answers to peers

How does your facility incorporate EBP in a clinical setting to promote patient outcomes? Do you have recommendations on how your facility can improve its use of EBP?

My facility incorporates evidence-based practice in the clinical setting in a resourceful manner in order to promote patient outcomes. The institution integrates clinical expertise, the best research evidence and patient values in the decision making process to foster the implementation of evidence based practice. In this endeavor, the facility also encourages patients to bring their personal preferences, unique concerns, values and expectations in order to ensure that the clinicians have a heighted understanding of their pertinent medical issues and provide patient-centered care that meets the distinct needs of the patients.

According to Polit & Beck (2011), through the practice of EBP, the healthcare facility can be in a better position to ascertain the effects of therapy, the prognosis of diseases, the utility of diagnostic tests as well as the etiology of disorders. It is worth mentioning that my facility follows various steps in implementing the EBP practices. These steps include assessing the patient, asking clinical questions derived from the patient’s case, acquiring the evidence through searching appropriate resources and then appraising the evidence for its applicability and validity. The other steps usually include integrating the evidence with patient preferences, clinical expertise and applying it to practice. The institution also encourages all practitioners to evaluate their performance with the patient as a yardstick for determining the effectiveness of the EBP process.

Although the facility has registered notable success in its EBP initiatives, various recommendations can help it to improve on these processes. One of such proposals is to aim at creating and sustaining strong nurse-client relationships (Majid, Foo, & Luyt, 2011) . This can enable the practitioners to have a better understanding of the patient’s unique values and preferences, all of which are fundamental components of EBP practice. The leaders of the facility should also serve as positive role models through advocating, embracing and communicating the benefits of EBP to other employees in the organization. Ultimately, this will help to create a culture that supports the adoption and implementation of evidence-based practice across the entire healthcare establishment (Polit & Beck, 2011) .

References

Majid, S., Foo, S., & Luyt, B. (2011). Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229–236. Retrieved June 10, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133901/

Polit, D., & Beck, C. (2011). Nursing Research: Generating and Assessing Evidence for Nursing Practice (9 ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.  

Discussion Question 2

How can you use EBP in your practice? Discuss some impediments to creating a program of nursing research in your clinical environment.

Identify and discuss strategies for promoting EBP in your practice.

In my practice, I can find innovative ways of using EBP to improve the treatment outcomes of patients and ensure that I promote my professional growth. As a first step of using the EBP, I will strive to ensure that I fully utilize and evaluate published research in the various aspects of operational and clinical processes. I will also conduct research projects related to the field of healthcare and share the knowledge from these projects with other nurses in the facility as well as nurses in other external organizations. Apart from looking at quality improvement data, research findings and other types of evaluation data, I will also strive to rely on expert opinion for identifying methods of improvement. The expert opinions can come from colleagues in the facility, particularly those with a wealth of experience in clinical issues (Atkinson, Turkel , & Cashy, 2008) .

Nonetheless, I must admit that there are various impediments to creating a program of nursing research in my clinical environment. One of these impediments stems from the heavy workload subjected to employees in the facility. This workload, which is a result of high turnover rates in the organization, denies practitioners the valuable time that they can use to engage in research and evaluate the effectiveness of their findings. Another major impediment to creating a program of nursing research at my clinical environment comes from the lack of financial resources. Levin, Marren, & Lauder (2010) contend that these resources are necessary for sustaining a long-term research project and guaranteeing its success. Furthermore, inability to comprehend statistical terms coupled with lack of time and inadequate understanding of jargons used in most research articles can pose some barriers to creating a program of nursing research in healthcare establishments (Majid et al., 2011) .

Various strategies can aid to promote EBP in my practice. As Majid et al. (2011) vividly point out, in order to ensure that the nursing research program becomes a success and fosters appropriate EBP practices, there will be need for conducting periodic EBP training and encouraging mentorship especially by those nurses who have vast experience in the evidence-based practices. Other viable alternatives include encouraging enculturation of research infrastructure, expanding journal clubs to the various nursing units and establishing nursing research councils that can foster the implementation of EBP in the healthcare establishment (Levin, Marren, & Lauder, 2010) .

