Evidence-Based Practice (EBP) Model

The evidence-based practice model is the approach for integrating the best available resources, proper clinical expertise and values of the patients as well as the circumstances related to the management of the patient and the clients and also help in making good Healthcare Policy Decision making (Jordan et al., 2019). In the clinical setting, all these factors are essential and important to the establishment of the EBP (Bianchi et al., 2018). The aim of this part of the assignment is to describe the boundaries and the barriers to implementing evidence-based practice. The strategies of incorporating the EBP in a clinical setting with the help of supporting literature.

The authors Alatawi et al., (2020) the authors highlighted that the evidence-based practice is an essential approach to the overall patient’s condition and health. This also help in making ethical practices in research as it helps to solve many technical problems by implementing a well-designed and well-integrated plan to improve the patient-centric care. The authors mainly conducted the research to understand and explore the barriers the nursing professionals face during the implementation of the evidence-based practice (EPB). Determining these barriers can help to improve the implementation of EBP. The authors Alatawi et al., (2020) did a literature review. The authors gathered the peer-reviewed data from online databases such as CINAHL, EBSCO, MEDLINE and the web of sciences databases. The authors implied proper inclusion and exclusion criteria. The authors selected articles from October 2018 to December 2018. The authors for the articles chose articles written in English and selected this as the primary language for the paper. The authors after all these filters obtained around 12 articles out of which six articles were quantitative and five articles were qualitative ad one of the selected studies was of mixed-methods. The authors analysed the qualitative data with the help of a quality appraisal tool. The authors after the analysis observed the four organizational barriers in the study which are discussed are as follows, 1. The nurses have no proper knowledge and understanding (Paradiso & Lally, 2018), 2. The nurses did not receive proper training in the evidence-based practices (Alhalal, 2020), 3. The nurses lack of professional characteristics and the 4. The attitudes and experience of implementing the EBP (Al-Busaidi et al., 2019). The authors explained that the nursing administrators and the hospital administrators have an essential role to play in order to overcome the barriers in the implementation of EBP. The authors concluded that the training and education is a significant tools in reducing the barriers of introducing the EBP in a healthcare setting.

The authors Li et al., (2018) conducted an integrative review which is empirical and theoretical methods and a significant study method for a study. The author highlighted the organizational contextual features for implementing the evidence practices across healthcare settings (Nilsen & Bernhardsson, 2019). This is a significant determinant and is used over the decade. The authors help from the online databases such as the CINAHL, Embase, Medline, the web of sciences, PsycINFO and Cochrane databases. The authors imposed the selected timeline of 2005 to 2017 and selected English as the prime language of the study. The authors selected the peer-reviewed articles for the research. The authors used the Mixed methods appraisal tool for the analysis of the qualitative data. The authors when searching the topic generated around 5152 articles ad after the duplicates and eligibility filters criteria was applied, only 36 articles were included in the studies in which 11 articles were quantitative articles and 5 articles were mixed studies. The authors highlighted the organizational gestures which are the cultural aspects followed in the organization, the type of leadership followed in the setting, the network and communication, resources in the setting, monitoring and the evaluation of the productivity in the healthcare setting, feedback and the communication. These aspect influence implementation of the EBP in the healthcare setting. These factors construct Consolidated Framework for Implementation research (CIFR). The organizational culture is a significant barrier to the implementation of EBP (Yoo et al., 2019). The authors focused on this aspect the most throughout the research. The authors also put forward that the leader in the organisation is an essential aspect of the implementation of EBP. The authors concluded in the study that the set of organizations discussed through the review is the essential component for the implementation of the EBP.  Evidence-Based Practice In Healthcare Settings Discussion Paper

Barriers To Implementation Of EBP

The authors Mahmoud & Abdelrasol, (2019) conducted a descriptive study to understand the boundaries in introducing the EBP practice. The intervention which is the evidence-based practice is known to provide positive outcomes to the patients (Zwakhalen et al., 2018). The author’s main aim for conducting the research is that there are significant boundaries faced by the nurses in applying the EPB in the healthcare setting. The authors conducted the study at the Benha University and hospital and took data from 164 nurses using the convenient sampling method. The tools that were used were the sociodemographic data sheet for including the characteristics of the patients. The obstacle scale was also used for understanding the utilization of EBP (Mahmoud & Abdelrasol, 2019). The authors found that the greatest obstacle faced for the implementation of the EBP is the limitations in the organization which is followed by the research quality and the accessibility of the research and the last is the skills and attributes of the nurses (Duncombe, 2018). The statistical correlation between the organization limitation and the nurse’s age, level of education and experience play significant boundaries (Maan et al., 2020). The authors concluded in the study that the expansion of the knowledge and expertise of the nurses plays an essential role.

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The authors Camargo et al., (2018) conducted an integrative review and stated in their study that the knowledge of the nurses and their attitudes plays an important role in the implementation of the EBP. As the EBP shows a direct correlation with the knowledge of the nurses which would affect the care that is provided to the patients.

