Evidence Based Nursing Research Practice

Question: Discuss about the Evidence Based Nursing Research Practice. Answer: Introduction: The position statement is on the topic of evidence based practice (EBP) which states that Evidence based practice (EBP) is the clinical decision making process which is based upon the best available evidence, new research findings, clinical experience and patient preferences. Nurses are expected to implement research findings into their practice, but many are not trained on how to do this. Therefore, it should not be expected that nurses are at the forefront of EBP implementation in the clinical setting. The position statement brings into focus the importance of evidence based practice in nursing. It has clearly introduced the topic by stating what evidence based practice means in nursing. Evidence based practice (EBP) is an approach to clinical practice and health issues that integrates best available evidence in making best health care decisions for patient (Grove et al., 2014). The author has precisely stated all the elements of evidence based practice in the introduction only by stating that it relies on new research findings, best available evidence, clinical experience and patients preference. Any health care professional access the research finding and current clinical guidelines related to their area of practice and then only apply the information on real world practice. Respecting patients value is also an important part of evidence based practice and the author has explicitly stated it by mentioning the word patients preference in the post. Clinical expertise is also an ess ential part of evidence based practice in which clinician utilize their cumulative experience, education on area of expertise and clinical skills to take best decision for patients for better health outcome. This whole concept was briefly stated in the post by the term clinical experience. After the introduction statement, the author has moved to stating that nurses are also expected to implement research finding in their practice. It also stated the problem that nurses are not aware of evidence based practice. However, one critical point that is missing is that the author has not emphasized on the National Competency Standard for Registered Nurse. The author has also not mentioned how evidence based practice can be implemented in health care organization and who should be involved in it. The author could have briefly stated the domain in which competency is required according to the National Competency Standard for registered nurse (Edmonds et al., 2016). The author could have mentioned the improvement in following domains to implement evidence based practice: Professional practice- It is related to demonstrating ethical and professional responsibility by demonstrating accountability in care and integrating best evidence literature in clinical practice Critical thinking and analysis- Critical thinking skills allows clinicians to reflect on their practice and experience and select appropriate resource related to individual patient situation. Coordination of care- Coordination of nursing care is also an important provision of nursing care. It includes assessment of patient, planning and evaluation of care. In relation to finding relevant evidence related to particular patient, the skill to appraise the research article and determining its usefulness in nursing practice is important. Collaborative and therapeutic practice- Therapeutic practice in the context of evidence based care will require a nurse to integrate that evidence in real patient situation (LoBiondo-Wood et al., 2013). The author has concluded by saying that nurses are not involved in implementation of evidence based care. This is in fact true. It is the role of health care organization or nursing leader to take the initiative to train staff on the importance of evidence based practice and implementing it in the organization. A short hint by the author on ways of implementation of evidence based practice in particular health organization would be an appropriate way to conclude the post. Individual position statement The call for evidence based quality improvement in the transformation of health care organization brings into the focus the issue of effective implementation of evidence based practice (EBP) in nursing facility. As the post analysis showed that the method of implementation of evidence based practice is missing in the post, the individual position statement is effective implementation of evidence based practice in health care clinic enhances the delivery of care. I feel working on this aspect is important because little attention has been paid on how to implement EBP in clinical setting. The report will explain the ways by which individual organization can redesign the system to implement EBP and practice according to National Competency Standard for Registered Nurse. It will also explain the issues faced in the implementation of this approach in nursing. It will help to identify patient safety issues and demonstrate a new way of practice that will lead to improvement in quality and p atient safety. Factors essential for evidence based practice A study by Stevens, (2013) has suggested that the critical impact of evidence-based practice across nursing practice. It emphasized the need for redesigning the system to launch an initiative to deliver evidence based practice. The factors essential for such initiative include the following: Practice adoption Alignment of nursing curricular and education Model and theory development Scientific engagement in new fields of research (Dogherty et al., 2013). The stress for EBP became evident after increased demand for safe and quality improvement in health care. For the effective implementation of EBP, the process of EBP should be adopted by individual care provider as