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Evidence-Based Practice and Implementation in the Nursing

FieldAbigail Wade

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Introduction to EBPThe need for evidence-based practice in

the nursing community is rapidly becoming a necessity for the nursing community and administering necessary care to patients.

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o When I first began learned about EBP, I was shocked that it was even seen as a controversial issue.

o Although EBP is a seemingly recent topic of debate, EBP has been around for a long time.

o The term evidence-based practice was not used until the 1980s when an article was published by the Journal of American Medical Association that familiarized the community with the term.

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EBP in Nursingo Physicians have many patients that they are held accountable

for, and often do not have the time to spend with their patients as they should.

o This leaves nurses to be responsible for most care administered, so the implementation of EBP in the nursing community is just as, if not more important than EBP among physicians.

o Along with that, conflict begins to arise between doctors and nurses and their patients.

o Doctors and nurses are more knowledgeable than any source that patients may reference in order to bring up an argument about how their care should be administered.

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The Need to Implement EBP

Methodso With the healthcare environment of today, the use of

EBP is needed now more than ever.

o The increased level of knowledge that patients can gain from a number of readily available sources, means that patients are less likely to tolerate doctors.

o There is a growing desire to release patient care from hospitals and to get them into an outpatient facility, in-home healthcare or to require no further care.

o The rapid advances in medicine and technology demand that hospitals and facilities are constantly updating their software, practices, and even care team management so they can do their jobs effectively.

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Analyzing Need for EBP

o The EBP methods put in place of an old method must be proven to be more beneficial and productive for the patient and medical staff.

o For research to be done, a problem with an existing policy or practice must be addressed.

o Once the problem is identified, research is started on a new care method.

o A very specific goal is set for the trials that are done, and expectations and possible outcomes are analyzed carefully.

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How Implementation Occurs

o The most common way of implementation is by completely throwing out an old practice and replacing it with a method that has been carefully researched.

o Another way implementation occurs is by modifying an existing method in some way.

o This method of implementation is easiest for medical staff to adjust to using than completely disregarding a previously used practice.

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Steps to EBPo Larrabee (2009), notes that the steps can be

interchangeable, occur in different orders, or some may be skipped all together.

o First, the need for change in practice must be assessed, and the best evidence located.

o Then the evidence must be critically analyzed, and after that, a change in practice can be designed, implemented and evaluated on a case-by-case basis.

o Finally, the change can be completely integrated and maintained within a practice. Each step has subsets within it that may vary.

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Dispositions of EBPo The way an individual feels towards EBP can also affect

how much they believe it benefits them personally.

o A study done be one source noted that although many nurses felt positively towards EBP, less than half of those that felt positively were likely to use it in their care.

o Belief in EBP was found to be higher than those who had participated in workgroups that studied or used EBP methods, but these individuals were less likely to trust their own instinctual beliefs and knowledge

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Arguments Against EBP: Costo The arguments against EBP are primarily bringing

attention to the fact that implementing EBP can be very time-consuming, and can be very costly.

o Many argue that the money spent on research and conducting it could be better spent on the patients directly, rather than in a seemingly indirect way.

o Finding the right individuals to conduct new research or locate existing evidence can be exhausting, and these staff members must be paid just as any doctor or nurse working in the facility.

o However, conducting research on EBP without adequate funding can result in finding evidence and research that is not of quality that patients deserve, and lackluster evidence can prove to be just as ineffective and a waste of valuable time.

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Arguments Against EBP: Timeo As with any research of experiment that requires

well documented and recorded evidence, it does take time.

o Research on potentially life-saving procedures can not be rushed or taken lightly, so it is important that an appropriate amount of time is granted, and the findings are not rushed.

o All circumstances must be acknowledged and tested before becoming official and used as a norm in the medical community.

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Countering Arguments Against EBPo Although large amounts of time and

money will be spent on research and running trials, the benefits that come from new methods far outweigh any cons.

o Often, new methods end up saving money and time.

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Using EBP While Minimizing Cost & Time

o In order to implement EBP without spending nonexistent resources, oftentimes medical facilities will use research that others have done.

o By using research done by others, this can drastically cut the cost of any EBP method imaginable, and make it easier for medical facilities to stay up-to-date with the most effective care possible.

o As long as findings are carefully documented and recorded, information and findings can be shared across the boards of medical facilities.

o Tests and trials must still be run at the facility they will be used at, but not as extensively as if it were an entirely new project.

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Sources of Researcho It does not matter where the information for a new EBP

method has come from, as long as the source can be deemed trustworthy and reliable.

o Regardless of how the information was gained, implementation of EBP methods and practices are crucial to today’s healthcare environment, patients, and medical staff.

o New research is done every single day, and if nurses and doctors were not to keep up with it, these practices and methods would never change for the better.

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Concluding Thoughtso Without implementing evidence-based practice, practices

and methods that could be improved or altered to reduce healing time or reveal a cure for a previously incurable disease are left untouched and ignored.

o The arguments against EBP for reasons of cost and how it can be time-consuming are not weighing over the idea that any EBP method implemented will be well worth any time or money used.

o In hindsight, without some EBP methods already been put in place, the medical world would not be where it is today with advances in technology and new practices discovered every day.

References:

Larrabee, J. (2009). Nurse to nurse: Evidence-based practice. New York: McGraw-Hill Medical.

McKay, C. (2007, August 1). Evidence based practices in mental health: Advantages, disadvantages, and research considerations. SPARC, 4(7). Retrieved from http://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1014&context=pib.

Poe, S., & White, K. (2010). Chapter 1: Transforming nursing practice through evidence. In Johns Hopkins nursing evidence-based practice: Implementation and translation (pp. 4-21). Indianapolis, IN: Sigma Theta Tau International.

References:

Rahman, A., & Applebaum, R. (2011, June 10). What's all this about evidence-based practice? The roots, the controversies, and why it matters. ASA Generations. Retrieved from http://www.asaging.org/blog/whats-all-about-evidence-based-practice-roots-controversies-and-why-it-matters

Stokke, K., Olsen, N. R., Espehaug, B., & Nortvedt, M. W. (2014). Evidence based practice beliefs and implementation among nurses: A cross-sectional study. BMC Nursing, 13(8). doi:http://dx.doi.org/10.1186/1472-6955-13-8

Timmermans, S., & Mauck, A. (2005, January 1). The promises and pitfalls of evidence-based medicine. Health Affairs. Retrieved from http://content.healthaffairs.org/content/24/1/18.full