Evidence Based Practice Essay

Implementation of Evidence Based Practice Rosemary Garcia Implementation of Evidence Based Practice Evidence Based Practice Nursing is the utilization by nurses of Evidence Based Research findings that, according to Houser (2012), steer the nurse toward integration of clinical expert opinion and experience with an unbiased exhaustive review of the best scientific evidence professional nursing care literature can provide while incorporating patient values and preferences. Evidence Based Practice Nursing entails adopting a systematic critical thinking decision making process guided by a deliberate and defined chosen Evidence Based Nursing model path that involves searching, appraising, synthesizing, adapting, implementing, and continually evaluating the Evidence Based Research findings implemented. Among these models are the Conduct and Utilization of Research in Nursing (CURN) project, the Stetler Model of Research Utilization, and the Iowa Model for Research in Practice. The purpose of this paper is to explore the impact of Evidence Based Research on nursing practice by defining Evidence Based Practice Nursing, directing attention to the importance of Evidence Based Research, briefly reviewing examples of qualitative and quantitative research and finally identifying some ways to overcome barriers that prevent nurse participation and utilization of Evidence Based Research. Importance of Evidence Based Research Evidence Based Research is important because it provides nurses with â€Å"actual knowledge of elements of practice that have been known to work† according to R. Simpson (2004). Evidence Based Practice Nursing is based on a disciplined methodological decision making process in which nurses continually ask for Evidence Based Research to support their actions and consistently weigh the validity and reliability of activities of each day. The Evidence Based Practice Nurse also plans for change according to Rosswurm and Larrabee (1999). Evidence Based Research findings come through  two proven methods, namely qualitative and quantitative research. Systematic reviews summarize and succinctly abstract findings from multiple studies and compile them into useable condensed formats for quicker study and review. A systematic review that includes a meta-analysis draws findings from multiple studies, recalculates the results to arrive at a new finding thus compounding its validity and re liability. The utilization of Evidence Based Research directly and positively improves nursing practice when the findings are implemented. Research Examples The following two examples of Evidence Based Research show how implementation impacts nursing practice. Nursing homes promote their quality of care using analyses and marketing strategies to influence public perception and attract business. How a nursing home addresses the phenomena of palliative care and the prevalence of pressure ulcers affects that perception. A nursing home may presume to have high quality of care because of high score on the Minimum Data Sheet (MDS) prevalence ulcer (PU) indicator and promote such a score. Similarly, how a nurse responds to a resident in palliative care also reflects on quality of care. Evidence Based Research of these two phenomena helps improve nursing practice in this arena. A nurse in a long term care facility that provides palliative care may be called upon to respond to a resident who may be struggling with issues of regret for life events and feel a need for forgiveness. A retrospective study by Ferrel, Otis-Green, Baird, and Garcia, (2013) through a convenience sample of 339 nurses attending palliative care educational courses throughout the U.S. and Belize, India, the Philippines and Romania sought to assess nurses’ responses to this issue. Since the purpose was to document the viewpoints and feelings, a descriptive qualitative research design using the phenomenology method was appropriate. The data was examined using content analysis and themes were identified. By focusing on nurses from a broad geographical base who were attending palliative care classes, the researches maximized the potential for gathering relevant data and enhanced transferability and validity through this convenience sample. They also minimized inherent cultural bias that could have potentially arisen if the sample had been solely from one country or region. The conclusion was that nurses would benefit from additional education regarding  how best to address these con cerns. Implementing these Evidence Based Research findings helps improve nursing practice. As noted earlier, the prevalence of pressure ulcers, their prevention and treatment is a common dilemma in a long term setting and nursing homes want to demonstrate success in this area as part of the quality of care. One method used to identify and monitor pressure ulcers is the Minimum Data Sheet (MDS) prevalence ulcer (PU) indicator. Bates-Jensen et al (2003) in a quantitative research descriptive study sought to determine whether the minimum data sheet pressure ulcer indicator of a high or low score reflected