Barriers, challenges, and strategies Essay

Most clinical health misgiving workers are aware that achieving the ikon of proof- ground usage (EBP) is the gold star ensample that champion strives for in his/her clinical invest. EBP is expected of healthcare clinicians and has get down a synonym for quality care twain by the institution of healthcare and its consumers (Brim & Schoonover, 2009). This essay willing define EBP for she-goats. The bars, ch wholeenges and strategies to run with and throughing evidence- ground breast feeding practice (EBNP) will be discussed with reference to relevant and authoritative literature. As well, the relevance and the links that EBNP has with the clinical area of Intensive deal will be discussed. EBP is the integration, by clinicians, of clinical expertise which is meticulous, explicit and uses current clinically appraised callingal familiarity (Eizenberg, 2011 Kenny, Richard, Ceniceros, & Blaize, 2010).EBP accommodates enduring preferences, views and set part to a fault guiding, cloging, validate and answering health care workers clinical judgements, practices, and examinations (Eizenberg, 2011 Kenny et al., 2010 Matula, 2005 Wolf, 2005). EBP is a process of asking a clinical psyche look foring for clinical evidence critically appraise this evidence and then expertly integrating this evidence with unhurrieds values, views and preferences evaluation of how the switchs to practice need had on impressions and finally disseminating the results that the EBP or change had on patient of outcomes (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010). The definition of EBP and EBNP and the carry outation of EBNP appear to be straightforward and easily accomplished however, EBNP implementation is farthest removed from being easy (Brim & Schoonover, 2009 Cullen, Titler, & Rempel, 2011 Eizenberg, 2011 Kenny et al., 2010 Tolson, Booth, & Lowndes, 2008). breast feeding question has uncovered numerous challenges and obstructions which the imple mentation of EBNP faces. These challenges and roadblocks can be classified as a inquiry, a clinician, an faceal, a breast feeding professional barrier, and non least patient barriers (Fernandez, Davidson, & Griffiths, 2008 Gerrish et al., 2011 Hutchinson &Johnston, 2006 Ross, 2010).Eizenberg (2011), Gerrish et al. (2011), and Ross (2010) effectuate that nurses face re expect and clinician barriers that include non having the time, skills and companionship to critically critique and/or synthesize research literature, un fitting to in effect use and search databases electronically, hold negative views toward research and feel research is too complex, aswell research at times is not clear on how to implement the findings and findings can be contradictory. Due to these barriers, nurses tend to cuss on synthesised evidence much(prenominal) as evidence-based protocols, policies and procedures (Gerrish et al., 2011). Eizenberg (2011) and Gerrish et al. (2011) as well found that n urses prefer to acquire in melodic lineation through thirdly parties such as their colleagues, the workplace, through patient care experience, and the acquaintance they received from their nurse schooling. Eizenberg (2011) found that the governing body is the greatest factor in favored EBNP implementation.The presidency controls entrance and the budget to and for evidence resources such as computing machines with internet access, a well-equipped library, and access to educational opport building blockies in EBNP procedures and theory (Eizenberg, 2011). The barrier of not having the effectiveness to change a care for practice also lies with the organisation a nurse may take away the undeniable research knowledge and experience to effectively change practice but cannot implement practice change due to the organisation not good-looking him/her the authority to instill change (Eizenberg, 2011). Few nurse cater members are given the opportunity to move in the traini ng of evidence-based policies and procedures therefore, most nurses are not engaged to support EBP.Ross (2010) further found organisational barriers such as the organisation giving priority to otherwise goals (for example excess sick leave) over EBNP, the organisation may perceive that the staff are not ready or willing to implement EBNP, and that the organisation believes EBNP is unachievable. These organisational barriers prevent EBNP being accomplished and to the greater terminus of not being implemented. A barrier of treat profession relates to the medical dominance of healthcare as such, nurses are not afforded the power, authority, autonomy and respect from colleagues for nursing practice that the status of being a profession decrees (Brim & Schoonover, 2009 Eizenberg, 2011 Gerrish et al., 2011).A further nursing profession barrier is it can be difficult to instill eagerness or information about an EBNP if turnover is amply there is a shortage of experienced nurses and s upport from colleagues is pretermiting (Gerrish et al., 2011 Mark, Latimer, & Hardy, 2010). Due to high turnover and staff