The Incorporation of Evidence-Based Practice into the Existing Nursing Practice - Term Paper Example

Nursing Leadership: Name: Institution: Date: Introduction Evidence based practice has evolved by meaning and naming over the ears since its inception during the 1980s. It moved from the term evidence-based medicine, to currently, Evidence Based Practice (EBP). In general, it is defined as, “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett, Rosenberg, Gray, Hayes, & Richardson, 1996). Evidence Based Practice can be defined as: “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. More so, Evidence-based practice means integrating individual clinical experience with the best available external clinical evidence from systematic research" (Sackett et al, 1996) There are five stages of Evidence Based Practice: • The question- The first step in evidence based practice is recognizing that there is a need for new information. • Finding the evidence- Choosing the right evidence is essential. • Appraisal- The evidence must be critically analyzed to determine its validity and potential usefulness. • Acting on evidence- Once you have concluded that the evidence is appropriate you then decide whether the evidence should be incorporated into your clinical practice.  • Evaluation and reflection- Evaluation and reflection are necessary to determine whether the action you have taken has achieved the desired results. This is now a fundamental part of nursing practice. Evidence based practice is a continuous process. The diagram below illustrates this continuous process: Successively, EBP and evidence-based healthcare work on the notion that evidence is used in the perspective of a patient’s desires and requirements, skill and the best judgment of clinicians, and the clinical situations. Moreover, healthcare professionals are expected to be able to criticize, amalgamate and interpret any research findings. This paper is aimed at demonstrating the relevance of EBP to high quality patient care and professional nursing practice. The Process of Change In Relation To Evidence-Based Practice However, it should be known that there are clear distinctions between research utilization, nursing research and quality improvement. Research utilization is common in nursing as an aid to their work so that they can afford the best care to their patients. This process engages the in-depth analysis and evaluation of research findings and the making sound judgment by the practitioners. It also involves the implementation of the research findings into the nursing practice. There are many reasons why nurses should engage in evidence based practice. These include: • The increasingly complex nature of health care decisions  • The Department of Health’s directive that services and treatments should be based on the best evidence of what does and does not work  • Compliance with Codes of Professional Conduct  • The nurse’s ability to make informed judgments is of importance to patients and assists nurses" in being valued members of multidisciplinary teams  • Nurses do not have the time to read extensively. The process of appraising and using the literature not only benefits patients it also expands the nurses" knowledge base ( Slattery & Beyea , 2006). On the other hand, quality improvement centers on systems satisfaction and the cost outcomes. It is not in any way designed to develop the standards of nursing practices, but they significantly add to the understanding the health care process, which actively involves nurses. Lastly, nursing research is designed to refine, develop and add to the nursing knowledge. It invites the nurses and the patients as well as their families and the communities in which they serve. The nurses’ research methods may either be qualitative, quantitative, or triangulated (Brown, Wickline, Ecoff, & Glaser, 2008). The guiding evidence for any practicing nurse should be,” what is the backup substantiation for this intervention?” or ” are these the best attainable results in this case?” in this regard nurses are obliged to question the existing nursing practices and thereafter use the evidence to offer the much needed care. In this case, EBP has several advantages in the nursing field. It helps the practitioners to offer quality healthcare to their patients. This quality health care must be based on goods research and knowledge rather than basing it on routine procedures. Additionally, it results to better patient’s outcome, maintains and updates the relevance of the profession, and increases confidence in the patient. Therefore, the integration of EBP into the nursing field ensures that the profession offers quality and reliable healthcare. Consequently, EBP is easier to use by the nurses if they relate to the already existing nursing guidelines. The guideline developers use a logical approach to criticize the already existing research, and compare them with their new finds in order to reach the suitable and more appropriate guidelines. Further, the mandate of this body is to give recommendations that will help reduce transmission of diseases to both patients and the care providers. Furthermore, there are various barriers that hinder the implementation of EBP. The most commonly experience barriers include, little or no regard the research, rigidity in changing the existing practice, hardships in assessing the already researched works, Complexity in the research procedure, unwilling mentors, and lack of awareness about research or EBP among others. However, regardless of these barriers, EBP is truly alive and making a difference in the health care sector. More so, these barriers can be overpassed if the institutions are willing and devoted towards it (Lyons, Brown, Tseng, Casey, & McDonald, 2011). The above implications and barriers can be maximized on if the organization outlines clear strategies to build an EBP culture in the organization. The advantages of EBP are receiving considerable attention in the nursing field even though at a reduced rate. This is so because the nurses are not optimistic about it and are opting to stick with the traditional way of practice. In addition, the nurses are not conversant with the research methods and their way of presentation in the medical journals as well as interpreting the finding and applying them in their daily practice. Therefore, even if the concept is enticing it requires a solid base and design so that it can succeed. Moreover, as a leader in the nursing department, one should embrace the EBP and thereby lead by action (Agency for Healthcare Research and Quality, 2012). In order for nurses to value the significance and identify with the importance and relevance of EBP, they need support