References

Atkinson, M., Turkel , M., & Cashy, J. (2008). Overcoming Barriers to Research in a Magnet Community Hospital. Journal of Nursing Care Quality, 23(4), 362 – 368. Retrieved June 10, 2015, from http://www.nursingcenter.com/journalarticle?Article_ID=815746

Levin, R., Marren, J., & Lauder, B. (2010). Evidence-Based Practice Improvement Merging 2 Paradigms. J Nurs Care Qual, 25(2), 117–126. Retrieved June 10, 2015, from http://ohiohospitals.org/OHA/media/Images/Patient%20Safety%20and%20Quality/Documents/39Weeks/Evidence-Based-Practice-Improvement-Model-1.pdf

Majid, S., Foo, S., & Luyt, B. (2011). Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229–236. Retrieved June 10, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133901/

second peer

Clinical research is not the same as evidenced based practice. Clinical research is “any kind of research that involves patients and ranges from case reports and case series” where the reviewer, uses a retrospective study of their own outcomes. (Neumayer, 2006).  The obstacles include time constraints, lack of support staff, reward or recognition, potential impact on the patient-doctor relationship, loss of professional autonomy, incompatibility of protocol with daily practice and problems with the consent procedure (Hebert, 2005).  Clinical trials also are expensive and take several years to complete  (Neumayer, 2006).  Evidence based research is a process that includes “collecting, processing and implementing research findings to improve clinical practice, the work environment or patient outcomes (Chrisman, 2014). Another great concern is protecting the vulnerable, which are “populations who are at risk of being misused in the course of medical research, either by coercion or a lack of knowledge or understanding” (Park, 2008). 

How does your facility incorporate EBP in a clinical setting to promote patient outcomes?  Do you have recommendations on how your facility can improve its use of EBP?

The facility for which I work has begun to use encourage and promote the use of evidence based research.  We have nurses that participate in different associations that return with information from other facilities that have made changes for the benefit of patient outcomes and have proof that it has worked.  Because journals and articles are researched with the evidence that supports better patient outcomes, my facility has continued to use this method.  As recent as yesterday, I was participating in a hospital wide meeting where we are discussing what each department is implementing to promote patient outcomes.  In my specific department, we have started the task of safety for the patients and for the staff,  This is due the fact that there have been some incidences where police have been involved and reports were filed on behalf of patients and the staff.  In this meeting, while there are employees, we also have upper management who encourage us to work on the project and have offered us use of libraries and studies where we can continue to research. Management specifically stated that evidence based research is more likely to be received and implemented over any other type of research.  This is encouraging to many staff, because it allows us to learn, research and make a better environment for our patients and our fellow coworkers.  Thankfully, my department not only has support from management but was offered additional evidence from one manager who had implemented safety measures at a previous facility.  

How can you use EBP in your practice? 

Our facility is working on becoming obtaining a magnet status and projects that are implemented must be evidence based. 

Discuss some impediments to creating a program of nursing research in your clinical environment. 

Patient selection would be an impediment in nursing research in our clinical environment, because we are in the ER and our population is continues to be open ended and rotating.  We also have the problem with our population of being inconsistent, with care, medications and follow up.  Another problem would be obtaining consent.  Many people are concerned about the integrity of confidentiality and may not desire to participate.  Timing is another issue, it takes time to gather and collect information, time and money and finance to complete and process the statistics and we need staff.  As we currently are, we work shifts that lack an appropriate amount of nurses and therefore must close sections, losing nurses to help in research would further create a deficit in patient care. 

Identify and discuss strategies for promoting EBP in your practice.

Our shared governance committee meets at regularly scheduled intervals and we report to corporate managers regarding our progress.  This is being used now, as a way to provide upper management with options that we suggest that can be implemented such as safety measures.  This also unites us as a department and a company with a common goal, improving patient outcomes.  Management gets to hear us provide them with proof of suggestions that we believe will work and we are dedicated to trying in order to solve solutions and provide better care.

References

Chrisman, J., Jordan, R., Davis, C., & Williams, W. (2014) Exploring evidence-based practice research. Nursing made Incredibly Easy, 12(4), 8-12. doi:10.1097/01.NME.0000450295.93626.e7

Hebert-Croteau, N., Brisson, J., Lemaire, J., & Latreille, J. (2005). The benefit of participating to clinical research. Breast Cancer Research and Treatment, 91(3), 279-81. doi:http://dx.doi.org/10.1007/s10549-005-0320-0

Neumayer, L. (2006). Clinical Research. The American Journal of Surgery, 192(2), 264. doi:http://dx.doi.org/10.1016/j.amjsung.2006.05.005

Park, S.S., & Grayson, M.H. (2008). Clinical research: Protection of the “vulnerable”? Journal of Allergy and Clinical Immunology, 121(5), 1103-1107. doi:http://dx.doi.org/10.1016/j.jaci.2008.01.014