Evidence Based Practice

Evidence-Base practice (EBP) is defined as: “based on problem identified from the practitioner’s area of practice; a combining of best evidence and professional expertise and an integration of this into current practice; about ensuring patients receive quality care, being part of quality improvement processes; about collaboration and requiring a team approach” (French, 1999). Scott and Mcsherry (2008) supported the French’s assertion, proposing the key elements of EBP are that it is a theory-driven process, which involves the use, evaluation and application of research; identification of best evidence; evaluation of care; problem solving; decision-making; clinical expertise; and requires patient involvement. Evidence-based practice is made of evidence, clinical expertise, patient preference, the context of care (Barker, 2013). In brief, evidence-based practice is the parameter in the nursing practice that it requires that the nurses gather and use clinical evidence to make decision for the patients so that in the nursing process they can deliver the quality of care for the patients (Ellis, 2013). In the other words, in the nursing practice all the nursing procedures performed by the clinical evidence supported.

Those specialist nurses are responsible for carry out EBP in the clinical area. Having a specialised nurses was found to be helpful for EBP development in the hospitals or organisations as they will act as facilitators in the organisations to facilitate the process of practice and policy change (Ring, Coull, Howie, Murphy‐Black, & Watterson, 2006). The specialist nurses will also act as mentors to mentor front-line nurses to adopting EBP. The research (Majid et al., 2011) found that nurses thought mentorship is helpful in adopting EBP. Morgan (2012) found that mentor-led EBP provides strong support to clinical nurses and they will encounter less

Experience with EBP: Evidence-based practice plays a crucial role in the quality of patient care. When care is performed based upon evidence opposed to outdated textbooks, instinct, tradition, or colleagues influence (Beyea & Slattery, 2006). The average nurse is currently more than forty years of age, without the frequent education upon new topics, many nurses’ knowledge has become outdated. As new textbooks are not published yearly or often times not kept up to date within facilities, they do not serve as reliable sources of

Nurses are cheered to integrate and apply EBP as part of their daily practice. EBP is “knowing that what we do is the best practice” (AMSN, 2014). EBP is very important in health care system and can dramatically change quality care and clinical outcomes. According from the Iowa/Titler Model from AMSN (2014), the EBP process have five steps:

Nurses are encouraged to integrate and apply evidence based practice in their daily practice. Evidence based practice is utilizing scientific knowledge/theory while making clinical decisions to provide quality care to their patients.EBP is very important and applicable in today’s clinical and nursing practice and it is used to provide best quality care to their patients and has to be monitored closely. Nurses should apply EBP in all day to activities like nursing intervention,

On the other hand, while those forms of evidence are essential for EBP has been emphasised taking into consideration the holistic aspect of care provided by the nursing profession as having an important contribution in developing guidelines and in EBP implementation (Mackey and Bassendowski, 2017). The EBP in nursing involves the process that promotes practices related to patient’s care and nurse’s knowledge (empirical, ethical, personal, aesthetic), improved and adapted from updated evidence and theories developed from research (Gray, 1997). Throughout the years has been debated that nursing holistic approaches (compassion, perception, knowledge gained through learned experience) cannot be measured but can be considered as well effective practice guidelines that lead to an improved patient outcome (Mackey and Bassendowski, 2017). Implementation of EBP in nursing has as results numerous benefits in healthcare practices by improving patient ’s outcomes and increasing patient safety through the provision of the most updated, reliable information about healthcare services and practices, aiming to address patient’s needs (treatments, guidelines, policies) (Chrisman et al., 2014).

First, EBP can only be created and initiated into health care facilities due to the research that was drawn from previous studies. Without the research, EBP would not be based upon actual fact. Next, when researchers seek to answer a noted problem it is evident that they aspire to have their research used. Ultimately, research is continuously used as it answers one question and then sets up another question to be answered. In conclusion, it is impossible to utilize EBP without crediting the research that made it possible (Melnyk & Fineout-Overholt,

The core principle of evidence-based practice is grounded on professional ethical considerations so as to build strong valid ethical practices. Unfortunately, there come varied challenges during the implementation of EBP by nurse educators, researchers and those in practice. Some of the difficulties that hinder proper EBP implementation have been discussed above whereby ethical dilemmas are very common (Berger,

