Healthcare Critique

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Introduction

Evidence based nursing is a new approach in medical profession. It is an approach whereby evidence obtained from clinical research is to be promoted over unsystematic nursing experience, intuition, and pathophysiology. Although definitions and descriptions of the term may change and be diluted over a time, the basic understanding remains simple; it is the practice whereby information that is relevant and valid is used to arrive at decisions related to nursing profession, practice which is evidence-based has gained much momentum with definitions varying widely. Research findings, clinical knowledge, knowledge resulting from basic science as well as opinion from expert are all regarded as “evidence”. Practices that are based on research findings, however, have high chances of resulting into outcomes that match the desires of patients across different settings as well as geographic locations.

Research Problem

The challenge for evidence based practice is caused by the pressure from health care facility due to containment of cost, larger availability of information, greater sway of consumer regarding care and treatment options. This kind of practice demands some changes in students’ education, more research which is practice-relevant, and a working relationship between researchers and clinicians. Evidence-based form of practice also brings an opportunity for nursing care to be more effective, more individualized, dynamic, streamlined and opportunities to maximize clinical judgment effects. When there is reliance on evidence in defining best practices but not for supporting practices that exist, then nursing care is said to be keeping pace with recent technological changes and benefits from developments of new knowledge (Ellis, 2010, p.49). Although many young professionals have embraced this new approach, it has come with its challenges. A number of research studies have indicated that perception of nurses towards EBP is positive and they regard it useful to better care of patients. This research will critically analyze the barriers towards full acceptance of EBP.

Literature Review

A number of studies conducted with regards to this subject have shown that, EPB has generally received positive welcome from the nurses. However, previous researches indicate that the pace of acceptance and implementation of EBP is quite slow. A number of studies done previously have tried to look into the possible challenges behind the adoption of EBP. One challenge that the studies identified was the tremendous amount of literature for health care, often published in different sources that make it hard for medical practitioners to remain up to date (Melnyk, & Fineout-Overholt, 2011, pp.71-3). Estimates show that about 8500 articles that are relevant to practice of the family are published on monthly basis, with a medicine practitioner of family required to dedicate about 21 hours per day to be informed of the fresh evidence.

Different authors have revealed other barriers towards acceptance, application and implementation of EBP. Griffiths et al. reported that lack of resources, lack of time, as well as the inability to comprehend statistical analysis are the top challenges towards the adoption of this recent approach by nurses in t community. Pettigrew and O’Connor investigated the said challenges towards implementation of the strategy for some therapists who were practicing in Southern Ireland. According to their research, the main significant challenge they came across was inadequate time to look for, read, understand and draw interpretation from the research findings. Other challenges towards acceptance and adoption of the approach is the insufficient access to information technology, lack of adequate technological searching skills for information stored in soft copy, as well as the storage facilities. As a result of the large adoption in present medical fields, such challenges to embrace the new technique have received great focus of late. Comparison of experiences of participants with the approach across different health fields, Asadoorian et al. indicated that both work place structure and individual factors both act as barriers and enhancers to adoption and implementation of EBP.

Suleman and Mclnerney discovered a key barrier towards implementation of EBP. According to his report, such obstacles are experienced by practitioners in academic health care in implementation of EBP in an institution in South Africa. This involved lack sufficient knowledge towards regarding EBP, insufficient time, inadequate evidence, and lack of research findings access (Malloch, & Porter-O’grady, 2010, p.21). Through mainstream literature review conducted by Spross and Solomon, it was established that facilitators and barriers to EBP application arise at both institutional and personal level, with the most significant challenges being inadequate time and lack of power and autonomy to make changes in the practice.

EBP implementation brings extra demands on professionals notably nurses to, make proper application of valid credible evidence to personal client circumstances through searching the related evidence by use of clinical judgments and putting into consideration the client’s system resources and values (Ellis, 2010, p.28). To effectively embrace the EBP approach, besides the other basic skills necessary to carry out the nursing roles, a nurse should have the capacity to: find out knowledge gaps, come up with that relevant questions, carry out a literature search that is efficient, apply evidence rules to ascertain the validity of research, apply the finding s of the literature to tie specific patient and involve the client in decision making pertaining the clinical work. Previous literature from other sources also illustrates the obstacles for nurses who are new in practice since EBP entails reconciliation of values of clients with evidence and professional judgment, which could be particularly hard for such new recruits as a result of their inadequate experience.