well as policy makers too. A study on the level of adoption of EBP in nurses showed that nurses have the intention to learn about the skills related to EBP, but they face several barriers in employing it in real world practice (Aveyard Sharp, 2013).From my experience as a nurse, I also feel that integrating research in real practice is difficult as we struggle in interpreting research article. However, according to NMBA standard of nursing practice, it is critical that nurses think critically and analyses their practice. It states that engaging in therapeutic relationship is vital for nurses (Nursing and Midwifery Board of Australia - Professional standards, 2016). For comprehensive assessment of patients and delivering responsive quality nursing practice, it is important that we learn ways to integrate research in nursing practice. Thus a sophisticated implementation of EBP plan is necessary that addresses the barriers too. Barrier to implementing evidence based practice As harnessing evidence to improve nursing care is an important element of EBP, it is necessary to identify the problem that nurses and clinicians need to overcome to enjoy the benefits of best practice research. The following are the barriers and their proposed solution for implementing evidence based nursing: Nurses like me have faced problem in interpreting research finding due to the size and complexity of research data. Nursing clinic can overcome this problem by using service that synthesize information in a simple manner and present it to nurses. This will make it easier for nurses to implement the nursing care (Aveyard Sharp, 2013).According to NMBA standard of nursing practice, this practice will enable them to participate in quality improvement activities and review their practice by utilizing evidence relevant to specific area of nursing practice (Nursing and Midwifery Board of Australia - Professional standards, 2016). In case of development of policy related to evidence based nursing, policy makers may face problem in developing an accurate nursing guideline according to National Competency Standard for Registered Practice. Nursing leader or hospital executive can take action to use information system that integrates evidence with patient care. They can also take the initiative to encourage delivery of safe and effective care along with introduction of disease management system (O'Connell et al., 2014). Another problem that I have faced in my nursing practice is lack of access to best nursing research articles related to specific area of practice. The Australian Nursing and Midwifery Council states that nurse must show analytical skill in accessing research evidence and they should document information to use it while dealing with patients. They are also encouraged to enquire when any evidence/ research is not clear to them or when they feel their application is doubtful (Nursing and Midwifery Board of Australia, 2016). Many nurses may not be aware of nursing practice guidelines set by the Nursing and Midwifery Council. In such situation, it will be the responsibility of managers in the health care organization to arrange programmes that hones nurses skill to interpret research findings and also improve their performance (Abbott et al., 2013). Organization may also act as barrier because many health care clinic do not realized the importance of EBP and they do not have any regulation in place so that nurses follow the process. Even if such programme is implemented, they are not continued for a prolonged period to make the change sustainable. Nurses may also face problem even after learning the process of EBP when patients do not adhere to their nursing treatment or intervention (Polit Beck, 2013).As a nurse, I feel that we can take help from senior or colleagues and discuss regarding the implication and usefulness of research article. Effective implementation of EBP in nursing For effective implementation of EBP, nurses will require the following core competency Providing patient centered care by identifying patients preference and respecting their needs. Nurse must have effective communication skills to achieve this so that they understand the concern of patients and provide coordinated continued care. In case of situations when patients preference will lead to adverse health outcome in them, it is essential that they educate patient about the pathophysiology of the condition and the rational for proposed intervention (Hamric et al., 2013). The NMBA standard of nursing practice have also emphasized that nurses must clarify this situation of refusing care with other medical team and advocate for positive health outcome of patient despite all issues in practice (Nursing and Midwifery Board of Australia, 2016). Working in interdisciplinary team is also important to coordinate and integrate EBP in nursing care. The provision of coordinated care according to National Competency Standard for Registered Nurse has also stated that coordination involves assessment of patient and then planning care. It relies on using evidence based assessment framework to collect data on overall health of patient by techniques like observation, physical assessment and interview (Nursing and Midwifery Board of Australia, 2016). The National Competency Standard also recognizes the fact that clinical judgment is the key to resolving conflicts (Masters, 2015). Nurses should have the skill to integrate best evidence with nursing expertise and patient values to achieve optimum quality of care. Nursing staff should develop the competency to apply quality improvement measures by identifying hazards in any nursing intervention for particular patient. They can refer to best evidence on particular technique to simplify and standardize intervention design. They must have the attitude and seriousness to continue quality of care in all areas-such as