Constraints to Applying Best Evidence into Practice in Nursing - Term Paper Example

Constraints to applying best evidence into practise in nursing Name Course/Unit Instructor 14 September 2012 Introduction Despite the increasing emphasis on evidence-based nursing, indications are clear as to how the process faces numerous challenges, which in turn have suffocated the process from achieving effective evidence-based nursing (Craig & Smyth, 2011). Efforts have been increased to address these challenges; where a number of initiatives have been developed to improve access to research findings. But, even with these efforts in place, nurses still face major challenges when translating best evidence into clinical practise (Craig & Smyth, 2011). Evidence-based practise appears to be complex and challenging, making it difficult to develop the most appropriate course of actions. Therefore, given that evidence-based nursing is inevitable, it is important to study the primary constraints that limit application of best evidence practises in nursing. Evidence- based practise Availability of best evidence in nursing is seen to be critical to the process of recognising and delivering high-quality care to the patients (Malloch & Tim, 2010). The understanding is that evidence-based practise remains part and parcel of healthcare process. As a result, evidence-based practice continues to be defined differently. According to Barker (2010), evidence-based practise constitutes the process of using precise and appropriate theories and research-based information to design appropriate care delivery for individual and groups of patients (cited in Emanuel et al., 2011). This type of care has to consider patients needs and preferences. At the same time, Fineout-Overholt (2005) perceives evidence-based practise to involve problem-solving approach (Emanuel et al., 2011). In this manner, evidence-based practise should be about solving clinical problems using systematic and critical appraisal evidences generated through experiences and skills of the nurse and the preferences and values of the patient (Emanuel et al., 2011). Furthermore, Carrier (2009) express that evidence-based practise should be based on grounded evidence that among other things put into consideration the needs and preferences of the patients (cited in Emanuel et al., 2011). Therefore, it is important to view evidence-based practise through the horoscopes of integrated research, theory and practise that gives the nursing practise an improved dimension from traditional dimension that is limited in scope. Here, evidence-based nursing disconnect from the traditional nursing practise that emphasises ritual, isolation, unsystematic clinical experiences and ungrounded opinions and traditions (Penz & Sandra, 2006). As a result, evidence-based nursing has become the appropriate avenue to ‘sanitise’ the nursing profession by making it operates based on sound evidence of patient care with a clear goal of improving the patient care (Penz & Sandra, 2006). Besides, evidence-based nursing incorporates both research and all forms of practise knowledge. This is to say, evidence-based nursing involves nurses making clinical decisions using the most current research evidence that are further blended with accepted policies, clinical guidelines, clinical expertise and judgment, and patient preferences (Penz & Sandra, 2006). Importance of evidence-based practise Nursing is a field that continues to change through evolution; this situation calls for nurses to constantly remain abreast to these changes. Nurses are therefore required to exhibit maximum characteristics of fitness to the nursing practise. To meet the fitness requirements, nurses are supposed to manifest ability of having clinical, theoretical and professional skills and standards (Emanuel et al., 2011). This requires the nurses to be up to date with the nursing practise. As a result, evidence-based nursing practise is viewed as a way of ensuring that the nursing practise remains current to the needs of patients. The modern nursing process is largely intertwined; where the need is to enhance patient’s care that improves outcomes. As a result, practitioners are required to identify and incorporate the best nursing methods that are valid, relevant and research-based in order to enhance the positive patient’s care (Eizenberg, 2011). Today’s patients are no longer passive consumers of healthcare interventions developed and administered to them by practitioners (Malloch & Tim, 2010). The patients have become more active in the healthcare process where they bring specific expectations, concerns and requirements to the clinical experience. As a result, nurses have to develop appropriate nursing interventions that address the needs of the patients appropriate. In this manner, nurses have been forced to integrate best possible research evidence with clinical expertise and with patient needs (Malloch & Tim, 2010). Therefore, evidence-based nursing practise has progressively become important since it provides an avenue for nurses to make a positive difference in the lives of patients using current practises and