Certainly, there are obstacles to the implementation of EBNP, and many of them are interrelated. Unsurprisingly, the issue voiced most by nurses in sheer amount of time it
takes to affect any sort of change. Already consumed in managing patients’ care, many of them see evidence-based practice as an added step and time drain in their workflow ((Melnyk, Fineout-Overhold, Gallagher-Ford, & Kaplan, 2012). Here, it can help to remind them that the conversion may not be as time-consuming as perceived and that the result will be more effective care, which, in turn, can save time. Another obstacle cited is limited access to literature. This could be caused by a lack of knowledge about how to access and search a database, the absence of computers at bedside or nursing stations or medical libraries with a dearth of information related specifically, to evidence-based nursing research. And, even with easy access to the appropriate information, many nurses have no knowledge or education in critical assessment of literature, requiring a new skill and reinforcing their concerns about time.
Another stumbling block is a factor inherent in the profession of nursing, which emphasizes practical vs. intellectual knowledge. Nurses do what they know best. Seasoned caregivers who did not encounter evidence-based practice principles in their education are comfortable and confident in the way they deliver care, believing their practice already is the best it can be. ((Melnyk, Fineout-Overhold, Gallagher-Ford, & Kaplan, 2012.)
Nurses also may be part of a work environment that does not encourage information-seeking, due to perceived lack of time, actual lack of resources and skepticism of the value of research and integration of findings into patient care. This can be especially true in organizations with few new nurses or that lack a researcher on staff. And, of course, healthcare institutions are being pulled in a myriad of directions at once, and leadership may have other goals to which they’ve assigned a higher priority.
The steps in addressing and resolving this issue:
If an organization truly wants to advance – and, importantly, sustain – a culture of
evidence-based nursing practice, there are tactics that can be used to minimize
opposition and encourage buy-in. First, it’s important to engender a strong belief by clinicians that evidence-based practice improves care and enhances outcomes. This assertion can be supported by looking at the organization’s own population, as well as the mass of research
that clearly shows the positive impact of evidence-based practice. This process likely will be easier for a clinical setting already working in partnership with an academic institution that can provide ready access to research and research assistants (Malone, R. 2008).
Next, nurses must be assured they will have the resources they need to increase
their knowledge of, and skills in, EBNP. This means access to webinars and
continuing education and other learning tools for all nurses, no matter their
position in the chain of command (Malone, R. 2008). The implementation of evidence-based requires both individual and organizational behavior change.
Melnyk B, M. Fineout-Overholt E, Gallagher-Ford L, Kaplan L (2012). The state of
evidence-based practice in US nurses: Critical implications for nurse leaders and
educators. Journal of Nursing Administration, 42(9):410-7.
Rycroft-Malone J (2008). Leadership and the use of evidence in practice. Worldviews on Evidence- Based Nursing, Fourth Quarter,1.
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