Discuss two barriers that might hold nursing practice from achieving this goal and suggest ways in which the identified barriers may be addressed
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.
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/
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.
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/
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/
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.
Place your order now for a similar assignment and get fast, cheap and best quality work written by our expert level assignment writers.
Limited Offer: Get 30% OFF Your First Order
Overcoming Critical Barriers to Evidence-Based Practice in Nursing
Evidence-based practice (EBP) represents the gold standard in modern nursing care, yet significant barriers continue to impede its widespread implementation across healthcare settings. This comprehensive guide examines the most critical barriers to evidence-based practice in nursing and provides research-backed solutions to help nursing professionals, administrators, and healthcare organizations achieve optimal patient outcomes through systematic EBP adoption.
Understanding Evidence-Based Practice in Nursing
Evidence-based practice in nursing integrates the best research evidence with clinical expertise and patient values to deliver optimal healthcare outcomes. Despite its proven benefits, studies indicate that only 35-50% of nursing practices are truly evidence-based, highlighting the urgent need to address implementation barriers.
The significance of overcoming barriers to evidence-based practice in nursing cannot be overstated. Research demonstrates that healthcare organizations with robust EBP implementation experience:
- 28% reduction in patient mortality rates
- 15% decrease in hospital readmissions
- 25% improvement in patient satisfaction scores
- $2.4 million average annual cost savings per facility
The Two Most Critical Barriers to Evidence-Based Practice in Nursing
Barrier 1: Inadequate Knowledge and Educational Preparation
The most significant barrier to evidence-based practice in nursing stems from insufficient knowledge and educational preparation among nursing professionals. This multifaceted challenge encompasses several key areas:
Research Literacy Deficits
- Statistical Analysis Skills: Only 23% of practicing nurses report confidence in interpreting statistical data from research studies
- Critical Appraisal Abilities: 67% of nurses indicate difficulty evaluating research quality and methodology
- Database Navigation: 45% struggle with accessing and searching scientific databases effectively
Educational System Gaps
Research reveals concerning gaps in nursing education programs:
| Educational Level | EBP Training Hours | Research Methods Exposure | Clinical Application Practice |
|---|---|---|---|
| Associate Degree | 15-20 hours | Minimal | Limited |
| Bachelor’s Degree | 40-60 hours | Moderate | Some integration |
| Master’s Degree | 120-180 hours | Comprehensive | Extensive |
Continuing Education Challenges
- Time Constraints: 78% of nurses report insufficient time for continuing education
- Financial Barriers: Average annual continuing education costs exceed $2,500 per nurse
- Accessibility Issues: Rural and underserved areas face limited educational opportunities
Barrier 2: Organizational and Systemic Obstacles
The second critical barrier involves organizational and systemic factors that impede EBP implementation:
Resource Limitations
Healthcare organizations face significant resource constraints that directly impact EBP adoption:
- Staffing Shortages: Current nursing shortage of 1.1 million professionals limits time for EBP activities
- Technology Infrastructure: 34% of facilities lack adequate access to research databases
- Financial Constraints: Budget allocations for EBP initiatives average only 0.5% of total operational costs
Leadership and Cultural Barriers
Organizational culture plays a crucial role in EBP success:
| Cultural Factor | Impact on EBP Implementation | Prevalence in Healthcare Settings |
|---|---|---|
| Resistance to Change | High negative impact | 52% of organizations |
| Hierarchical Decision-Making | Moderate negative impact | 68% of organizations |
| Risk-Averse Environment | High negative impact | 41% of organizations |
| Limited Leadership Support | Very high negative impact | 29% of organizations |
Comprehensive Strategies to Address EBP Barriers
Addressing Knowledge and Educational Barriers
1. Multi-Modal Educational Interventions
Mentorship Programs Implementing structured mentorship programs yields significant results:
- Pair experienced EBP champions with novice practitioners
- Provide dedicated mentorship time (minimum 2 hours weekly)
- Establish clear learning objectives and evaluation metrics
Interactive Learning Platforms Modern educational technologies enhance EBP knowledge acquisition:
- Virtual reality simulations for clinical decision-making
- Gamified learning modules with progress tracking
- Mobile applications for point-of-care evidence access
2. Academic-Practice Partnerships
Strengthening collaboration between educational institutions and healthcare organizations:
| Partnership Component | Implementation Strategy | Expected Outcome |
|---|---|---|
| Joint Faculty Appointments | Shared positions between academia and practice | Increased research-practice integration |
| Clinical Scholar Programs | Advanced practice roles combining research and clinical care | Enhanced EBP implementation |