interventions. Current constraints to applying best practise evidence Despite huge developments in the field of evidence-based practise, Craig & Smyth (2002) are convinced that nurses still face challenges especially when translating best evidence into clinical practise. This observation is further captured by McEwen (2002) where the author sees nursing profession to face challenges of implementing results of evidence-based practise into clinical practise (cited in Penz & Sandra, 2006). Moreover, Young (2003) is of the view that despite enormous progress in evidence-based practise, the concept is yet to become reality in all areas of practise (cited in Penz & Sandra, 2006). All these are indications that there exist current constraints that make it hard to apply the best practise evidence. It can be ascertained that there are current clinical practise settings that may affect ability of new practitioner to implement evidence practises. As a result, there is an urgent need to identify the clinical nursing issues that may affect the implementation of evidence-based nursing practise. Research studies have established that clinical nursing issues that can be regarded as constraints that at same time need to be addressed include time factors, access to information and resources, nurses research knowledge and skills and the current nursing culture (Penz & Sandra, 2006). On the other hand, Emanuel et al. (2011) observe that evidence-based nursing practise has been handicapped by the lack of motivation and competency skills among those training as nurses. This eventually affects their future attitude and approach, which limit their ability of integrating evidence-based nursing in the practise. Moreover, it is expressed that nursing students fail to develop and acquire necessary skills that are flexible and adaptive in order to integrate well in the holistic field of evidence-based practise nursing (DiCenso, Cullum & Ciliska, 1998). All these aspects are considered to be the major ones hindering the application of best evidence into the practise of nursing. Time constraints have been identified to be the primary issue in the present clinical practise. The observation that has been made is that nurses, especially the new practitioners, feel that they are hugely preoccupied; where the situation has denied them an opportunity to participate in evidence-based nursing activities (Amanda et al., 2009). Moreover, many nurses have expressed lack of time to be the major reason as to why they are failing to access and review evidences that can contribute to development and implementation of evidence-based practise (Penz & Sandra, 2006). Apart from time, new practitioners have been constrained in their attempt to implement evidence-based practise by inadequate access to information and resources (DiCenso, Cullum & Ciliska, 1998). Information, specifically in their currency, is critical to implementation of appropriate evidence-based practise. But, many new practitioners are likely to have inappropriate access to current information and resources that are important to the development of new knowledge. As a result, it can be suggested that appropriate evidence-based nursing approach is possible when nurses have access to libraries, current research journals, research resources and internet. Besides, evidence-based nursing practise has been constrained by inadequate research knowledge, skills and learning opportunities for nurses (Amanda et al., 2009). The observation made is that new practitioners, just like continuing ones, require additional quality knowledge and skills that can enable them appreciate evidence-based practise. Numerous evidence exist as to how evidence-based nursing approach can be positively enriched by aspects like additional learning, research for current evidence, skills to critique available research studies, and ability to read, interpret and translate research into practise (DiCenso, Cullum & Ciliska, 1998). Furthermore, it has been established that current nursing culture is responsible for lack of application of best evidence into practise in nursing (Nai, Teng & Lee, 2010). The understanding is that, information-seeking behaviours and how to use current evidence continue to suffer from lack of support and are not valued. This has led to a complacent culture among both new and experienced nurses. This complacent nursing culture does not promote nor support effort to implement evidence-based practises. Many nurses are seen to lack confidence, enthusiasm, courage or intention to question the ability and suitability of the existing nursing practises (Nai, Teng & Lee, 2010). Strategies to limit impact of constraints The identified constraints to the application of best evidence practise in nursing calls for development and implementation of appropriate strategies to address the constraints. It is important for concerned stakeholders to device ways of increasing time available for nurses to participate in evidence-based practises. The current situation where the worth of nurse is measured in tasks accomplished rather than critical thinking capabilities has to be evaluated. Where