Evidence-Based Practice in Nursing

Evifence-based Practice In Nursing

Purpose of the appraisal

The article chosen is Hauck, Winsett, and Kuric (2013) Leadership facilitation strategies to establish evidence-based practice in an acute care hospital, because it addresses a vital aspect of nursing practice. Evidence-based practice is critical for nursing in order to ensure that preventable complications are avoided. Improving patient care is one of the burdens that is placed upon hospitals, and this would only be achievable if they implement evidence-based practice. This is a research article focusing on the effects of leadership towards establishing evidence-based practice strategies within a hospital. The researchers intended to analyze the beliefs of nurses on the importance of using evidence-based practice to improve patient care (Hauck et al., 2013). The researchers also investigated the readiness of the organizational in using evidence in the daily nursing practice. The research article focuses on an area that has been neglected by many researchers (Hauck et al., 2013), which makes this article quite effective for improving and increasing knowledge in the field of nursing. The researchers chose an area that is vital for maintaining nursing knowledge, which is vital for improving patient care. By increasing the usage of evidence practice, a nurse would have vital information on what to do when faced with a specific situation. Evidence-based practice gives a nurse the opportunity to use research studies when making practical decisions, which would support and ensure that they make informed decisions. The researchers were attempting to solve the clinical problem of failing to use evidence-based practice in the performance of their duties. Hauck et al. (2013) were able to proof that implementing evidence-based practice within the hospital needs to receive backing from all stakeholders and not just the direct nurses. Using evidence-based practice, a nurse would have to increase their knowledge, as they would be reading and analyzing different studies. Incorporating evidence with their expertise, the nurses can make better decisions and improve patient care.

There is a challenge in changing the mindsets of people, which has made it hard to implement evidence-based practice successfully within a hospital. The nursing leaders were assumed to be supporting the usage of evidence-based practice, but they are mostly at fault when it comes to the strategy implementation (Hauck et al., 2013). Nursing leaders should be at the forefront of implementing evidence-based practice within the hospital. The researchers were attempting to establish how effective the three distinct groups of nurses were when it came to evidence-based practice. The researchers wanted to demonstrate that the use of EBP within a facility would improve patient care and increase nurse satisfaction with their decision. In order for the researchers to do this, they needed to gauge who were the champions of implementing this practice. Using the article one can clearly see that there is room for improvement if EVB is to be fully implemented within the hospital. There is a clear indication that leaders should be more encouraging and supportive of EBP.

The problem been addressed in the article is affected by the lack of support from leaders and indirect care RNs (Hauck et al., 2013). There has been limited training on how to best implement an EBP culture within an organization. The support afforded by the leaders is not demonstrated physically. This makes it difficult to create such a culture within the hospital. According to Hauck et al. (2013) the failure to rely on evidence-based practice forces nurses to rely on their clinical experience when making decisions. Decision-making that is supported by evidence will not raise many questions, and it is likely to lead to favorable results than decisions based on experience. The reliance on experience is preferred by most nurse’s because they like handling the situations in the same way. Using evidence-based practice would mean that a nurse had to try something they have not done, and they might fear the outcomes.

Appraisal of the article

The level of evidence presented by the research article is 2c. This is because the research uses a prospective descriptive comparative design, which attempts to analyze the nurses’ beliefs on the importance of EBP, the frequency of EBP use in their daily practice, and the organizations readiness for EBP after implementing a strategic plan for EBP (Hauck et al., 2013). The study only describes what is happening and does not try to examine the effects of the various independent and dependent variables. The study been prospective means that the data to be used is not available, and it is only after the study has begun that the data would be generated. Since the strategy has not been implemented, the researchers could not generate any data. The research was conducted in a single hospital, and it incorporated nurses who were already working within the facility for at least three months (Hauck et al., 2013). The study was located in a non-teaching hospital, which was a limitation. This is because the evidence discovered could not be assumed true for other teaching hospitals. The researchers have critically appraised relevant studies, and they have demonstrated the importance of using EBP in nursing care (Hauck et al., 2013). The article has been well formulated, and it has incorporated vital information from different sources. The relevance of the information is presented in a discussion manner and the researchers have attempted to link the literature to their research. The research design does support the research question, but the design is limited because the researchers can only make observations of the strategy implementation without altering any variables. The research question is vital for the advancement of EBP in hospitals, and the research should be expanded to include other hospitals. Conducting the research in two separate locations would assist in determining the effective methodologies for implementing the strategy. Hauck et al. (2013) states that the instruments used for measuring the results are evidence-based practice belief scale, evidence-based practice implementation scale, and organization culture and readiness for system-wide integration survey. The instruments were used to measure change before and after the strategy implementation. These are valid and reliable instruments since they showed if there were any changes and indicated the level of change. The before measurement was vital as it demonstrated who supported EBP most and the level of support offered. The instruments are reliable since there was enough evidence to support the measurements. The researchers have shown that there was an increment in the baseline and actual results obtained. Hauck et al. (2013) posits that the impact of the strategic EBP plan on the nurses’ beliefs increased by 7%, which indicated that the strategic plan target was achieved. The practice belief scale used 16 items that were scored on a Likert-like scale. The researchers also used Cronbach’s alpha in their measurements. According to Hauck et al. (2013) the impact of the strategic plan on frequency of using EBP indicated low scores, and there was not difference between baseline and final scores. The scores might have been low, but the hospital achieved a 14% increment from the baseline. The organizational culture was impacted by the EBP strategic plan since the hospital was able to achieve a 19% increase while the target was set at 10%. Organizational readiness achieved the highest percentage in terms of how much it was impacted by the EBP strategic plan. The target was set at 10%, and the result indicated a 26% increase (Hauck et al., 2013).

