Evidence-based practice into practice
Introduction
Integrating scientific evidence generated from research to nursing practice is fundamental for providing high-quality healthcare. Healthcare professionals should integrate evidence-based research, clinical expertise, and patient values/preference for better outcomes of care in decision-making. The following paper comprehensively describes the steps of integrating evidence-based practice in the healthcare environment, existing barriers to implementing the new practice, and internal evidence sources useful in providing data to enhance outcomes.
Part 1
Steps to Integrating Evidence-Based Practice into Clinical Environment
The first step to integrating evidence-based practice in the healthcare environment is the establishment of formal implementation teams. An implementation team would inspire stakeholders and foster the adoption of the new practice. The team comprises highly skilled nurses and other healthcare professionals who act as change agents by providing logistics on integrating the new practice in the care setting. The team should also incorporate nursing champions who provide mentorship and support hence fostering a better understanding of the new practice guidelines. Champions collaborate with leaders to mentor staff and peers by advocating for implementing best practices for improved healthcare outcomes.
The second step is developing a PICOT research question. The implementation team is guided by the spirit of inquiry to develop a research question to address the clinical issue of interest. An example of a clinical PICOT research question is; in college students with depression, what is the effectiveness of mindfulness compared to yoga in curbing depression? The team can then complete systematic evidence research that will comprehensively answer the question. Members of the team must appraise the research sources to ensure they are credible, valid, and verifiable. Gathering and analyzing all scientific evidence will help develop answers for the clinical question of inquiry (Melnyk & Fineout-Overholt 2015). It also provides a strong rationale for the integration of EBP into clinical practice.
The third step is the dissemination of evidence. According to Melnyk & Fineout-Overholt (2015), successful evidence dissemination requires identifying the appropriate audience and the use of effective communication medium. During this step, the implementation team utilizes various strategies to disseminate the information and eliminate knowledge deficit within the clinical environment. Some of the ways of information dissemination may include; interactive workshops, onsite educators, online tutorials, websites, and continued education libraries (Melnyk & Fineout-Overholt 2015). Posters may also be placed at strategic points for the clinical team members to learn about the proposed evidence-based change. During this step, there is also a significant need to address the concerns, questions, and issues raised by stakeholders. Positive outcomes of evidence dissemination are fundamental for integration to clinical practice.
The fourth step entails developing clinical tools that will aid in the implementation of the new evidence. At this step, the implementation develops organizational guidelines that will promote the adoption of the change. These guidelines provide clear, systematic, and practical ways of using the evidence in practice and decision making. The guidelines also outline suitable structures, equipment, and resources to implement the proposed EBP change (Melnyk & Fineout-Overholt 2015). For instance, the implementation team can develop a toolkit to aids healthcare practitioners utilize mindfulness to aid patients in managing stress and depression. Fall prevention and management tool is an example of clinical tools which integrating EBP into practice.
The fifth step entails performing a pilot test. Implementation of the EBP change in the entire organization requires changes in routines and workflows, hence challenging. The use of small clinics or department to implement the evidence can promote staff acceptance and reduce resistance (Melnyk & Fineout-Overholt 2015). In addition to that, pilot testing will allow the implementation team to collect feedback, identify issues, and improve the implementation of EBP in the healthcare setting. It is essential to involve staff at this stage since it fosters a positive attitude and promotes acceptance of the change. Testing helps in evaluating the impact of the change on a day to day work. For instance, a few patients may be put on mindfulness as an intervention to manage depression and the healthcare outcomes evaluated (Melnyk & Fineout-Overholt 2015).
The sixth step entails preserving the energy sources. The perception of the stakeholders is fundamental in the adoption of EBP in healthcare settings. EBP training should be offered to personnel to foster their confidence in integrating new evidence into practice. During this step, it is crucial to provide staff members with adequate time to learn, understand, and incorporate EBP. This reduces uncertainty, stress, and anxiety (Melnyk & Fineout-Overholt, 2015).
The seventh step involves prioritizing the changes to implement and developing a timeline for success. Prioritization of EBP changes to implement aids in saving organizational expenses/cost of implementing change. The implementation team should evaluate the EBP change, identify and implement the critical aspects that will lead to desired outcomes. Understanding the timing and existing impediments to delivery foster a more straightforward implementation. The step also allows the healthcare organization to incorporate the changes as routine practice at the right time and acceptable rate (Melnyk & Fineout-Overholt 2015).
The last step is celebrating the successful implementation/incorporation of the new evidence-based practice in the healthcare setting. This step also entails sharing with the rest of the staff the positive effect of the adopted evidence. The members of the implementation team are also recognized in newsletters and organizational announcements to appreciate their roles. This empowers other staff members to actively participate in future changes by engaging in research to transform practice.
Barriers to implementation and solutions.