possible, the time-task imperative has to be eliminated and more time created for nurses to take part in evidence-based practises. At the same time, there is need for proper training, mentoring and role model for new practitioners in evidence-based practises (Nai, Teng & Lee, 2010). New practitioners in most cases exhibit little knowledge, skills and experience in evidence-based practises, and the situation calls for proper training and mentorship opportunities. Furthermore, change of nursing culture may be necessary if the current state of affairs is to change. Appropriate, supportive and encouraging nursing culture is important to ensure new nurses find an environment that can support their overall strategies and desires to develop and apply best evidence practises to their profession. Access to information and knowledge and need for nurses to increase their research, skills and learning opportunities remains critical. Therefore, the need for nurses to be introduced to appropriate information technology is important (Penz & Sandra, 2006). Challenges to the strategies adopted Major challenges to the above suggested strategies remain to be availability of inadequate resources to carry out the drastic changes and developments (Emanuel et al., 2011). The current situation in healthcare indicates that efforts at all levels are geared towards realising efficiency and this call for cost cutting and constraints in budgeting. As a result, healthcare sector may not have necessary resources to initiate key reforms and programmes to address the current constraints to implementation of best evidence-based nursing practises. At the same time, absence of proper policy to guide the entire process both at local and national level makes the entire process stagnate and remain just a recommendation (Emanuel et al., 2011). These two challenges can be overcome through adoption of specific strategies. First, there is need for all stakeholders to develop appropriate strategies that can be used to mobilise resources in the healthcare sector to advance and promote acquisition of evidence-based practises. At the same time, key stakeholders have to evaluate different strategies that can be used to mobilise the resources. Apart from this, development of key policy framework to guide and provide direction to the entire process is necessary. This again requires active participation of diverse stakeholders in order to generate a policy that is strong in content and possible in implementation. Conclusion Nursing continue to advocates for evidence-based practise in the nursing process. The healthcare field has been changing, a situation that has resulted in emergence of numerous challenges in administering quality healthcare to the patients. Nursing, being one of the healthcare fields, has not escaped from the increasing challenges posed in modern world for quality healthcare at appropriate cost. As a result, there is need for stakeholders in the nursing practise to emphasise the need to adopt an evidence-based practise in order to improve and increase the quality of patient care. But to do this, the primary constraints have to be addressed using appropriate measures. Major constrains as identified earlier have suffocated the ability of new nurses to participate effectively in the implementation of evidence-based practises. Therefore, evidence-based practise can be said to involve provision of high quality patient care at appropriate cost using current evidence practises. References Amanda, J. F., Dennis, F., Tara, J. S., Joseph, G. D., LeAnn, E. B., Bruce, S. O., & Sar, B. K. (2009). The Challenges of Implementing Evidence Based Practise: Ethical Considerations in Practise, Education, Policy, and Research. International Online Journal of Social Work and Society, 7 (2). Craig, J. V., & Smyth, R. L. (2011). Evidence-Based Practise Manual for Nurses. London: Elsevier Health Sciences. DiCenso, A., Cullum, N., & Ciliska, D. (1998). Implementing Evidence-Based Nursing: Some Misconceptions. Evidence Based Nursing, 1 (2), 38-39. Eizenberg, M. M. (2011). Implementation of Evidence-Based Nursing Practise: Nurses’ Personal and Professional Factors? Journal of Advanced Nursing, 67 (1), 33-42. Emanuel, V., Karen, D., Diegnan, L., &Maxine, P. (2011). Developing Evidence-Based Practise among Students. Nursing Times, 107 (49/50), 21-23. Retrieved September 13, 2012, from Nursing Times: http://www.nursingtimes.net/nursing-practise/clinical-specialisms/educators/-developing-evidence-based-practise-among-students/5038920.article Malloch, K., & Tim, P. (2010). Introduction to Evidence-Based Practise in Nursing and Health Care. London: Jones & Bartlett Publishers. Nai, M. L., Teng, C. L., & Lee, M. L. (2010). The Place and Barriers of Evidence-based Practise: Knowledge and Perceptions of Medical, Nursing and Allied Health Practitioners in Malaysia. BMC Research, 3, 279. Retrieved September 13, 2012, from http://www.biomedcentral.com/1756-0500/3/279/ Penz, K. L., & Sandra, L. B. (2006). Evidence-Based Nursing in Clinical Practise: Implications for Nurse Educators. The Journal of Continuing Education in Nursing, 37 (6), 250-254. Read More