Integrating Evidence-Based Practice in a Clinical Setting
Evidence-based practice (EBP) entails balanced, objective, and responsible use of research findings and the best available evidence to guide patient care and policies in the clinical setting while improving outcomes (Chien, 2019). EBP helps in decision-making, aiding in the provision of high-quality care, reducing the cost of care, and improving patient outcomes.
It also contributed to the clinical setting and improved nursing proficiency (Shayan et al., 2019). Therefore, integrating EBP in clinical settings is an integral part of the realization of quality care to patients as well as improving the clinical experience of care providers. The integration process follows some steps and is well associated with some facilitators and barriers to its use in the clinical setting.
This current paper is divided into two main parts. The first part will discuss the main steps of integrating EBP in the clinical environment, potential barriers to implementation, and strategies to overcome barriers and enhance success. The second part of the discussion will explore the sources of internal evidence that can be used to provide data regarding improvements in outcomes.
Eight Steps of Integrating Evidence-Based Practice
Integration of EBP is a crucial clinical matter that follows a series of steps. The first step is cultivating a spirit of inquiry which entails identifying the clinical issue, the population of concern, researchers addressing the clinical issues, and experts and stakeholders for the project.
The second step entails coming up with a PICOT question. PICOT is an abbreviation P stands for population, I for proposed intervention, C for comparison intervention, O for expected outcomes, and T for the time frame. PICOT sets the ground for searching for information from databases (Chien, 2019).
The next step involves finding research evidence from various databases that help answer the PICOT question. Vital information can be retrieved from reputable databases, including PubMed, MEDLINE, CINAHL, ProQuest, and Google Scholar. The use of keywords helps in finding relevant information on the topic.
The fourth step involves a critical appraisal of the evidence. This step helps in assigning the study articles to various levels of evidence as well as determining the validity, reliability, and applicability of the evidence to address the research question (Shayan et al., 2019).
After critical appraisal, integration of the clinical evidence follows. This step involves offering detailed evidence of how the findings are applicable in the clinical settings as well as involving other healthcare workers and stakeholders in implementing the research into clinical practice. Organizational factors that act as facilitators or barriers must be put into consideration. The implementation and evaluation of the EBP in terms of the expected outcomes follow.
In case of adverse outcomes, appropriate take effect to improve outcomes (Shayan et al., 2019). The final step of the process is the dissemination of the EBP findings. Dissemination can be achieved through paper works, brochures, PowerPoint presentations, or other online media. Multidisciplinary teams can be involved in the dissemination process.
Barriers to Implementation and Strategies to Overcome.
When implementing an EBP, there are expected barriers that come with changes, especially for patients with schizophrenia. One of the major obstacles is resistance to change. Introducing change can be faced with resistance, especially from top managers and nurses who oppose the change (Chien, 2019). Some may view the change as inappropriate and opt not to support the changes but rather be reluctant.
Overcoming resistance requires involving the leadership through communication about the objectives of the EBP and the expected outcomes. This can help the organization to adopt the change. Implementing social skill training can help improve the outcomes of patients with schizophrenia.
Yet, another obstacle related to resistance to change is a lack of education about the EBP changes. Focusing on training nurses about research rather than methods of integrating it contributes to hindrances in the implementation of the change. Offering EBP practicals can help improve nurses’ knowledge about EBP and the integration process, which can help facilitate implementation (Li et al., 2019).
Another possible obstacle is inadequate resources, such as nurses, to implement the project change. The shortage of nurses is a global health issue faced by various health organizations (Mathieson et al., 2019). Such shortage increases workload and lacks enough time to participate in the change project. Inadequate support from nurses can impact the implementation of EBP and can lead to the failure of the project.
Overcoming these challenges requires involving stakeholders in healthcare to address the issue of the nursing shortage and avail the resources to support change (Mathieson et al., 2019). In addition, the nurses should be educated about the importance of the project change to enhance their participation in the project.
Sources of Internal Evidence
Internal evidence provides data that can be used to assess improvement within the organization. These sources can range from health personnel, stakeholders, and documentation within an organization. The first source of internal evidence is the electronic health record (EHR).
EHR is used to collect and store patient information that can be retrieved. Furthermore, the patient record charts from EHR can be used to track patient progress and can be used in improving patient care (Li et al., 2019). Finding more information about an organization and patients can be obtained from the health information systems (HIS).
The information from HIS, including patient data, procedures, results, and laboratory data can be used in improving interventions. Personnel ranging from patients, healthcare providers, administration, human resources, and stakeholders can help provide internal evidence. Health practitioners can use information and experiences from interactions with patients. The information can help reveal the gaps and strengths of the organization that can be used to improve patient care.
Additionally, it can provide critical information regarding their experiences in healthcare which can be used to improve various sectors. They can also provide feedback to healthcare providers, which can be used in improving EBP outcomes. Another source of internal evidence is the administration which can provide vital information regarding patients.
The human resource department is part of the administration that can provide vital information regarding employees’ terms of employment, education, and activities (Mathieson et al., 2019). Information from the human resource can be used to improve performance and outcomes. Finally, the quality management department is another source of internal evidence that can provide reports in the healthcare center. This department helps provide the trends in healthcare that can be used to guide improvement initiatives.
Integrating evidence-based practice in a clinical setting is an important issue. However, it is a slow and tedious process. Understanding the process and the steps of implementation is vital to ensure the success of the project. The steps range from cultivating a spirit of inquiry to the dissemination of the evidence into clinical settings. However, during the process of implementation, there are barriers to be expected, and coming up with innovative strategies is paramount to overcoming the barriers. Using internal evidence is also helpful in improving interventions.
Chien, L.-Y. (2019). Evidence-based practice and nursing research. The Journal of Nursing Research: JNR, 27(4), e29. https://doi.org/10.1097/jnr.0000000000000346
Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses—a systematic review. Medicine, 98(39), e17209. https://doi.org/10.1097/md.0000000000017209
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(e6), e6. https://doi.org/10.1017/S1463423618000488
Shayan, S. J., Kiwanuka, F., & Nakaye, Z. (2019). Barriers associated with evidence-based practice among nurses in low- and middle-income countries: A systematic review. Worldviews on Evidence-Based Nursing, 16(1), 12–20. https://doi.org/10.1111/wvn.12337