Integrating Evidence-Based Practice

Introduction

Evidence-Based Practice is essential in clinical practice as its objective is to offer the most appropriate care available to improve patient outcomes. This is because patients expect nurses to provide them with the best care in consideration of available evidence. EBP enables nurses and other healthcare providers to critically think when dispensing care. Care has to be disseminated based on the best available evidence combined with the patient’s preferences involving their family and the interdisciplinary team. When all these people work together, the patient receives the best available care hence improves their outcomes. This paper will look at steps that are vital in integrating evidence-based practice in a clinical environment and  some of the barriers that nurses face while implementing EBP.

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Eight Steps to Integrating Evidence-Based Practice into the Clinical Environment

Integrating evidence-based practice into the clinical environment the right way is essential in determining its success. This is the reason Melnyk and Fineout-Overholt (2015) suggests the eight steps to make this happen. The following are the eight steps that are critical in this process.

Step 1 – Establish Formal Implementation Teams

This involves enlisting advanced practice nurses and other clinical team leaders in the integration process. The reason for enlisting APNs is because they have more expertise and skills in the nursing profession in comparison to other nurses. They have specialized in their preferred fields of practice hence possess the right qualifications to lead an EBP implementation team.

Step 2 – Create Excitement

This involves creating discomfort within the status quo. It will involve enlisting the opinion of local leaders who have experience with the need to have a change in practice. If you find an influential member of the society who has had a negative experience with the current way of operations; they will influence others and make them see the need to have the change. Speakers from outside the institution can also play an important role in motivating and inspiring key stakeholders into buying in the change.

Step 3 – Disseminate Evidence

To successfully disseminate the evidence, you need to employ more strategies to increase awareness on the need for change. Those people who are skeptic need to receive more information to make them believe in the change. Also, there has to be enough time to take in the new practices to a point that the implementers are comfortable with the practice.

Step 4 – Develop Clinical Tools

There also has to be clinical tools and processes that the members of staff will use to implement the change. An example of such a tool is PICO that is used to form and answer a health related question in evidence-based practice. The staff also has to have easy access to clinical resources; some of the resources include journals from professional bodies that help nurses advance their practice. The staffs also need constant exposure to evidence-based information to be up-to-date with current practices.

Step 5 – Pilot Test

It is important to carry out a pilot test before fully implementing the change. The site for the pilot test should consider the strength of the unit leadership, the diversity in patient population, perception, and location. After piloting, you will identify areas that need improvement where you will be at a better position to solve them. Depending on the magnitude of the challenges encountered during the pilot process, you will make a decision of whether to abandon, adopt, or adapt the change.

Step 6 – Preserve Energy Sources

In every change, it is expected that challenges will occur. It is for this reason that you have to engage personnel that you are sure will support the process. It is also recommended to implement projects in phases instead of implementing one large project at one go.  This will help you better manage and remedy challenges that come up. Also, you have to expect setbacks, therefore, persistence and patience are virtues that you need to have for the change to be implemented successfully.

Step 7 – Allow Enough Time

Implementing change takes time and should never be done in a hurry. You need to have a practical timeline of implementing the change. Developing incremental project steps is a good way to do this as it is easier to identify problems in each step.

Step 8 – Celebrate Success 

Lastly, in every successful step, you have to acknowledge the members of staff who have played a major role in its success. This creates morale and motivates them to do even more in adopting the change; mention their names to the administration and supervisors for recognition. 

Barriers to Implementing a New Practice

One of the barriers that might impede prevention of childhood obesity is uncooperative parents. One of the reasons for childhood obesity is unhealthy eating habits at home; most parents are busy with work hence have no time to prepare a healthy meal for the family. Getting the parent to adopt healthy eating is an uphill task. Another barrier is lack of time from the nurse to educate care givers when children come for check-up. This is necessitated by the huge number of patients that a nurse has to attend to hence finding no time to provide patient education to parents. Also, it may be difficult to convince the school administration to change their menu into a healthier one. This is because most school cafeteria’s serve unhealthy foods such as French fries and soda to their students (Ginex, 2018). 

Strategies to Increase Success and Overcome Barriers

To overcome the above barriers, hospital administrators can increase the number of nursing staff to lessen the number of patients that a nurse has to serve. This will leave more time for them to provide health education to caregivers and parents on ways to prevent childhood obesity. When parents have enough information on this, they will take the initiative to petition school administrators in schools that their children attend to change the cafeteria menu into a healthier one. When the petition comes from parents, the school administration will take action faster as parents are major stakeholders in the school (Ginex, 2018).

Describe Six Sources of Internal Evidence that could be Used in Providing Data to Demonstrate Improvement in Outcomes.

The six sources of internal evidence are quality management, finance, human resource departments, clinical systems, administration, and electronic medical records (Melnyk & Gallagher-Ford, 2015). 

  1. Quality management – this include incident reports and patient satisfaction scores. Also when you accreditation, there is some information that the accreditation body needs to provide it; this information is also a source of data to determine improvements in outcomes. Patients’ satisfaction scores are probably the biggest source of data to establish if there is improvement in service delivery. This is because patients are the main consumers of any service at a healthcare institution hence the primary focus of the facility should be to satisfy them. 
  2. Finance – this include charges for tests, equipment, supplies, medication, patient days, and readmission rates.  The number of days a patient stays at the hospital and the rate at which they are readmitted are important indicators of gauging outcomes. If patients take too long at the hospital or get readmitted a few days after discharge, it means that the type of care administered was ineffective. 
  3. Human resource department – staff education levels, turnover, staffing ratios, and contract labor use.  High staff turnover indicates dissatisfaction of members of staff with the administration.  Their education level is important in determining if they have the required education and skills to provide efficient health care services. 
  4. Clinical systems – patient diagnostic data, test results, and prescription are another source of evidence.  Diagnostic data can help establish if there is success in reducing the prevalence of a certain illness. This can also be determined by lab tests results and prescription information.
  5. Administration – the administration receives patient complaints; the complaints will reveal if there is an improvement in outcomes.
  6. Electronic Medical Records – all information regarding the patient is found in the EMR. When there is an analysis of this information, it will deduce a trend that will aid in demonstrating improvement outcomes. 

Conclusion

Integrating evidence-based practice into the clinical environment requires coordinated effort from all the stakeholders. One has to follow the necessary steps to make the change a success. It is therefore the duty of the hospital administration to ensure that they provide all things that are necessary to make the implementation of the EBP process a success. 

References

Ginex, P. K. (2018). Overcome Barriers to Applying an Evidence-Based Process for Practice Change. Retrieved from https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-change

Melnyk, B. M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed.) Philadelphia, PA: Wolters Kluwer Health. ISBN: 978-1-4511-9094-6.Melnyk, B. M., & Gallagher-Ford, L. (2015). Implementing the New Essential Evidence-Based Practice Competencies in Real-world Clinical and Academic Settings: Moving From Evidence to Action in Improving Healthcare Quality and Patient Outcomes. Worldviews on Evidence-Based Nursing, 12(2), 67-69. doi:10.1111/wvn.12089

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