from the Chief Nurse Executive (CNE) and the nursing leadership team. The leadership team must embolden nurses’ exertions to query the existing practice, have access to resources in the library and from research professionals, and afford enough time for nurses to work on EBP projects. Additionally, the team must value education scholarships and clinical inquiries. Therefore, the nurses should be permitted to use substantiation to advance their practice. Consequently, they should have the funds to realize goals that allied to improving the worth and welfare of nursing care (Slattery & Beyea, 2006). Most importantly, strategies that are in use should be in line with the culture and willingness of the nursing society. For instance, the CNE may lack financial resources to employ a nurse researcher in the initial stages, thus; a first step to EBP might be to call for the use of at least two research articles in progress or adjustment of nursing guidelines and techniques. Such condition will benefit nurses to learn about the available library resources in the institution, and as such, they will begin to understand how to interpret the research. Consequently, it might be needful to employ a nurse researcher to help in the implementation of the ongoing EPB and accord support to the existing staff nurses (Slattery & Beyea, 2006). Likewise, one of the most acute resources is the support from mentors in the research process because they are experts in such processes. An organization that lacks such resources must source for such opportunities to team up with organizations that already in order to share the needed research expertise. Resistance to Change and Strategies for Meeting Resistance The government has in the recent past recognized the need for EBP in the hospitals. This has, therefore, seen the adoption of new laws demanding the utilization of such practices. However, the nursing profession had recognized the importance of EBP for many years although, in some cases, the implantation was faced with some resistances as outlined above. Such resistance requires that the nursing leaders trend carefully so that they balance the needs of the institution and the freedom of their staff. Therefore, the leading team should observer several key factors in the process of introducing EBP in their institutions. These factors include; adopting a compassionate attitude that recognizes that it is not sufficient to provide scientific evidence alone (Rodak, 2011). As such, hospital leaders need to adopt a compassionate approach that respects nursing expertise and principles. In fact, it is evident that unless the nurses are thoughtfully presented with evidence conflicting with their customs, then they are exceptionally rigid. More so, leaders should hold dialogues with the nurses so as to understand their perception on EBP. Such an approach makes the concerned parties feel being part of the system rather than evaluation within the institution and /or the management. Moreover, encouraging physicians to practice EBP should also focus on the safety of patients. In general clinicians are more cautious to data addressing safety or quality issues rather than the cost issue surrounding EBP. Secondly, the hospital leaders need to present solid evidence that is consequential to the nurses and other practitioners. It is believed that if the nurses would see the system work then they will start to trust it and embrace it. The evidence should be delivered by a respected colleague from the management/ leadership team and be addressed towards specific challenges facing the nurses (Sackett, Rosenberg, Gray, Hayes, & Richardson , 1996). Thirdly, the management should take steps towards the inclusion of links to information in the hospital's electronic health records (EHR) systems. The EHR should be updated with links to the most recent evidence or practice standards. Through such efforts, the nurses y access will EBP easily. In fact, the best method to better the nursing corporation is through the presentation of evidence at the point of care during the treatment of patents (Rodak, 2011). Lastly, the usage of automated clinical decision support is one best way to encourage nurses to embrace EBP. This support would produce prompt and relevant alerts to the when nurses when they key in choices about a patient's condition in the EHR. Such a system would ensure that quality evidence is availed so that the clinical decision support provided, is based on the best evidence available. Resistance to change is viewed as the rigidity of moving from the norms towards new and advanced practices. Resistance to change has its advantages as well as its shortfalls and, therefore, the management should be able to evaluate and gauge the best challenges that crop up during the implementation of EBP in their institutions. The management should not enforce EBP through dictatorial means but should hear out the grievances raised by the nurses since, in the end, it is through them that the project will accomplish its objectives. In general, it should be understood that not all resistance is inadequate (Virani, Lemieux-Charles, A. Davis, & Berta, 2009). However, in the scenario the resistance to change prevails in the project management is expected to, arrange EBP training and avail time off from work for the nurses to learn and implement new techniques. Similarly, as EBP is an information-intensive activity, librarians and statistical professionals working in hospitals should play a substantial role in developing basic information knowledge skills, mainly literature searching skills, among other medical practitioners and the nurses. Many challenges in organizations emanate from an organization’s culture, which simply refers, to the way in which the organization, including its stakeholders behaves and thinks. Hence, for one to comprehend the culture of an organization and its development, it is imperative to evaluate its inception and history (Head, 2008). For instance, if an organization began out of disapproval against the existing system, then the fighting mood was most likely exceptionally strong. Consequently, such a fighting mood can become a limitation, if the organization remains rooted to it. It is, therefore, necessary to understand the organization based on its history and contexts. More so, the disturbances that impact their way of dealing with external effects or change (Riggio, Chaleff, & Lipman-Blumen, 2008). In essence, Organizational culture is not just based on decisions, but it also depends on the outcome of a lasting process, in which the attitude, beliefs and conduct of people are progressively shaped. Organizational culture may not be objectively effective, but