The Melnyk and the Fine-Overholt have developed the framework for the advancing research and the clinical practices through the process of the close collaboration (Abaraogu et al., 2018). The ARCC model focuses on the system-wise establishment of the EBP in order to achieve quality healthcare treatment (Melnyk et al., 2021). This model is tested by several researchers and it was found out that over the course of the 12 months and it was believed that the patient’s healthcare outcome was significantly increased ad also the patient’s satisfaction increased drastically. The implementation of the EBP integrates positive movement for better organizational health records (Patton et al., 2022). Understanding the availability of the resource, considering what are the available resources specific to the field in which research is conducted, the establishment of the patient-centric goals and the identification of the preference. The need to incorporate research findings in decision-making is driven by the speed with which proper healthcare is delivered, as well as the professional duties of clinical professionals to ensure high-quality treatments. Healthcare practitioners, individuals, and institutions all benefit from the implementation of EBP (Mejia et al., 2021). EBP integration in healthcare situations is a complex procedure that necessitates a variety of solutions, including personal and organisational aspects, as well as patient-related factors. Transformative leadership management teams and decision makers can ascertain strategic planning based on the enablers and barriers of EBP, and then start providing the heritage and required infrastructure to assist diagnostic and therapeutic staff in developing EBP knowledge and skills and a professional career, resulting in staff career advancement and improved quality of healthcare services. According to the authors, Mathieson et al., (2019) evidence-based research is known to improve the quality of life of the people in a health care setting. This similar factor is highlighted in the previous paper research paper as well. The authors explained that less research is conducted on the topic of community nursing hence the improvement strategies of implementation and improving the evidence-based practice are also less researched. The authors concluded that the implementation of EBP is a growing field of study, although it is hampered by a lack of language uniformity and a restricted application of the concept. Community nursing implementation is a difficult process that necessitates individual and organizational acceptance as well as administrative assistance (Powers et al., 2020). Evidence-based practice, on the other hand, can only be adopted successfully if nursing professionals find it beneficial and there is data that it will benefit the patient and as well their healthcare provider. The authors Bruns et al., (2019) conducted a study to understand the role of the policies, demographics and fiscal factors in the implementation of EBP. The authors highlighted in their study that a number of unchangeable state criteria, such as per capita growth, the prevailing major organization, and the Supplemental nutrition assistance program, predicted the level of government financial expenditures in EBT. Modifiable characteristics, such as enhancing cooperation and expenditure in research institutions, were found to be more explanatory of EBT-friendly governmental policies. The level of adult EBT acceptance was linked to state financial assistance for EBT, whereas child EBT acceptance was more strongly linked to supporting regulations (Balasuriya et al., 2021). Both infant and adult EBT adoption were predicted by governmental per capita expenditure and direct state administration of facilities rather than outsourcing for commodities. The authors concluded that the adoption and the association of the EBP are linked with the array of policies, demographics and several fiscal factors. The authors Kendall & Frank, (2018) conducted a study to understand the protocols for implementing the evidence-based practice. The authors described that EBP is an umbrella that is associated or linked with the characteristics of the patients, their culture and beliefs and also their preferences. All these factors are combined with the knowledge available in order to implement the EBP in a clinical setting. The authors concluded their study by explaining that as the interest of the patients grows in the upcoming years the approaches related to the implementation of the EBP also would also expand.

Strategies For Incorporating EBP In Healthcare Settings

It can be analysed that implementing evidence-based research is challenging a difficult in a clinical setting and hence proper strategies are needed for the implementation of the EBP.

The part of the assignment identifies the PICO question related to the implementation of evidence-based practice in a clinical setting and also provides a comprehensive search related to the literature review conducted in part 1 of the assignment.

The articles for the essay were searched using the keywords on the online databases. The online databases used for the search strategy are the Google Scholar and PubMed. These databases are selected for the study as these are the most authentic search engines where many articles are available which helps in implementing a wide search on the selected topic. The keyword used for the search are the “BARRIERS” and “BOUNDARIES” and “EVIDENCE-BASED PRACTICE” and “STRATEGIES”. The filters used for the search are: 1. The articles with the full-text availability are used for the research, these inclusion criteria are established to understand the relevancy of the content in the field of research. 2. The timeframe chosen for the research is for 2018- 2022 which is five years. 3. Articles that are written in the English language are selected for the research., this is selected as the inclusion criteria to help the prospective audience understand the context of the research. 4. The articles which are peer-reviewed journals are selected for the paper, these inclusion criteria are selected for the research to obtain the authentic paper. 5. The paper with the proper digital object identifier (Doi) or with proper Uniform Resource Locator (URLs) are selected for the research.

The PICO question identified in the research is: The problem faced by nurses (P) in implementing the Evidence based practice (I) vs not implementing the Evidence-based practices (C) in improving the patient’s condition in a clinical setting (O).

