[ANSWERED 2024] Discuss two barriers that might hold nursing practice from achieving this goal and suggest ways in which the identified barriers may be addressed – Free Expert Answer

Discuss two barriers that might hold nursing practice from achieving this goal and suggest

Topic 1 DQ 1

The National Academy of Medicine (formerly the Institute of Medicine) championed the goal that 90% of clinical decisions will be evidence-based by 2020. A recent systematic review of the published literature indicates that evidence-based practice (EBP) implementation remains deficient despite an ongoing effort to increase implementation. Discuss two barriers that might hold nursing practice from achieving this goal and suggest ways in which the identified barriers may be addressed.

Expert Answer and Explanation

Nursing interventions should adhere to evidence-based practice for various reasons, including ensuring that patients receive the best care possible that is safe and meets their preferences. Research has shown that implementing evidence-based practice in clinical settings has various advantages, such as enhanced patient satisfaction, improved job satisfaction for care providers, and better patient outcomes (Connor et al., 2021).

Two Barriers That Might Hold Nursing Practice from Achieving This Goal

Nonetheless, there are still several barriers that hinder the implementation of evidence-based practice in clinical settings. One of the two barriers that might hold nursing practice from achieving this goal is inadequate nurse skills and knowledge to integrate evidence-based practice in their care settings (Pitsillidou et al., 2021). Evidence-based practice requires knowledge and skills acquired through education and training to integrate research findings, patient preferences, including cultural considerations into practical clinical solutions.

The second barrier is lack of time to find relevant research to support evidence-based practice in clinical settings (Mathieson et al., 2019). Various reasons explain why nurses cite lack of time as a barrier. One of the reasons is due to nurse shortages that consequently cause increased workloads and limited time to implement evidence-based practice. Another reason could be a poor organizational culture that does not emphasize evidence-based culture, thus making it a lower-priority issue among the nursing staff (Pitsillidou et al., 2021).

Ways To Address Barriers Identified

One strategy that can be adopted to deal with the two barriers, is to have in place a supportive organizational culture that prioritizes evidence-based practice necessitating increased allocation of time for nurses to conduct research for quality improvement initiatives (Mathieson et al., 2019). Another strategy is to encourage nurses to pursue higher levels of education that will allow them to acquire more skills to integrate evidence-based practice as a best practice in their clinical settings.

References

Connor, L., Dean, J., McNett, M., Tydings, D. M., Shrout, A., Gorsuch, P. F., & Gallagher‐Ford, L. (2023). Evidence‐based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews on Evidence‐Based Nursing, 20(1), 6-15. https://doi.org/10.1111/wvn.12621

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: A systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20, e6. https://doi.org/10.1017/S1463423618000488

Pitsillidou, M., Roupa, Z., Farmakas, A., & Noula, M. (2021). Factors affecting the application and implementation of evidence-based practice in nursing. Acta Informatica Medica: AIM: Journal of the Society for Medical Informatics of Bosnia & Herzegovina, 29(4), 281–287. https://doi.org/10.5455/aim.2021.29.281-287

Alternative Expert Answer

Barrier to EBP

One significant barrier to achieving the widespread implementation of evidence-based practice (EBP) in nursing is the lack of adequate education and training among healthcare providers. Many nurses, particularly those who have been in practice for an extended period, may not have been adequately exposed to EBP during their initial education. This can result in limited understanding and skills in accessing, appraising, and applying research findings in clinical settings. Furthermore, ongoing professional development opportunities focusing on EBP may not always be prioritized, leaving nurses without the tools needed to integrate evidence into practice.

To address this barrier, healthcare organizations and academic institutions must invest in comprehensive EBP education and training programs (Crawford et al., 2023). Offering workshops, seminars, and online modules tailored to various levels of nursing expertise can bridge knowledge gaps. Encouraging mentorship programs where experienced EBP practitioners support other nurses in adopting these practices can also foster a culture of evidence-based care.