the process and outcome in relation to patient needs (Billing et al., 2015). They should be able to utilize informatics, manage nursing knowledge related to nursing competency skill and mitigate errors by using information technology. After the above mentioned competency is achieved in nurse, they can proceed in the following ways for effective implementation of EBP in nursing cares: The first step is knowledge creation and filtering evidence based information. It will mean cultivating a spirit of inquiry. For example I will deal with patient with head injuries, I will try to critically reflect on how supine position or elevating head of bed affects intracranial pressure. Without this type of inquiry in nurses, the process of EBP cannot happen. The second effective step is asking clinical question in PICOT format. In this step, nurse can inquire about a topic based on population of interest (P), intervention (I), comparison of intervention (C), projected outcome (C) and time involved (T). It is an effective framework to retrieve research studies related to the nursing question. For example in case of rapid response from nursing staff, we can question how a rapid response team can have impact of patient outcome compared to staff not having a rapid response team? The third step is identifying the best evidence related to the question or nursing complication. This s tep becomes easier after utilizing PICOT format of framing question. I will also try to apply PICOT to aids in identifying the key words and then identifying related articles in databases like Medline or Cinahl. For the question on rapid response team, the key words can be rapid response team, acute emergency care and other similar terms. The next step would be to critically appraise the evidence. This step is essential to determine the most relevant article applicable to the clinical question (Stevens, 2013). The usefulness of an article can be evaluated by questions like are the result of research appropriate?, why are they important? and will the study finding help nurse to apply this for current patient situation? This step will be followed by integrating the information with nursing expertise and referring to patient preference and values too. Just finding the related nursing evidence is not the end of EBP process. It also requires clinical judgement based on patients diagnosti c outcome, patient assessment and patients preference. For example if there is strong evidence related to reduced signs of depression after cognitive therapy, nurse can decide on including this intervention in patient (Belnap, 2016). After application of evidence based practice in particular patients, the final step will be to evaluate the outcome based on relevant evidence. This step is crucial to monitor changes in outcome and decide whether positive or negative results have been found. In case of positive outcome, this intervention will be disseminated and in case of negative outcome, other remedy will be found out for the problem (Grol et al., 2013). Conclusion Thus, the position statement focused on the method of effective implementation of EBP in nursing practice. It stated the factors required for effective implementation of this approach and the way by which one can overcome the barrier in clinical practice. The stepwise process of implementing EBP in real nursing practice along with specific example helped in getting accurate idea for implementation such process. Therefore, the effort of both organization and nurse is required to integrate this new model in nursing care practice. Reference Abbott, P., Mc Sherry, R., Simmons, M. (Eds.). (2013).Evidence-informed nursing: A guide for clinical nurses. Routledge. Aveyard, H., Sharp, P. (2013).A Beginner's Guide to Evidence-based Practice in Health and Social Care. McGraw-Hill Education (UK). Belnap, J. (2016). Scratching the Surface: Using Informatics in Education.Journal of Doctoral Nursing Practice,9(1), 164-166. Billings, D. M., Halstead, J. A. (2015).Teaching in nursing: A guide for faculty. Elsevier Health Sciences. Dogherty, E. J., Harrison, M. B., Graham, I. D., Vandyk, A. D., Keeping Burke, L. (2013). Turning Knowledge Into Action at the Point of Care: The Collective Experience of Nurses Facilitating the Implementation of Evidence Based Practice.Worldviews on Evidence Based Nursing,10(3), 129-139. Edmonds, L., Cashin, A., Heartfield, M. (2016). Comparison of Australian specialty nurse standards with registered nurse standards.International nursing review. Grol, R., Wensing, M., Eccles, M., Davis, D. (Eds.). (2013).Improving patient care: the implementation of change in health care. John Wiley Sons. Grove, S. K., Burns, N., Gray, J. R. (2014).Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences. Hamric, A. B., Hanson, C. M., Tracy, M. F., O'Grady, E. T. (2013).Advanced practice nursing: An integrative approach. Elsevier Health Sciences. LoBiondo-Wood, G., Haber, J., Berry, C., Yost, J. (2013).Study Guide for Nursing Research: Methods and Critical Appraisal for Evidence-based Practice. Elsevier Health Sciences. Masters, K. (2015).Role development in professional nursing practice. Jones Bartlett Publishers. Nursing and Midwifery Board of Australia - (2016).Nursingmidwiferyboard.gov.au. Retrieved 15 September 2016, from https://www.nursingmidwiferyboard.gov.au/ Nursing and Midwifery Board of Australia - Professional standards. (2016).Nursingmidwiferyboard.gov.au. Retrieved 15 September 2016, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx O'Connell, J., Gardner, G., Coyer, F. (2014). Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing.Journal of advanced nursing,70(12), 2728-2735. Polit, D. F., Beck, C. T. (2013).Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams Wilkins. Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas.The Online Journal of Issues in Nursing,18(2).