differences in processes related to pressure ulcer prevention and treatment. The convenience sample consisted of 321 residents from 16 different nursing homes. The resident had to be at risk for pressure ulcer development using the PU Residential Assessment Protocol of the MDS to meet the criteria for inclusion. This was a quantitative study designed to collect numerical data by measuring 16 care process quality indicators (10 related to PU care processes, five related to nutrition and one related to incontinence management) using medical record data, direct human observation, interviews and data from wireless thigh movement monitors. The statistical data results revealed that the MDS PU indicator was not a useful indicator of quality of care and could be misinterpreted if not explained. Family members who are considering long term care benefit from this research and in a facility that might have mistakenly interpreted the meaning of the MDS PU indicator, Evidence Based Practice Nursing would implement corrective measures regarding future use of the scores and thus bring about an improved change. Barriers Preventing Research Utilization Nursing improves when Evidence Based Research findings can be utilized and implemented by nurses in their daily practice. J. Dracup (2006) stated what some nurses had identified as barriers to Evidence Based Research, namely: â€Å"accessibility of research findings, anticipated outcomes of using research, organizational support to use research, and support from others to use research.† Dracup believed that â€Å"evidence-based practice must include an assessment of the available resources† since the cost of implementation is yet another barrier and â€Å"will not be adopted if resources are insufficient to incorporate them into the daily routine† nursing care. G. Mitchell  (1999) raised â€Å" the lack of sufficient meaningful research† as an additional barrier. A multidisciplinary effort by researchers and educators of all fields will be required to work toward the removal of these barriers. Collaborate to provide a more efficient system of information dissemination must take place. Systematic reviews, sometimes combined with meta-analysis, already advance the cause of having multiple sources of research data condensed to a useable quickly reviewable format. One possible way that nurses could gain access to Evidence Based Research through the Cochrane Library, for example, is by way of grants to school districts and local libraries allowing free or low cost subsidized access. After obtaining this access and recognizing nurses’ research time restraints, the formation of high school clubs like â€Å"Cochrane Library Scholars† would allow nurses to pose Research Questions to the club who would in turn compile relevant research articles for the nurse. Similar clubs could be â€Å"AHRQ Research Scholars† and â€Å"Campbell Library Scholars.† Since addressing the barrier of cost of Evidence Based Research implementation is equally important., to purposefully draw community leaders’ attention to the Evidence Based Research available at their local library, create a logo such as â€Å"LIBR[LIBRARY]ARY† with the slogan â€Å"A Library within A Library.† By raising awareness of the benefits of Evidence Based Research of public and private pivotal decision makers, these individuals could prove instrumental in helping to identify and acquire the resources needed to implement Evidence Based Research within their sphere of influence. By opening avenues to Evidence Based Research findings through local libraries, engaging students as researchers and raising community awareness, more nurses could gain knowledge that translates into Evidence Based Practice Nursing. Participants would be engaged in raising the quality of care within their own communities. Raising widespread awareness of the importance and value of Evidence Based Research could be the catalyst that propels groups to collectively seek resources for implementation of Evidence Based Practice in communities across the nation. Conclusion Evidence Based Research impacts Evidence Based Practice Nursing if it is utilized. A deliberate effort to promote the understanding of its importance combined with taking measures to remove barriers that prevent  nurses from using Evidence Based Research findings will impact, improve, and ensure the best possible nursing practice. References Bates-Jensen, B.M., Cadogan, M., Osterwell D., Levy-Storms L, Jorge, J., Alsamarrai, N., Grbic, V. & Schnelle, J.F. (2003) The Minimum Data Set Pressure Ulcer Indicator: Does It Reflect Differences in Care Processes Related to Pressure Ulcer Prevention and Treatment in Nursing Homes? Journal of American Geriatric Society, 51(9). DOI: 10.1046/j.1532-5415.2003.51403.x Dracup, J. (2006). Evidence-Based Practice is Wonderful †¦ Sort Of, American Journal of Critical Care. 15(4) Ferrel, B., Otis-Green, S, Baird, R.P., & Garcia, A. (2013). Nurses’ Responses to Requests for Forgiveness at the End of Life. Journal of Pain System Management, DOI: 10.1016/j.jpainsymman.2013.05.009 Houser, J. (2012). Nursing Research: reading, using, and