Mindfulness was an effective non-pharmacological intervention of managing stress, anxiety, and depression as justified in credible, valid, and relevant evidence-based research. However, its implementation still encountered many barriers. One of the most common barriers is resistance to change. Most nurses have a negative attitude towards a change since they already conform to traditional practices such as pharmaceutical drugs, which may be costly (Khusid &Vythilingam, 2016). Such nurses can significantly affect the process of change implementation. One of the leading causes of resistance is the knowledge deficit about the change and fear of change (Correa-de-Araujo, 2016). To overcome this barrier, it is fundamental to devote time and energy to the staff’s adequate education and training. This will help them to understand better, accept, and adopt the practice. Sharing with nurses the outcomes and evidence-based results associated with proposed change can aid in avoiding resistance to change (Correa-de-Araujo, 2016)
Another significant barrier is the lack of leadership support in project implementation. According to a study conducted by Khusid & Vythilingam (2016), support from organizational leadership is fundamental in implementing non-pharmacological interventions such as mindfulness (Khusid & Vythilingam, 2016). A lot of time and resources may be invested in training patients to implemented mindfulness or yoga. Without goodwill and support from the leadership, it may be impossible to implement the change. To overcome the barriers, it is fundamental to include the clinical setting’s leadership by engaging them at every step of the implementation process (Correa-de-Araujo, 2016). This not only fosters successful implementation but also positively influences staff perceptions about change.
Thirdly redundant and lengthy guideline documentation about mindfulness and yoga interventions for depression was another significant barrier. This significantly affected the motivation of staff members to read, understand, and implement the intervention. To avoid the barrier, it is fundamental to short but explicit documentation that is easier to understand. In addition to that, other tools that may help in implementing the change should be developed (Correa-de-Araujo, 2016). Such tools may include the use of video tutorials and summarised versions of the documentation in posters.
Another significant barrier is the lack of time and resources to implement mindfulness programs. According to Butterfield et al. (2017), teaching mindfulness requires time and commitment, making nurses reluctant to change. However, through proper education on the importance and long term impact of the intervention, the barrier may be overcome. Additionally, patients may be reluctant to participate in mindfulness intervention for depression due to time and resource constraints (Butterfield et al., 2017). However, overcoming the barrier requires proper education on the significance of the EBP intervention. In addition to that, psychiatric nurses can collaborate with patients to formulate flexible sessions for work, health, and life balance (Correa-de-Araujo, 2016).
Most of the psychiatric research has been centered on pharmacological interventions for treating depression (Falsaffi, 2016). However, most psychotic medications have adverse side effects, complications, and tolerance issues, especially among geriatric patients (Falsaffi, 2016). Lack of EBP mentors in the organization may be another barrier since there is little research on non-pharmacological interventions to treat depression. This may significantly affect the acceptance and adoption of the EBP change. To avoid this barrier, effective communication backed with research evidence will convince the leadership and staff of the feasibility of the intervention. Non-pharmacological interventions, such as mindfulness and yoga, have no adverse side effects. In addition to that, they are not only cost-effective but also enhance the general wellbeing of the individual.
Part 2
Source of internal evidence
According to Melnyk & Fineout-Overholt (2015), internal evidence comprises data collected from safety measures, quality experience and satisfaction, and staff perspective. Quality management is one of the sources of internal evidence. In an organization, quality management is responsible for supervising the quality of care rendered to patients. Quality management collects data from incident reports such as medication errors, falls, and pressure ulcers. The collected data enables the organization to identify organizational areas that need improvement and outcome of improvement processes (Melnyk & Fineout-Overholt 2015). The financial department is another fundamental source of the internal department. Data collected from the financial department on the cost of depression in the medical institution. Billing information such as procedures, testing, admission, duration of stay, and readmission, aids the healthcare institution needs that may improve care outcomes. Human resources is another significant source of internal evidence. It can also provide comprehensive information on staff educational levels. The statistics help developing educational and training programs to foster care delivery. Educated and well-trained staff members recognize the significance of incorporating evidence-based practice to transform the nursing profession (Melnyk & Fineout-Overholt 2015). The fourth source of internal evidence is medical records. Researchers, quality improvement departments, and clinicians can analyze medical records’ information and examine the effectiveness of newly implemented practice.
Reports from the quality medical records can determine the outcome of the improvement initiative. The fifth source of internal evidence is the improvement committee. The committee collects data from departments and develops solutions that can aid improve the care outcomes. Organizational policies and regulations are founded on research conducted by quality improvement committees. Lastly, a patient’s experience and satisfaction is another source of internal evidence. The source is utilized in providing the patient’s opinion about the outcome of improvement processes (Berkwitz, 2016). The patient experience can be generated through surveys that explore their opinion about the responsiveness of staff, communication about mindfulness, the quietness of care environments, cleanliness of the clinical setting, and transition care. The survey aids in determining the negative or positive impacts of implemented change (Berkwitz, 2016).
Conclusion
In conclusion, evidence-based practice is fundamental for quality healthcare outcomes in clinical settings. Understanding the significance of integrating EBP, addressing barriers, and evaluating process outcomes is fundamental. Leadership support, staff engagement, and effective communication are fundamental to EBP integration. It is also fundamental to identify barriers and develop practical solutions to mitigate them. Lastly, it is essential to identify internal evidence sources that can be utilized in evaluating the outcome of the improvement process.