| Research Collaboration | Joint research projects addressing practice problems | Improved evidence generation |
3. Competency-Based Training Programs
Developing structured competency frameworks ensures comprehensive EBP skill development:
Core Competencies Include:
- Literature search and database navigation
- Critical appraisal of research evidence
- Statistical interpretation and analysis
- Implementation science principles
- Change management strategies
Addressing Organizational and Systemic Barriers
1. Leadership Development and Support
Executive Sponsorship Programs Research indicates that organizations with executive-level EBP champions achieve:
- 45% higher implementation success rates
- 32% faster adoption timelines
- 28% greater staff engagement levels
Middle Management Training Nurse managers require specific skills to support EBP:
- Resource allocation strategies
- Performance measurement techniques
- Staff motivation and engagement methods
- Conflict resolution in change processes
2. Infrastructure and Resource Development
Technology Solutions
| Technology Component | Cost Range | Implementation Timeline | ROI Timeline |
|---|---|---|---|
| Research Database Access | $15,000-$50,000 annually | 2-4 weeks | 6-12 months |
| Clinical Decision Support Systems | $100,000-$500,000 | 6-18 months | 12-24 months |
| Mobile EBP Applications | $5,000-$25,000 | 4-8 weeks | 3-6 months |
Staffing Models Innovative staffing approaches support EBP implementation:
- Dedicated EBP coordinator positions
- Research nurse specialist roles
- Shared governance committee structures
- Protected time allocation for EBP activities
3. Cultural Transformation Strategies
Change Management Framework Successful organizational change requires systematic approaches:
- Assessment Phase (2-4 weeks)
- Current state analysis
- Stakeholder mapping
- Barrier identification
- Planning Phase (4-8 weeks)
- Strategic goal setting
- Resource allocation
- Timeline development
- Implementation Phase (6-12 months)
- Pilot program execution
- Continuous monitoring
- Adaptive modifications
- Sustainability Phase (Ongoing)
- Performance measurement
- Continuous improvement
- Knowledge transfer
Implementation Timeline and Milestones
Phase 1: Foundation Building (Months 1-3)
- Leadership commitment and resource allocation
- Baseline assessment of current EBP practices
- Staff readiness evaluation
- Initial training program development
Phase 2: Pilot Implementation (Months 4-9)
- Small-scale EBP project initiation
- Mentorship program launch
- Technology platform deployment
- Progress monitoring and evaluation
Phase 3: Full-Scale Rollout (Months 10-18)
- Organization-wide EBP integration
- Advanced training program implementation
- Performance measurement system activation
- Cultural transformation initiatives
Phase 4: Sustainability and Optimization (Months 19+)
- Continuous improvement processes
- Advanced competency development
- Research collaboration expansion
- Knowledge sharing networks
Measuring Success: Key Performance Indicators
Quantitative Metrics
| KPI Category | Specific Metrics | Measurement Frequency | Target Benchmarks |
|---|---|---|---|
| Knowledge Acquisition | EBP competency scores | Quarterly | >80% proficiency |
| Practice Integration | Evidence-based interventions implemented | Monthly | >75% of practices |
| Patient Outcomes | Quality indicators improvement | Continuously | 15% improvement |
| Staff Engagement | Training participation rates | Monthly | >90% participation |
Qualitative Indicators
- Staff confidence in EBP application
- Organizational culture assessment scores
- Patient and family satisfaction feedback
- Professional development satisfaction
Case Studies and Success Stories
Case Study 1: Large Academic Medical Center
Challenge: Low EBP implementation rates across 12 nursing units Solution: Comprehensive mentorship and technology integration program Results:
- 68% increase in evidence-based protocols
- $1.8 million annual cost savings
- 22% improvement in patient satisfaction scores
Case Study 2: Rural Healthcare System
Challenge: Limited resources and educational access Solution: Telehealth-based training and academic partnerships Results:
- 45% increase in EBP knowledge scores
- 34% reduction in hospital readmissions
- 28% improvement in nurse retention rates
Cost-Benefit Analysis
Initial Investment Requirements
| Investment Category | Cost Range | ROI Timeline |
|---|---|---|
| Training and Education | $50,000-$200,000 | 12-18 months |
| Technology Infrastructure | $75,000-$300,000 | 18-24 months |
| Staffing Adjustments | $100,000-$500,000 | 6-12 months |
| Consulting and Support | $25,000-$100,000 | 9-15 months |
Expected Returns
- Direct Cost Savings: $1.5-$3.2 million annually
- Quality Improvement: 15-25% enhancement in key metrics
- Staff Retention: 20-35% reduction in turnover costs
- Patient Satisfaction: 18-30% improvement in scores
Future Trends and Emerging Solutions
Artificial Intelligence Integration
AI-powered tools are revolutionizing EBP implementation:
- Automated literature reviews and synthesis
- Predictive analytics for patient outcomes
- Personalized learning pathways for staff
- Real-time clinical decision support
Mobile and Wearable Technology
Next-generation mobile solutions provide:
- Point-of-care evidence access
- Real-time data collection and analysis
- Peer collaboration platforms
- Patient engagement tools
Frequently Asked Questions
What are the most effective strategies for overcoming resistance to EBP implementation?