Research design.

This will be a descriptive research design. Qualitative research does not, by definition, aim to precisely estimate population parameters or test hypotheses. However, most qualitative projects do attempt. This design was identified as the most convenient and ensured that the data obtained gave answers to the research questions. Descriptive design also offers the opportunity for a logical structure of the inquiry into the problem of the study. According to Dicenso (2005) descriptive surveys are good at providing information and explanations to research questions (p.45).

Methods of Data Collection

In this research, survey questionnaires were used as a means of collecting data. The questionnaire was formulated by a team that consisted nurses and professionals from information technology department in the university. Also, great deal of consultation was given to research survey instruments that have been used by previous researchers in the same subject. For this matter, the questionnaires that were previously issued tackling data seeking behavior and information needs of nurses and other medical practitioners were also given considerable weight in review. Review of draft copy of the questionnaire was conducted to ensure the contents were valid (Levin, & Feldman, 2012, p.12). This was performed by a group of experts consisting nurse researchers, lecturers of information studies, registered nurses, nursing managers. Some few changes were made to that effect.

Sample

This research covered a population size consisting all nurses in the state. However, a sample will be selected and presumption made that the sample will reflect the features of the entire population. In this research, cluster sampling technique was used. Under this method, a number of clusters were made and questionnaires issued randomly.

Data Analysis

Data was first edited to identify and eliminate errors made by respondents. Code numbers were assigned to each answer of survey question followed by the coding and listing of the frames obtained from the field. Coding is expected to organize and reduce research data into manageable summaries. Both qualitative and quantitative statistics were used to analyze the data. Quantitative data was analyzed using mean, percentages. Qualitative data will be analyzed based on content analysis.

Ethical Issues

Approval was obtained from the office of the Chief Medical Officer and a go ahead granted on the understanding that the respondents were aware that filling the questionnaire involved their giving informed consent.

Discussions and Recommendations

A big number of the nurses from public hospitals indicated positive attitude towards EBP. This was in line with some researches performed previously. Experienced nurses were less unlikely confident in adoption and implementation of this approach. Also, nurses who had been trained on EBP counted themselves more satisfied in integrating the approach into nursing practice. The research also looked into the factors that could motivate nurses to embrace EBP whereby majority of respondents expressed their concern on time. Time is essential for nurses to train and implement EBP (Kent, & Mccormack, 2010, p.56). Nurses need adequate time also to identify and resolve clinical issues. Management of hospitals has to prepare new schedules for nurses, factoring in the aspect of time for nurses to train.

Another challenge to adopting EBP which was noted was little understanding of statistical terminologies as well as technical jargon applied in research forms. A properly structured training manual is possibly going to overcome those problems to a larger extent. Management of hospitals can develop conducive environment that offer to nurses socializing opportunities so as to promote knowledge sharing (Holland, & Rees, 2010, pp.33-6). Librarians can also help to attain this objective by teaching nurses the portion of search strategies as part of EBP skills program. However, many personnel were willing to accept the new approach, barriers arose. This research information will be useful for hospital managements intending to implement EBP in their institutions.

References

Dicenso, A. (2005). Evidence-based nursing: a guide to clinical practice. St. Louis, Mo. ; London, Mosby

Holland, K., & Rees, C. (2010). Nursing: evidence-based practice skills. Oxford, Oxford University Press.

Kent, B., & Mccormack, B. (2010). Clinical context for evidence-based nursing practice. Chichester, West Sussex, Blackwell Pub

Levin, R. F., & Feldman, H. R. (2006). Teaching evidence-based practice in nursing a guide for academic and clinical settings. New York, Springer Pub. Co. http://site.ebrary.com/id/10265330

Levin, R. F., & Feldman, H. R. (2012). Teaching evidence-based practice in nursing. New York, Springer Pub.

Ellis, P. (2010). Evidence-based practice in nursing. Exeter, England, Learning Matters.

Malloch, K., & Porter-O’grady, T. (2010). Introduction to evidence-based practice in nursing and health care. Sudbury, Mass, Jones and Bartlett

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: a guide to best practice. Philadelphia, Wolters Kluwer/Lippincott Williams & Wilkins.