References:

Abaraogu, U., Ezenwankwo, E., Dall, P., Tew, G., Stuart, W., Brittenden, J., & Seenan, C. (2018). Barriers and enablers to walking in individuals with intermittent claudication: A systematic review to conceptualize a relevant and patient-centered program. PLoS One, 13(7), e0201095. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201095

Al-Busaidi, I. S., Al Suleimani, S. Z., Dupo, J. U., Al Sulaimi, N. K., & Nair, V. G. (2019). Nurses’ Knowledge, Attitudes, and Implementation of Evidence-based Practice in Oman: A Multi-institutional, Cross-sectional Study. Oman medical journal, 34(6), 521–527. https://doi.org/10.5001/omj.2019.95

Alhalal, E. (2020). Nurses’ knowledge, attitudes and preparedness to manage women with intimate partner violence. International nursing review, 67(2), 265-274. https://onlinelibrary.wiley.com/doi/abs/10.1111/inr.12584

Balasuriya, L., Berkowitz, S. A., & Seligman, H. K. (2021). Federal nutrition programs after the pandemic: Learning from P-EBT and SNAP to create the next generation of food safety net programs. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 58, 00469580211005190. https://journals.sagepub.com/doi/full/10.1177/00469580211005190

Bianchi, M., Bagnasco, A., Bressan, V., Barisone, M., Timmins, F., Rossi, S., … & Sasso, L. (2018). A review of the role of nurse leadership in promoting and sustaining evidence?based practice. Journal of Nursing Management, 26(8), 918-932. https://onlinelibrary.wiley.com/doi/abs/10.1111/jonm.12638

Bruns, E. J., Parker, E. M., Hensley, S., Pullmann, M. D., Benjamin, P. H., Lyon, A. R., & Hoagwood, K. E. (2019). The role of the outer setting in implementation: associations between state demographic, fiscal, and policy factors and use of evidence-based treatments in mental healthcare. Implementation Science, 14(1), 1-13. https://link.springer.com/article/10.1186/s13012-019-0944-9

Camargo, F. C., Iwamoto, H. H., Galvão, C. M., Pereira, G. D. A., Andrade, R. B., & Masso, G. C. (2018). Competences and Barriers for the Evidence-Based Practice in Nursing: an integrative review. Revista brasileira de enfermagem, 71, 2030-2038. https://www.scielo.br/j/reben/a/Jn6qys9NmzTnNYNjbtbyNNv/abstract/?lang=en

Duncombe, D. C. (2018). A multi?institutional study of the perceived barriers and facilitators to implementing evidence?based practice. Journal of Clinical Nursing, 27(5-6), 1216-1226. https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.14168

Jordan, Z., Lockwood, C., Munn, Z., & Aromataris, E. (2019). The updated Joanna Briggs Institute model of evidence-based healthcare. JBI Evidence Implementation, 17(1), 58-71. https://journals.lww.com/ijebh/Fulltext/2019/03000/The_updated_Joanna_Briggs_Institute_Model_of.8.aspx

Kendall, P. C., & Frank, H. E. (2018). Implementing evidence-based treatment protocols: Flexibility within fidelity. Clinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association, 25(4), e12271. https://doi.org/10.1111/cpsp.12271

Li, S. A., Jeffs, L., Barwick, M., & Stevens, B. (2018). Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: a systematic integrative review. Systematic reviews, 7(1), 1-19. https://link.springer.com/article/10.1186/s13643-018-0734-5

Maan, A. T., Abid, G., Butt, T. H., Ashfaq, F., & Ahmed, S. (2020). Perceived organizational support and job satisfaction: a moderated mediation model of proactive personality and psychological empowerment. Future Business Journal, 6(1), 1-12. https://link.springer.com/article/10.1186/s43093-020-00027-8

Mahmoud, M. H., & Abdelrasol, Z. F. M. (2019). Obstacles in employing evidence-based practice by nurses in their clinical settings: A descriptive study. Frontiers of Nursing, 6(2), 123-133. https://sciendo.com/es/article/10.2478/FON-2019-0019

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary health care research & development, 20. https://doi.org/10.1017/S1463423618000488

Mejia, M. C., Zoorob, R., Gonzalez, S., Mosqueda, M., & Levine, R. (2021). Key Informants’ Perspectives on Implementing a Comprehensive Lung Cancer Screening Program in a Safety Net Healthcare System: Leadership, Successes, and Barriers. Journal of Cancer Education, 1-8. https://link.springer.com/article/10.1007/s13187-020-01931-x

Melnyk, B. M., Tan, A., Hsieh, A. P., & Gallagher?Ford, L. (2021). Evidence?Based Practice Culture and Mentorship Predict EBP Implementation, Nurse Job Satisfaction, and Intent to Stay: Support for the ARCC© Model. Worldviews on Evidence?Based Nursing, 18(4), 272-281. https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12524

Nilsen, P., & Bernhardsson, S. (2019). Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC health services research, 19(1), 1-21. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4015-3

Paradiso, C., & Lally, R. M. (2018). Nurse practitioner knowledge, attitudes, and beliefs when caring for transgender people. Transgender health, 3(1), 48-56. https://www.liebertpub.com/doi/pdfplus/10.1089/trgh.2017.0048

Patton, L. J., Garcia, M., Young, V., Bradfield, C., Gosdin, A., Chen, P., … & Tidwell, J. (2022). Exploring nurse beliefs and perceived readiness for system wide integration of evidence based practice in a large pediatric health care system. Journal of pediatric nursing, 63, 46-51.    Evidence-Based Practice In Healthcare Settings Discussion Paper