creating evidence. (2nd ed.). Salisbury, MA: Jones & Barlett Publishing Mitchell, G. (1999). Evidence-based practice: Critique and alternative view. Nursing Science Quarterly, 12(1), 30-35. Retsas A. (2000). Barriers to using research evidence in nursing practice. Journal of Advanced Nursing, 31:599-606. Rosswurm, M. A., & Larrabee, J. (1999). A model for change to evidence-based practice. Journal of Nursing Scholarship, 31(4), 317-322. Implementation of Evidence Based Practice Rosemary Garcia Submitted to Karen Rhoades, MS, RN in partial fulfillment of NR460R Evidence Based Practice August 10, 2013 Implementation of Evidence Based Practice Evidence Based Practice Nursing is the utilization by nurses of Evidence Based Research findings that, according to Houser (2012), steer the nurse  toward integration of clinical expert opinion and experience with an unbiased exhaustive review of the best scientific evidence professional nursing care literature can provide while incorporating patient values and preferences. Evidence Based Practice Nursing entails adopting a systematic critical thinking decision making process guided by a deliberate and defined chosen Evidence Based Nursing model path that involves searching, appraising, synthesizing, adapting, implementing, and continually evaluating the Evidence Based Research findings implemented. Among these models are the Conduct and Utilization of Research in Nursing (CURN) project, the Stetler Model of Research Utilization, and the Iowa Model for Research in Practice. The purpose of this paper is to explore the impact of Evidence Based Research on nursing practice by defining Evidence Based Practice Nursing, directing attention to the importance of Evidence Based Research, briefly reviewing examples of qualitative and quantitative research and finally identifying some ways to overcome barriers that prevent nurse participation and utilization of Evidence Based Research. Importance of Evidence Based Research Evidence Based Research is important because it provides nurses with â€Å"actual knowledge of elements of practice that have been known to work† according to R. Simpson (2004). Evidence Based Practice Nursing is based on a disciplined methodological decision making process in which nurses continually ask for Evidence Based Research to support their actions and consistently weigh the validity and reliability of activities of each day. The Evidence Based Practice Nurse also plans for change according to Rosswurm and Larrabee (1999). Evidence Based Research findings come through two proven methods, namely qualitative and quantitative research. Systematic reviews summarize and succinctly abstract findings from multiple studies and compile them into useable condensed formats for quicker study and review. A systematic review that includes a meta-analysis draws findings from multiple studies, recalculates the results to arrive at a new finding thus compounding its validity and reliability. The utilization of Evidence Based Research directly and positively improves nursing practice when the findings are implemented. Research Examples The following two examples of Evidence Based Research show how implementation impacts nursing practice. Nursing homes promote their quality of care using analyses and marketing strategies to influence public perception and attract business. How a nursing home addresses the phenomena of palliative care and the prevalence of pressure ulcers affects that perception. A nursing home may presume to have high quality of care because of high score on the Minimum Data Sheet (MDS) prevalence ulcer (PU) indicator and promote such a score. Similarly, how a nurse responds to a resident in palliative care also reflects on quality of care. Evidence Based Research of these two phenomena helps improve nursing practice in this arena. A nurse in a long term care facility that provides palliative care may be called upon to respond to a resident who may be struggling with issues of regret for life events and feel a need for forgiveness. A retrospective study by Ferrel, Otis-Green, Baird, and Garcia, (2013) through a convenience sample of 339 nurses attending palliative care educational courses throughout the U.S. and Belize, India, the Philippines and Romania sought to assess nurses’ responses to this issue. Since the purpose was to document the viewpoints and feelings, a descriptive qualitative research design using the phenomenology method was appropriate. The data was examined using content analysis and themes were identified. By focusing on nurses from a broad geographical base who were attending palliative care classes, the researches maximized the potential for gathering relevant data and enhanced transferability and validity through this convenience sample. They also minimized inherent cultural bias that could have potentially arisen if the sample had been solely from one country or region. The conclusion was that nurses would benefit from additional education regarding how best to address these concerns. Implementing these Evidence Based Research findings helps improve nursing practice. As noted