The study results demonstrate that of the three categories namely direct care, indirect care, and director/leader, the direct care group was supportive of the use of EBP in their daily nursing duties. The leaders whom it had been initially indicated by the baseline results were supportive of the use of EBP were found to be a hindrance to the strategy implementation (Hauck et al., 2013). The direct care nurses complained that the leaders and indirect care nurses were hindering their progress. The usage of baseline scores prevented the researchers from foreseeing problems during the strategy implementation, which could be seen as a problem strategy success. The lack of support affected the study results in that it showed that the leaders were assumed supportive, but in the real sense, they were unwilling to adopt the strategy. The study can be easily replicated in another setting, but the results obtained from this study cannot be relied upon. This is because it only centered on one location, which was a non-teaching and faith-based hospital.

Findings

The current practice has incorporated a clearly focused strategic plan that is used to modify the culture of the nurses and their leaders. The unit is currently encouraging the usage of EBP and material facilitation is done upon request and approval. The leaders have undergone training that encouraged them to modify their views, and this has positively affected the nursing practice within the unit. Nurses are encouraged to challenge each other’s decision, but this challenge should not affect patient care. Patient care should be at the helm of all decisions. The current practice is reflective of the positive outcomes of the study. Using EBP has assisted the unit to make informed decisions and not rely upon experience. Experience has limitations because the same procedure could have detrimental consequences on another patient. The use of EBP has had positive outcomes in that the unit is now able to understand and easily conduct research analysis.

The risks associated with change are obstacles during implementation, failure, and lack of resources. The changes been proposed need support from all within the hospital (Hauck et al., 2013). In order to ensure there is support for the change directors should be the champions for the change. Adopting this change would ensure that all hospital staff are on board and would prevent any legal claims that might arise from using EBP. The usage of evidence-based practice could result in unexpected outcomes, which might lead to patient complications. This would be unethical as the nurses should have conducted due diligence to ensure that there were no side effects to the procedure. Research studies might have overlooked an area that might cause problems during the implementation of the procedure (Hauck et al., 2013). This might give rise to legal problems that might affect the hospital negatively.

In order for the findings to be implemented within the hospital, the management should make sure that there is a library of studies readily available for the nurses. The EBP is only possible if there are relevant studies available for use within the facility. A library should be created, and nurses encouraged to utilize it for increasing their knowledge. The nurses should be accorded time for research, which would allow them to combine research with their work. Hauck et al. (2013) argues that time is vital, as nurses are mostly overwhelmed with responsibilities. Without enough time, it would be impossible to implement the change successfully. Nurse leaders should be willing to undergo leadership training in order for them to become change champions. These training would demonstrate to them the need to be adaptive and willing to adopt new changes. Once they accept changes, it would be easy for the nurses to follow them. It would be desirable to implement the study findings, but there is a need for organizational change. This change would ensure that the implementation is successful, and the nurses benefit from the study findings. It is feasible to implement the changes because one does not need to begin with a major implementation, but rather the leaders should implement the change in phases. Phase implementation ensures that each stage is well-planed for, and the outcomes are achieved before the next stage begins. Implementing the study findings will provide the hospital with the necessary tools for encouraging EBP amongst the nurses. It also demonstrates its commitment towards EBP.

Translation and application

The study findings can be easily translated into practice, but they will require considerable support from all stakeholders. The hospital management should develop a strategy that understands the needs of the nurses. The strategy should also indicate the anticipated risks, which would assist them to mitigate against the risks. Translating the findings into practice will need for clear roles assignment. This will ensure that all stakeholders know what they are responsible for, and they can plan for it properly. The baseline findings should not be relied upon since the study findings have shown that these measurements are misleading, especially for the indirect nurses and director category (Hauck et al., 2013). The decision to use the study findings should be based on the literature review conducted by the researchers, the results of the study, and their demonstrated ability of using EBP. The study has shown that culture change is possible, and there are more benefits to gain from using EBP for decision-making. Patient care would also be improved since most emphasis is placed on reducing preventable complications (Hauck et al., 2013). Using evidence, a nurse would know the effects of the procedure and if it will be successful beforehand. The study findings are not easy to translate in order to decide on its implementation. This is because it focused solely on one hospital, and the results might not be translated to another facility. The findings are only applicable if the conditions are the same. This would make it hard to implement the findings at another setting that has different conditions, but for the same facility, the findings could be easily implemented. The study findings have demonstrated that the direct nurses are willing to use evidence-based practice (Hauck et al., 2013), but they receive resistance from the other two categories. The lack of support demonstrates a common hindrance to implementing this change. For the implementation to succeed it is vital for the hospital to empower its direct nurses (Hauck et al., 2013), this ensures that they have the power to implement and follow up on research they believe is beneficial for the care of their patient.

In order to translate the findings into practice, it would be vital to interview the patients and establish if they have any objection to the hospital implementing EBP. The patients would have an opportunity to voice their concerns or support for EBP. Patient support is vital, as they should be willing to embrace EBP if the hospital is to implement the practice successfully. Patients should be shown how EBP could be beneficial to their care and its cost saving benefits. Expert opinion is applied to all research, and this is vital as it offers some insights that the researchers might have failed to notice. Evidence-based practice should only use research and studies that have been reviewed. This will ensure that there is expert opinion on the usage of the study for actual patient care.

References

Hauck, S., Winsett, R.P., & Kuric, J. (2013). Leadership facilitation strategies to establish evidence-based practice in an acute care hospital. Journal of advanced nursing, 69(3), 664-674. doi: 10.1111/j.1365-2648.2012.06053.x