Eight Steps to Integrating Evidence-Based Practice
Evidence-based practice (EBP) is defined as an approach aimed at solving health issues, by integrating the best evidence from well-designed surveys with the values and preferences of patient and clinicians expertise (Melnyk, et al., 2014). EBP comprises of eight steps, which commences with cultivating a spirit of inquiry and incorporates it to the EBP environment and culture. The second step involves the use of PICOT format to ask questions, which includes the aspect of the population, intervention, control, outcome, and time. This step is followed by a literature review or searching for the best evidence and Lodewijckx et al. (2012) explain that it requires being in line with the PICOT question.
The fourth step is evidence appraisal, which is conducted to select the most relevant articles for a study in terms of validity, reliability, and applicability to the research problem. The following step is the integration of evidence with clinical expertise and patient values and preferences. The sixth EBP step is outcome evaluation, which assists a researcher to remedy any negative effects while supporting positive effects. The researcher then provides a detailed description of every key intervention: references, description, rationale, and grading. The eighth step is the dissemination of EBP information through conferences in health facilities, reports in peer-reviewed journals, or EBP rounds in health facilities.
Barriers to the Implementation of Evidence-Based Practice
Several factors inhibit the use of evidence-based practice in everyday nursing practice. The major barrier to the use of EBP is lack of enough time where for example, nurses are required to cater for several patients at ago and EBP steps may be too much for the nurse. JoAnn (2019) explains that nurses and clinicians face high demands in the provision of quality patient care and limits on available structures, resources, and time. Additionally, nurses lack sufficient knowledge of the implication of EBP in improving patients’ outcomes and saving costs.
The second barrier is a culture that fails to support EBP, where, in very busy health facilities with inadequate staffing it is challenging to implement the aspect of EBP. Warren et al. (2016) explain that nurses face varying resistance from nurse leaders and nurse managers, which is challenging as nurse leaders and managers require to be role models in EBP implementation. The issue of education poses a challenge in EBP implementation where nurses in education system 20 years ago did not learn these aspects. Another problem is that educators and administrators illustrate EBP as a consistent approach in the provision of quality care rather than an extra project or duty.
Strategies for EBP Implementation
One factor to consider while implementing EBP is that it cannot be attained overnight and requires a change of behavior, which takes time. One strategy that can result to behavioral changes is by placing nurse managers and leaders as bedside mentors for EBP, to work hand in hand with nurses and clinicians to assist them to learn and understand skills required in EPB. The aspect of education can be rectified through enrollment to online continuing programs where nurses and clinicians access EBP membership skills from across the world. Another strategy is the integration and collaboration of health professionals. JoAnn (2019) explains that there is need to reframe the understanding of nurses on the forms of information applied in clinical decision making, by impacting them with the knowledge to garner information from aesthetic, personal, ethical, and empirical sources of professional nursing practice.
JoAnn, M. (2019). Call to action: How to implement the evidence-based nursing practice. Nursing Center.
Lodewijckx, C., Decramer, M., Sermeus, W., Panella, M., Deneckere, S., & Vanhaecht, K. (2012). Eight-step method to build the clinical content of an evidence-based care pathway: the case for COPD exacerbation. Trials, 13(1). doi: 10.1186/1745-6215-13-229
Melnyk, B., Gallagher-Ford, L., Long, L., & 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. doi: 10.1111/wvn.12021
Warren, J., McLaughlin, M., Bardsley, J., Eich, J., Esche, C., Kropkowski, L., & Risch, S. (2016). The Strengths and Challenges of Implementing EBP in Healthcare Systems. Worldviews On Evidence-Based Nursing, 13(1), 15-24. doi: 10.1111/wvn.12149
Part 2: Sources of Internal Evidence
Wager, Lee, and Glaser (2017) explain that there are six sources of internal evidence that a health facility can apply in the provision of information that will improve health outcomes. The sources include EMR, administration, clinical systems, human resource department, and finance and quality management. The first element is the Quality Management Department Information, which strives at increasing patient satisfaction and improving the effectiveness of treatment. Due to the increasing need for patient-centeredness in health care, quality management is highly applied by health managers to monitor patients’ opinion and outcome using subjective and objective means. Some of the sources of internal evidence using quality management are through data collection by accreditation or regulatory bodies, patient satisfaction scores, and incident reports.
Electronic medical records (EMR) according to Cowie et al. (2016) plays a vital role in enhancing patient care, facilitating clinical research, and promoting performance measures in clinical practice. As a source of internal evidence, EMR represents longitudinal data (in electronic format), which is attained during the day to day routines. Cowie et al. (2016) explain that EMR improves healthcare quality and have the potential to assess research feasibility, enable client recruitment, restructure data collection, and perform comparative effectiveness studies, or post-marketing randomized registry studies, or embedded pragmatic, or conduct entirely EHR-based observational, which help in research that is source of internal evidence.
Sittig and Singh (2015) explain that a healthcare information system captures, stores, manages, and transmits data that relates to the organization’s or individuals’ activities. Hanf and Finn (2014) explain that the financial system manages billing submissions and tracks the revenue of a health facility. Accordingly, it provides information on readmission rates, charges for patient days, medical equipment, medications, and tests. With this, health care organizations are able to track all the money in and money out to identify the profitability of the organization.
Another division of the health information system is clinical and administrative health information system. Nguyen, Bellucci, and Nguyen (2014) explain that all health facilities are required to have a patient administration system. Nguyen et al. (2014) explain that patient administration is responsible for providing information to health managers in the form of hospital episode statistics and retrospective data entry. The retrospective data entry is responsible for entering the patient’s information after they are discharged, as well as information for every care episode.
Clinical information system depends on other administrative information or systems. A clinical information system is defined as a computer-based system that collects, stores, manipulates, and avails clinical information that is vital in healthcare delivery (Sittig and Singh, 2015). One role of a clinical information system is that it allows the production of patients’ data, as well as patient follow-up. It is typically applied in pharmacy data and diagnostic test.
The last element is the human resources information system (HRIS), which according to Mosadeghrad (2014) the system supports several human resource management practices like performance management and recruitment of employees, as well as providing leaders with vital information to manage resources. HRIS is available in hospitals as hospital information systems (HISs), components of integrated enterprise resource planning (ERP), or stand-alone packages (like payroll). Some of the measures for human resource include staffing ratios, provider skill mix, contract labor use, hours by labor or pat category, employees’ education levels, and turnover rate.
Hanf, T., & Finn, C. (2014). U.S. Patent No. 8,799,006. Washington, DC: U.S. Patent and Trademark Office.
Mosadeghrad, A. M. (2014). Factors influencing healthcare service quality. International journal of health policy and management, 3(2), 77.
Nguyen, L., Bellucci, E., & Nguyen, L. T. (2014). Electronic health records implementation: an evaluation of information system impact and contingency factors. International journal of medical informatics, 83(11), 779-796.
Sittig, D. F., & Singh, H. (2015). A new socio-technical model for studying health information technology in complex adaptive healthcare systems. In Cognitive Informatics for Biomedicine(pp. 59-80). Springer, Cham.Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems: a practical approach for health care management. John Wiley & Sons.
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