concept of EBP, their potential barriers, and facilitators relating to the implementation process. Identified Gaps Several researches have been carried out on the EBP in Saudi; however, several gaps still exist that require further studies. The major gap revolves around the perception and involvement of the patients seeking healthcare services. The literatures identified only highlight the roles played by the patients during EBP though it remains complex and under-researched. The perception of the patients with regard to care management and associated impacts on trust and care satisfaction is an area of research that requires further studies. Furthermore, the conducted research majorly stressed on knowledge as one of the barriers of having an effective EBP in Saudi. Focusing on education and training are crucial in developing the desired skills. The literatures frequently mention the responsibility played by education and training in improving EBP but the detailed studies structure, process of implementation, and evaluation still remain limited. The reliable information on the gaps that exist between clinical evidence and clinical practice is usually difficult to find. References 1. Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. 2. Alnahedh, T., Suttle, C. M., Alabdelmoneam, M., & Jalbert, I. (2015). Optometrists show rudimentary understanding of evidence-based practice but are ready to embrace it: can barriers be overcome? Clinical and Experimental Optometry, 98(3), 263-272. 3. White, K. M., & Dudley-Brown, S. (2012). Translation of evidence into nursing and health care practice. New York: Springer Pub. Co. 4. Wolfe, J. (2006). Overcoming Barriers to Evidence-Based Practice: Lessons From Medical Practitioners. Clinical Psychology: Science and Practice, 6(4), 445-448. 5. Roffey, S. (2012). Positive relationships: Evidence based practice across the world. Dordrecht: Springer. 6. Brodribb, W. (2011). Barriers to translating evidence-based breastfeeding information into practice. Acta Paediatrica, 100(4), 486-490. 7. Bahammam, M. A., & Linjawi, A. I. (n.d.). Knowledge, attitude, and barriers towards the use of evidence based practice among senior dental and medical students in western Saudi Arabia. - PubMed - NCBI. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25316471 8. Alshimemeri, A. (2013). Chronic obstructive pulmonary disease: An evidence-based update. Saudi Journal for Health Sciences, 2(2), 75. 9. Centre for Evidence-Based Medicine. (2016). Connecting with Saudi Arabia - CEBM. Retrieved from http://www.cebm.net/connecting-saudi-arabia/ 10. Ashria, N., Al-Amrob, H., Lubna Hamadahb, L., Al-Tuwaijrib, S., & Metwallyc, A. E. (n.d.). Dental and medical practitioners’ awareness and attitude toward evidence based practice in Riyadh, Saudi Arabia. A comparative study. Retrieved from http://www.sciencedirect.com/science/article/pii/S2210815713000437 11. Abt, E. (2004). Complexities of an Evidence-Based Clinical Practice. Journal of Evidence Based Dental Practice, 4(3), 200-209. 12. Steelman, V. M. (2006). Evidence based practice. Philadelphia: Saunders. 13. Filieri, R. (2010). Overcoming knowledge sharing barriers through communities of practice: Empirical evidence from a big automotive supplier. Newcastle upon Tyne: Cambridge Scholars. 14. Famili, D. (2006). Peer Review and Evidence-Based Dental Practice. Journal of Evidence Based Dental Practice, 6(1), 119-120. 15. Poell, R. F., & Woerkom, M. V. (2010). Supporting workplace learning: Towards evidence based practice. Dordrecht: Springer. 16. Alsanea, O. (2006). Applying evidence-based practice: lessons from dying surgical critical patients in Saudi Arabia. Current Opinion in Critical Care, 12(4), 362- 364. 17. Almeedani, S. A., & Old Dominion University. (2014). Knowledge, attitudes, and barriers toward evidence-based practice among oral health professionals in Saudi Arabia. Cardiff: Al-Husaini. 18. Metcalfe, B., & Mimouni, F. (2011). Leadership Development in the Middle East. Cheltenham: Edward Elgar Pub. 19. Abu-Gharbieh, E., Khalidi, D. A., Baig, M. R., & Khan, S. A. (2015). Refining knowledge, attitude and practice of evidence-based medicine (EBM) among pharmacy students for professional challenges. Saudi Pharmaceutical Journal, 23(2), 162-166. 20. Rayess, Z. A. (2016). The Saudi Center for Evidence Based Healthcare (EBHC) - Director’s Message. Retrieved from http://www.moh.gov.sa/endepts/proofs/pages/home.aspx 21. Ateef, M. (2015). Evidence-based learning and practice in physical therapy: A need for novice physical therapists. Saudi J Sports Med, 15(1), 106. 22. Richardson, W. S. (2005). Teaching evidence-based practice on foot. Evidence-Based Nursing, 8(4), 100-103. 23. Aveyard, H. (2009). A beginner's guide to evidence based practice in health and social care professions. Maidenhead, Berkshire: McGraw Hill/Open University Press. 24. Washington (State), & Washington State Library. (2008). Evidence based practice. Seattle, Wash.: The Council. 25. Straus, S. E., Tetroe, J., & Graham, I. D. (2009). Knowledge translation in health care: Moving from evidence to practice. Chichester, UK: Wiley-Blackwell/BMJ. Read More