Nursing is an essential aspect of medicine, and despite being viewed as an understudy of medication, various fundamental elements in the discipline cannot be ignored. In Nursing, the rules that govern the subject cut across medicine as well, and nursing consists of caregiving, which is a vital element of medicine. Once a person is taken care of properly by their nurse in a clinical setup, it aids in their recovery and their health. Nurses are responsible for ensuring that the patients have had their medicine administered to them and that they have been given general care, and it enables the patient to feel a certain way. It goes a long way in facilitating their general wellbeing (Browne, 2018). There are absolute essentials that aid these caregivers in ensuring that they have been able to give their best in their line of duty.
Steps to integrating evidence-based practice into the clinic environment
Several steps are used to make sure that evidence-based practice is engrained in the clinic environment. These steps are vital to any method that undertakes caregiving, and that follows the rules as stipulated in the ethics of medicine. The first step of integration is to select a framework in which decisions are made, this framework mostly consists of other practitioners within the clinical environment, and this may include the caregivers. The science of implementation has been able to gravitate towards a systematic approach, and this type of procedure uses specific theoretical frameworks that enable the whole process to be guided in a particular manner (Melnyk, 2014). The challenge of this is that there are likely to be disagreements, and therefore it may lead to consensus, and also making decisions may, in turn, become tedious in the long run (Melnyk, 2014). For this process to succeed, there need to be critical individuals in practice to be involved in the decision-making process.
The second step involves asking the clinical question, and this primarily consists of developing a PICOT question, and this is critical in ensuring that the clinical problem can be identified. This should include the patient population, and under this, there are specific considerations that need to be made, such as ethnicity, gender, and patients with particular healthcare problems (Melnyk, 2014). Interventions, Comparisons, Outcomes, and Timing also constitute the PICOT question (Browne, 2018). The barrier to this is having all these different elements, and it can stretch resources if the PICOT question is not sought after, and the nurses are likely to suffer, probably due to overpopulation issues.
The third step is to evaluate the reliability, applicability, and validity of the team to answer the clinical question. The team of members that have been selected must delve deep into examining the quality of evidence that has been collected during the literature research. The barrier to this may be the interpretation and comprehension of the literature, and it would be best to draft a combined report that has been compiled by the whole team (Browne, 2018). The next step is determining a grade that can be able to guide the recommendations that are used to incorporate findings into practice.
The application of the evidence closely follows this into practice, and this is where theory changes into practice. Drafting and formulating these clinical questions is the more natural part of the whole integration process. The barrier to this is that during the practice, some things can be left out that had been discussed in the meetings, and to avoid this, the integration needs to be done systematically, which can be through a step by step process (Melnyk, 2014). This step is then followed by dissemination of results, and they are often communicated through meetings and conferences in most organizations.
The most outstanding barriers for the implementation of evidence-based practice include the lack of education about the EBP and also poor leadership to support the integration of the EBP fully into the organization (Browne, 2018). It is vital for the organization’s leaders to remove the barriers to facilitate the spirit of inquiry. Once the sense of investigation is given leeway, it enables there to be clinical questions, and these questions have to be answered because they give perspective and knowledge. They are also capable of improving the care providing process in the organization (Melnyk, 2014). Coupled with these steps are formulation of an answerable question and this is done to promote the aspect of being inquisitive which enables the asking of question to improve health care. After that step there is the systematic search for the research evidence to be able to promote evidence based practice in the facility. To ensure that the implementation of the EBP is a thriving hospital and medical facilities must ensure that they have created structure and processes and this is closely followed by increasing access to databases by the staff to promote EBP.
Internal evidence that could be used in providing data to demonstrate improvement in outcomes
Various quality improvement strategies can be used by the practice to verify the integration process is working and that it has been able to impact the whole facility and the nursing practice at large because the caregiving aspect is vital for the facility. The first step is to enact a PDSA, which is known as a Plan-Do-Study-Act, and this will enable us to gain knowledge of the favorable outcomes of the whole process (Melnyk, 2014). This method is usually used for rapid cycle improvement. This method enables the growth of quality efforts to establish a causal relationship between changes in processes and outcomes.
The six sigma is also used to demonstrate improvements in the outcomes, and it involves designing, monitoring, and improving the process to eliminate waste at the same time optimizing satisfaction and increase stability in the facility (Browne, 2018). The lean production system is also used by the facility to overlap the six sigma process because it aims at identifying the needs of the customers and improve operations by removing activities that do not add value.
Root cause analysis is also used, and given that it is mainly used in the engineering process, it can be used to investigate and solve problems by looking into the root causes of those problems and addressing those problems in an effective manner (Browne, 2018). This can be closely followed by failure modes and effects analysis. Through this, we know that errors are likely to occur, and at times these errors cannot be predicted the FMEA is an evaluation technique that can identify and eliminate known or potential failures in a system before they can occur (Melnyk, 2014). A HFMEA can also be conducted, and it is used as a risk assessment tool in the process.
The end justifies the means, and in this process, the outcomes will be indicated by how much importance was given during the process of implementation and integration. The EBP integration process has to be given attention and detail to work, and the clinical questions have to be asked for the process to work. If the leadership does not ensure that there is a spirit of inquiry, the process may be completely undermined.
Browne, K. (2018). Organizational Planning for Adopting Evidence-Based PracticeMelnyk, B. M., Gallagher‐Ford, L., Long, L. E., & Fineout‐Overholt, E. (2014). The establishment of evidence‐based practice competencies for practicing registered nurses and advanced practice nurses in real‐world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence‐Based Nursing, 11(1), 5-15.
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