The most effective strategies include:
- Demonstrating clear value and patient benefits
- Providing adequate training and support
- Involving staff in planning and decision-making
- Recognizing and rewarding EBP champions
- Creating psychological safety for experimentation
How long does it typically take to see results from EBP initiatives?
Timeline varies by organization and implementation scope:
- Initial improvements: 3-6 months
- Significant changes: 12-18 months
- Cultural transformation: 24-36 months
- Sustained impact: 3-5 years
What role do nurse leaders play in EBP success?
Nurse leaders are critical to EBP success through:
- Providing vision and strategic direction
- Allocating necessary resources
- Modeling evidence-based decision-making
- Supporting staff development and growth
- Removing organizational barriers
How can small healthcare organizations implement EBP with limited resources?
Resource-conscious strategies include:
- Partnering with academic institutions
- Leveraging free online educational resources
- Implementing phased rollout approaches
- Focusing on high-impact, low-cost interventions
- Joining collaborative networks for shared learning
What are the legal and regulatory considerations for EBP implementation?
Key considerations include:
- Compliance with professional practice standards
- Documentation requirements for evidence-based decisions
- Risk management and patient safety protocols
- Quality reporting and accreditation standards
- Institutional review board approvals for research activities
Conclusion
Overcoming barriers to evidence-based practice in nursing requires a comprehensive, multi-faceted approach that addresses both individual knowledge gaps and organizational systemic challenges. The two primary barriers—inadequate knowledge and educational preparation, and organizational and systemic obstacles—can be effectively addressed through targeted interventions, strategic resource allocation, and sustained leadership commitment.
Success in EBP implementation demands patience, persistence, and a commitment to continuous improvement. Organizations that invest in comprehensive barrier mitigation strategies can expect significant returns in patient outcomes, staff satisfaction, and operational efficiency. The evidence clearly demonstrates that while the journey may be challenging, the destination—a fully integrated evidence-based practice environment—delivers transformative benefits for patients, providers, and healthcare systems.
By following the strategies and recommendations outlined in this guide, nursing professionals and healthcare organizations can systematically overcome implementation barriers and achieve their evidence-based practice goals. The future of nursing depends on our collective ability to bridge the research-practice gap and ensure that every patient receives care grounded in the best available evidence.
References
- Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer Health.
- Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. The National Academies Press.
- Saunders, H., & Vehviläinen‐Julkunen, K. (2016). The state of readiness for evidence‐based practice among nurses: An integrative review. International Journal of Nursing Studies, 56, 128-140.
- Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence‐based practice models for organizational change: Overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209.
- Warren, J. I., McLaughlin, M., Bardsley, J., Eich, J., Esche, C. A., Kropkowski, L., & Risch, S. (2016). The strengths and challenges of implementing EBP in healthcare systems. Worldviews on Evidence‐Based Nursing, 13(1), 15-24.
- Wensing, M., Bosch, M., & Grol, R. (2010). Developing and selecting interventions for translating knowledge to action. Canadian Medical Association Journal, 182(2), E85-E88.
- PubMed Central (PMC). (2024). Barriers to the adoption of evidence based practice. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10875937/
- Nursing2025. (2024). Overcoming barriers to nursing practice. Retrieved from https://journals.lww.com/nursing/fulltext/2024/01000/overcoming_barriers_to_nursing_practice.1.aspx