shortages, nurses are unable to leave the bed grimace and contribute control time to participate in EBNP projects such as journal clubs, or to attend training in EBP, PICO(Population/Intervention/Comparison/Outcome), and database searches (Brim & Schoonover, 2009 Brown, Johnson, & Appling, 2011). entertains, as Kenny et al. (2010) found were hesitant to change their practice if the change would perceivably increase an already heavy workload. Brim & Schoonover (2009) found that some nurses believed EBNP to be an optional course of action as they were neer shown a clear direction of what EBNP is essential to nursing and his/her practice. One of the main premises of EBNP is that the evidence and the values and beliefs of the patient/s are synthesised together to form an EBNP which is foremost favourable for a positive outcome for the patient/s (Fernandez et a l., 2008).Such factors as treatment, travel, and ethical drug costs denial of diagnosis inadequate knowledge level of disease and strategies to decrease risk factors lack of social support and cultural issues can all potentially become barriers to implementing an EBNP for a patient or patients (Fernandez et al., 2008). The high acuity of an intensive care unit (intensive care unit) patient significantly affects a nurses king to search a database for answers (Brim & Schoonover, 2009 Kenny et al., 2010). An answer to a question is usually compulsory immediately or momentarily therefore, ICU nurses rely on experience, colleagues, and knowledge of evidence-based policies, procedures and guidelines (Eizenberg, 2011 Gerrish et al., 2011). I know I rely firmly upon in-services, experience, and speaking with the ICU clinical concord Educators and Nurse Educators who will do a literature search to acquire information or answers to a question I have posed but at a time again this evide nce/information has been synthesised by others and is third hand and I have not in full practiced EBN (Eizenberg, 2011 Gerrish et al., 2011).To try and challenge this barrier I do try and read the clinical information the educator obtained at a later(prenominal) date usually at home or on a break. Strategies to overcome these challenges and barriers abound from EBP and EBNP journal articles and books. Some of the leading strategies are for the organisation to richly support EBNP through alkali, strong leadership from nurse managers and/or modern practice nurses, and by ensuring a context in which EBNP can flourish (Gerrish et al., 2011 Tolson et al., 2008). The infrastructure needs to provide access to a computer which can access online databases. Infrastructure needed to be in place includes a staffed evidence based nursing library with a librarian able to educate nurses on the process ofEBNP (Pochciol & Warren, 2009). The added challenge is to have EBNP info accessible to t he nurse at the patients bedside (Pochciol & Warren, 2009).Nursing leaders need a Masters degree or above, as studies show that leaders with these credentials read and implement more than research literature are more confident and they consider themselves more competent in supporting others through the EBNP process (Eizenberg, 2011 Gerrish et al., 2011). Leaders, as suggested by Cullen et al. (2011), hold the responsibility to provide support to build, to create, and hold open an organisational culture that has the capacity to support EBP at both(prenominal) a clinical and administration level. Leaders essentialinessiness be given the power, authority, and support to introduce change without this authority change cannot occur (Eizenberg, 2011). Scholars agree that if EBNP is to copy and be sustainable nurses need to be better and mentored on the implementation process of EBNP (Brim & Schoonover, 2009 Brown et al., 2011 Eizenberg, 2011 Gerrish et al., 2011 Pochciol & Warren, 2009 Ross, 2010 Tolson et al., 2008).EBNP education of nurses needs to begin at orientation to the infirmary and is essential that this education is continually built upon and support with extra education given to nurse managers, educators and advanced practice nurses (Pochciol & Warren, 2009 & Tolson et al, 2008). Ross (2010) suggests nurses information literacy be improved to tell nurses are able to practice EBN. Information literacy is the ability to competently recognise, locate, and evaluate the fundamental information demand at a given point (Ross, 2010). The ICU, where I am employed, has undergone significant changes to the staff and managerial side of the unit. At one point the Clinical Nurse Specialists ratio decreased to less than 5% of nursing staff and there was not a ageless full time Clinical Nurse Consultant. Without the necessary support acquired from these roles the education of ICU nurses and the implementation of vernal practices, policies and procedures decr eased significantly.These barriers significantly halted EBNP from occurring in the ICU as there were very few highly better leaders available to support EBNP. As suggested by Eizenberg, (2011), Gerrish et al. (2011), and Cullen et al. (2011), educated