it will always adapt to a changed environment. Thus, organizational culture may be compared to the managing mechanisms where if it is effective in one situation it can be internalized in the other. On the other hand, institutions should be aimed at creating a culture of followership. Followership simply implies to the act of the staff emulating their leader so that they can accomplish the set objectives. Further, the leader should be of certain valued characters so that they are envied by their staff. Such characteristics include the ability to create the leader- follower loop, trustworthy, innovative, respectable, and supportive, among others. using this trend, the organization has the ability to form a culture that will be followed by the existing and incumbent staff. In such cases, implementation of certain project like the EBP will be easy (Riggio, Chaleff, & Lipman-Blumen, 2008). Quality Improvement and Assessment Healthcare is no longer a luxury as it used to be in the earlier days. The rich had the capacity to enjoy quality healthy care since they could afford to pay the high fees demanded in the private health institutions. However, with the raising human rights activities, and enlightenment among members of the society, the government has had little or no option but to offer the best and quality health care possible. Moreover, the nursing sector has been adopting EBP so that the care accorded to patients is well researched. This is the leading objective of enrolling this program in many heath institutions across the state. In addition, the vision of the healthcare sector is to offer quality care to all patients regardless of their race, nationality, or social status. The practitioners are further sworn to do their duty without favoritism and discrimination to the public ( American College of Emergency Physicians, 2008). Consequently, the Donabedian model adopts the analysis of quality to include three factors: structure, process, and outcome. Structure denotes to the fundamentals, such as hospital structures, staff and equipment. On the other hand, process defines how structure is to be incorporated into practice, such as rehabilitations. Lastly, outcome refers to the product of processes, for example,, results of therapy (Kunkel, Rosenqvist, & Wester, 2007). A qualitative scrutiny of department leaders and quality planners can be done by evaluating the Donabedian's model for the context of quality systems, rather than to quality itself. In this perspective, structure will refer to the available resources, such as time and funds for working towards quality improvement. Further, it may also refer to the management of quality systems, for example, recording of procedures and staff support methods. Likewise, process will define quality enhancement culture and co-operation within and amid the practitioners. Lastly, outcome refers then to evaluation of goal accomplishment and advancement of proficiency linked to quality enhancement (Rodak, 2011). As such, scrutinizing the interactions between structure, process, and the outcome could offer evidence that will assist clinicians and other specialists, as well as the team leaders and the health strategy makers, when developing and implementing the quality improvements. The objectives of this scrutiny will be to determine whether structure, process, and outcome can be of use when to describing quality systems, to deliberate the insinuations of these associations, and establish if these mechanisms are connected (Kunkel, Rosenqvist, & Wester, 2007). In the resent upraise of EBP, there are other emerging models of health care that are in line with the development of the healthcare quality management. One outstanding example is the Patient-Centered Medical Home (PCMH). PCMH is a developing health care delivery model that is aimed at to affording quality healthcare that expands patient effects and cuts on their costs. They are particularly focused on the administration and prevention chronic diseases. An all-inclusive PCMH characteristically reflects on whole-person and team-based upkeep, recognition of delivery, and sustaining trusts. It is characterized by at least two of the following constituents: improved access, widespread care, harmonized care, and systems-based policies to progress safety and quality. The PCMH model is a hopeful conduit to enhanced principal health care quality, welfare, effectiveness and, efficiency (Agency for Healthcare Research and Quality, 2012). The PCMH model visualizes a healthcare arrangement through which patients have an ongoing association with a personal physician/ nurse who offers all-inclusive, socially and linguistically apposite care. This practitioner also takes accountability for harmonizing care with other healthcare providers. This model is established on patients having heightened access to their personal practitioner and compacts prolonged hours and same-day scheduling. Essentially, this model recognizes the practice of evidence-based medicine/practice, quality enhancement, and performance evaluation, improved use of technology especially in the information sector, EHRs, and a revised reimbursement system to reimburse benefactors who convert to a patient's medical home (Riggio, Chaleff, & Lipman-Blumen, 2008). Moreover, the actualities of the current dysfunctional healthcare structure stand in unambiguous contrast to the creditable objectives of the PCMH. Earlier ideas for change that looked auspicious have showed that carefulness is indispensable if stakeholders expect to evade accidental and negative results. However, shifting financial and structural resources to support the PCMH model may result to adverse effects on f the healthcare system. In addition, to the broad ideologies supported by proponents shows that pertinent details must be addressed before implementing the PCMH model (American College of Emergency Physicians, 2008). Conclusion In conclusion, the incorporation of EBP into the existing nursing practice proves to be more beneficial to all citizens because they will gain through the provision of quality healthcare. However, the nursing stuff should be included in all stages of this process so that they accord their input rather than repel the system. In fact, this essay has proved that nurses are particularly beneficial in the provision of quality health care since they spend most of their time socializing and attending to their patients. The management and the lead team should associate worth the practicing nurses so that they can become conversant with their grievances. This will ensure that the system of EBP is implemented and accomplishes its maximum potential. 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