Nurses face challenges in their day to day practice to find and use reliable, credible evidence to support their clinical decision-making that allows them to meet the expectations of evidence-based practice (EBP) (Fitzpatrick, 2009). EBP refers to making decisions about patient care that are based on the best evidence produced by clinical research combined with nursing expertise and the patient’s desires and views (Barker, Linsley and Kane, 2016). Not only does EBP enhance the quality of care patients receive, it also reduces medical complications and reduces health-care costs (Jeffs et al., 2013). EBP allows nurses to expand their knowledge and skills in order, to deliver high-quality health care based on research and knowledge, rather than supporting possibly outdated nursing traditions.

(2015) found that there was not a difference in pre-test scores depending on education level or work experience. Goode et al. (2015) did note important difference note in EBPQ depending on education and work status. Most research done on EBP only partially meets the goal, as it is often noted that more research is required. Studies that show the effectiveness of online EBP classes or courses via pre and post-testing; it is still unclear if the knowledge changed behavior in practice. Time restrictions and lack of background knowledge of EBP and research are noted to be hindering factors from nursing school education to implementing in clinical settings. The lack of background knowledge of EBP and research was even an issue for graduate nursing students. This indicates the importance of front loaded EBP courses in nursing school, prior to graduate level in nursing education. Hauck et al. (2014) research supported the receptiveness and improvement of direct care nurses whom were supported by management with the resources and time for education and mentoring in EBP. Financial and time restrictions are often the hindrance involved with implementing EBP education in clinical settings. Further research is needed to evaluate the implementation of EBP into practice settings, effectiveness of EBP courses and competency of educators. Further beneficial resources for nurses and students would be access to data bases and journals. Best practice is the most current EBP research available to date. Nurses must come together and support one another in obtaining EBP knowledge and implementation. Nurses can join committees for policy and procedure updates to ensure EBP is included. Nurses can get involved in developing EBP guidelines for best practice to have readily available to direct care nurses. Nurses can mentor and support coworkers during the EBP implementation transition. Nurses advocate for their patients daily. Getting involved and supporting

Although the benefits of EBP are widely acknowledged, implementing EBP in daily clinical care is hard to achieve because of many obstacles such as lack of time, demanding workloads, lack of knowledge of the process of EBP, and organizational culture that does not support EBP. In addition, inadequate financial support, insufficient resources, lack of access to resources, and unrealistic goals for better quality of care are also included (White et al. 2013). These obstacles are usually associated among nurses because they don't have the support and encouragement by the administraton of the hospitals or healthcare organizations. Let's find out the strategies in the findings of researchers about these barriers.

The study done by White-Williams et al. (2013) recognized how certain variables among the nursing staff affected their use, knowledge, and attitudes of EBP. These variables were correlated with a higher overall score on the

In considering the implementation of EBP’s, it would be easy to presume that initiating best practice would meet limited resistance, as these measures have been proven to have the most favorable outcomes when treating patients. However, this is not the case as health professionals from multiple disciplines cite many barriers that prevent carrying out these best practices. As listed in Melnyk & Fineout-Overholt; some of these are knowledge and skills deficit, attitudes

A 5-point semantic differential scale was used for collecting nurses’ perceptions of their skills for performing different EBP activities: a response of ‘‘poor’’ received a score of 1 and a response of ‘‘excellent’’ received a score of 5. A set of 9 statements was used for capturing information about their abilities related to implementing EBP. The first statement asked about their ability to identify potential clinical issues or problems where they can implement EBP. The mean score for this statement was 3.25, which indicated that the nurses felt that they possessed slightly above average ability to identify clinical problems (Table 3). However, the mean score for the next statement, dealing with their ability to translate a clinical problem into a well-formulated clinical question, was

Most were older than ten years old and the authors did not use any references dated within the last five years. The authors did not effectively critique the research used in the literature review. The review of the literature has an almost biased tone as it mostly discusses that nurses would like to implement EBP into their practice but they have many barriers to overcome. Although specific citations were made concerning relevant information, the authors often used terms like “some” and “many” in reference to findings. In these instances a substantial citation could have been more effective in depicting the scope of the problem. Within the literature review, the authors did not discuss the strengths or weakness of the research they used nor did they offer recommendations for future areas of study.