leaders and managers are needed to apply and instill EBNP to an institution. To obtain Magnet Status hospitals must ensure that EBNP is in place, is supported, and is sustained by the organisation (Brown et al., 2011). To procure nurseinterest in EBNP, and note Magnet Status, some hospitals have linked battle in EBNP to clinical race procession and a monetary reward in the form of a wage increase with advancement up the ladder (Whitmer, Aver, Beerman, & Weishaupt, 2011). To hold their position on the clinical advancement ladder the nurse must show, yearly, that he/she is supporting, or implementing, or participating in EBNP within the orbit they are employed (Whitmer et al, 2011).The benefits of practicing EBN includes patients ability to access effective evidence based treatment information facilitates consistent improvement, through decision making, to healthcare systems facilitates decisions based on up-to-date evidence and technologies and reduces variances in nursing care from one nurse to another standard and competencies are evidence based and consistent through evidence based competencies the professional status of nursing is elevated to higher heights (Gerrish et al., 2011 Eizenberg, 2011). In conclusion, the challenges/barriers, barrier strategies, and benefits of EBNP has been discussed. Little discussion on EBNP within an ICU was attempted as the ICU nurses face the comparable situations, challenges/barriers, strategies and benefits as nurses in other areas of healthcare (Sciarra, 2011). Nurses must be given organisational support, education and knowledge needed to participate proficiently in EBNP.ReferencesBrim, C. B., & Schoonover, H. D. (2009). Lessons learned while conducting a clinical t rial to facilitate evidence-based practice the neophyte researcher experience. The journal of Continuing preparation in Nursing, 40(8), 380-384. DOI 10.3928/00220124-20090723-06 Brown, C. R., Johnson, A. S., & Appling, S. E. (2011). A taste of nursing research an interactive program, introducing evidence-based practice and research to clinical nurses. ledger for Nurses in Staff development, 27(6), E1-E5. DOI 10.1097/NND.0b013e3182371190 Cullen, L., Titler, M. G., & Rempel, G. (2011). An advanced educational program promoting evidence-based practice. Western Journal of Nursing Research, 33(3), 345-364. DOI 10.1177/0193945910379218Eizenberg, M. M. (2011). Implementation of evidence-based nursing practice nurses personalized and professional factors? Journal of Advanced Nursing,67(1), 33-42. DOI 10.1111/j.1365-2648.2010.05488.xFernandez, R. S., Davidson, P., & Griffiths, R. (2008). cardiac rehabilitation coordinators perceptions of patient-related barriers to implementing cardiac ev idence-based guidelines. Journal of Cardiovascular Nursing, 23(5), 449-457. Gerrish, K., Guillaume, L., Kirshbaum, M., McDonnell, A., Tod, A., & Nolan, M. (2011). Factors influencing the persona of advanced practice nurses to promoting evidence- based practice among front-line nurses findings from a cross-sectional survey. Journal of Advanced Nursing, 67(5), 1079-1090. DOI 10.1111/j.1365-2648.2010.05560.x Hutchinson, A. M., & Johnston, L. (2006). beyond the BARRIES Scale commonly reported barriers to research use. Journal of Nursing establishment, 36(4), 189-199. Kenny, D. J., Richard, M. L., Ceniceros, X., & Blaize, K. (2010). Collaborating across services to advance evidence-based nursing practice. Nursing Research, 59(1S), S11-S21. Mark, D. D., Latimer, R. W., & Hardy, M. D. (2010). Stars aligned for evidence-based practice. A TriService initiative in the Pacific. Nursing Research, 59(S1), S48-S57. Matula, P. (2005). Evidence-based practice at the bedside Igniting the spirit of inquiry. The public address system Nurse, Dec, 22.Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). The seven steps of evidence-based practice. Following this progressive, sequential approach path will lead to improved health care and patient outcome. The American Journal of Nursing, 110(1), 51-53.Pochciol, J. M., & Warren, J. I. (2009). An information applied science infrastructure to enable evidence-based nursing practice. Nursing Administration Quarterly, 33(4), 317-324. Ross, J. (2010). Information literacy for evidence-based practice in perianesthesia nurses readiness for evidence-based practice. Journal of PeriAnesthesia Nursing, 25(2), 64-70. DOI 10.1016/j.jopan.2010.01.007Sciarra, E. (2011). Impacting practice through evidence-based education. Dimensions of Critical palm Nursing, 30(5), 269-275. DOI10.1097/DCC.0b.013e318227738c Tolson, D., Booth, J., & Lowndes, A. (2008). Achieving evidence-based nursing practice impact of the Caledonian development model. Journal of Nursing Management, 16, 682-691. DOI 10.1111/j.1365-2834.2008.00889.xWhitmer, K., Aver, C., Beerman, L., & Weishaupt, L. (2011). Launching evidence-based nursing practice. Journal for Nurses in Staff Development, 27(2), E5-E7. DOI 10.1097/NND.0b013e31820eefd2Wolf, Z. R. (2005). Clinical challenges and evidence based nursing practice. The Pennsylvania Nurse, Dec, 20.