Another barrier is the lack of organizational support and resources necessary for effective EBP implementation. Nurses often face time constraints, heavy workloads, and limited access to research databases or evidence-based guidelines, which hinder their ability to engage in EBP. Additionally, the absence of a supportive leadership structure that values and encourages EBP can create an environment resistant to change. Addressing this barrier requires healthcare organizations to foster a supportive infrastructure by allocating time and resources for EBP activities (Furtado et al., 2024).

Leadership can play a critical role by promoting a culture that prioritizes evidence-based care through policies, recognition programs, and incentives for EBP initiatives. Establishing dedicated EBP teams or committees to support research translation into practice and providing easy access to research databases and clinical decision-support tools can empower nurses to adopt evidence-based interventions effectively.

References

Crawford, C. L., Rondinelli, J., Zuniga, S., Valdez, R. M., Tze‐Polo, L., & Titler, M. G. (2023). Barriers and facilitators influencing EBP readiness: Building organizational and nurse capacity. Worldviews on Evidence‐Based Nursing, 20(1), 27-36. https://doi.org/10.1111/wvn.12618

Furtado, L., Coelho, F., Mendonça, N., Soares, H., Gomes, L., Sousa, J. P., … & Araújo, B. (2024, January). Exploring Professional Practice Environments and Organisational Context Factors Affecting Nurses’ Adoption of Evidence-Based Practice: A Scoping Review. In Healthcare (Vol. 12, No. 2, p. 245). MDPI. https://doi.org/10.3390/healthcare12020245

Topic 1 DQ 2

In preparation for your assignment this week, brainstorm two to three clinical practice problems or issues you can develop into a nursing practice change. What indicates these are clinical issues in nursing practice? Support your discussion with two peer-reviewed journal articles.

Expert Answer and Explanation

Clinical Practice Problems and Evidence

Clinical settings face various challenges that have negative implications on patient safety. Among the common challenges are hospital-acquired infections. Hospital-acquired infections are a wide range of infections ranging from central line-associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated pneumonia. These hold a significant burden to patients, payers, and the facility.

Research has shown that the prevalence rate of HAIs is 7.5% in high-income countries and varies between 5.7 and 19.2 in low-income countries (Raoofi et al., 2023). If left uncontrolled, they can lead to longer hospital stays, increased care costs, poor patient outcomes, lower patient satisfaction scores, and low job satisfaction among care providers.

Another challenge that is common in clinical settings is medication errors. Research estimates indicate that around 500,000 medication errors occur annually, which indicates a significant burden on the healthcare system (Rasool et al., 2020). Some of the consequences of medication errors include higher rates of hospitalization, decreased patient satisfaction, and a growing lack of trust in the healthcare system.

The third clinical issue is poor nursing handover communication. Handover communication plays a critical role in ensuring there is a proper transition of responsibility and accountability in patient care among nurses. Without effective handover communications, patients face a risk of being exposed to other clinical issues such as medication errors, disconnect in patient-centeredness in care delivery, and ultimately, lower patient satisfaction (Pun, 2021). These three issues are critical in determining the quality of care and are among the most common clinical problems healthcare facilities experience.

References

Pun, J. (2021). Factors associated with nurses’ perceptions, their communication skills, and the quality of clinical handover in the Hong Kong context. BMC Nursing, 20(1), 1-8. https://doi.org/10.1186/s12912-021-00624-0

Raoofi, S., Pashazadeh Kan, F., Rafiei, S., Hosseinipalangi, Z., Noorani Mejareh, Z., Khani, S., & Ghashghaee, A. (2023). Global prevalence of nosocomial infection: A systematic review and meta-analysis. PloS One, 18(1), e0274248. https://doi.org/10.1371/journal.pone.0274248

Rasool, M. F., Rehman, A. U., Imran, I., Abbas, S., Shah, S., Abbas, G., & Hayat, K. (2020). Risk factors associated with medication errors among patients suffering from chronic disorders. Frontiers in Public Health, 8, 531038. https://doi.org/10.3389/fpubh.2020.531038

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