earlier, the prevalence of pressure ulcers, their prevention and treatment is a common dilemma in a long term setting and nursing homes want to demonstrate success in this area as part of the quality of care. One method used to identify and monitor pressure ulcers is the Minimum Data Sheet (MDS) prevalence ulcer (PU) indicator. Bates-Jensen et al (2003) in a quantitative research descriptive study sought to determine whether the minimum data sheet pressure ulcer indicator of a high or low score reflected differences in  processes related to pressure ulcer prevention and treatment. The convenience sample consisted of 321 residents from 16 different nursing homes. The resident had to be at risk for pressure ulcer development using the PU Residential Assessment Protocol of the M DS to meet the criteria for inclusion. This was a quantitative study designed to collect numerical data by measuring 16 care process quality indicators (10 related to PU care processes, five related to nutrition and one related to incontinence management) using medical record data, direct human observation, interviews and data from wireless thigh movement monitors. The statistical data results revealed that the MDS PU indicator was not a useful indicator of quality of care and could be misinterpreted if not explained. Family members who are considering long term care benefit from this research and in a facility that might have mistakenly interpreted the meaning of the MDS PU indicator, Evidence Based Practice Nursing would implement corrective measures regarding future use of the scores and thus bring about an improved change. Barriers Preventing Research Utilization Nursing improves when Evidence Based Research findings can be utilized and implemented by nurses in their daily practice. J. Dracup (2006) stated what some nurses had identified as barriers to Evidence Based Research, namely: â€Å"accessibility of research findings, anticipated outcomes of using research, organizational support to use research, and support from others to use research.† Dracup believed that â€Å"evidence-based practice must include an assessment of the available resources† since the cost of implementation is yet another barrier and â€Å"will not be adopted if resources are insufficient to incorporate them into the daily routine† nursing care. G. Mitchell (1999) raised â€Å" the lack of sufficient meaningful research† as an additional barrier. A multidisciplinary effort by researchers and educators of all fields will be required to work toward the removal of these barriers. Collaborate to provide a more efficient system of information di ssemination must take place. Systematic reviews, sometimes combined with meta-analysis, already advance the cause of having multiple sources of research data condensed to a useable quickly reviewable format. One possible way that nurses could gain access to Evidence Based Research through the Cochrane Library, for example, is by way of grants to school districts and local  libraries allowing free or low cost subsidized access. After obtaining this access and recognizing nurses’ research time restraints, the formation of high school clubs like â€Å"Cochrane Library Scholars† would allow nurses to pose Research Questions to the club who would in turn compile relevant research articles for the nurse. Similar clubs could be â€Å"AHRQ Research Scholars† and â€Å"Campbell Library Scholars.† Since addressing the barrier of cost of Evidence Based Research implementation is equally important., to purposefully draw community leaders’ attention to the Evidence Based Research available at their local library, create a logo such as â€Å"LIBR[LIBRARY]ARY† with the slogan â€Å"A Library within A Library.† By raising awareness of the benefits of Evidence Based Research of public and private pivotal decision makers, these individuals could prove instrumental in helping to identify and acquire the resources needed to implement Evidence Based Research within their sphere of influence. By opening avenues to Evidence Based Research findings through local libraries, engaging students as researchers and raising community awareness, more nurses could gain knowledge that translates into Evidence Based Practice Nursing. Participants would be engaged in raising the quality of care within their own communities. Raising widespread awareness of the importance and value of Evidence Based Research could be the catalyst that propels groups to collectively seek resources for implementation of Evidence Based Practice in communities across the nation. Conclusion Evidence Based Research impacts Evidence Based Practice Nursing if it is utilized. A deliberate effort to promote the understanding of its importance combined with taking measures to remove barriers that prevent nurses from using Evidence Based Research findings will impact, improve, and ensure the best possible nursing practice. References Bates-Jensen, B.M., Cadogan, M., Osterwell D., Levy-Storms L, Jorge, J., Alsamarrai, N., Grbic, V. & Schnelle, J.F. (2003) The Minimum Data Set Pressure Ulcer Indicator: Does It Reflect Differences in Care Processes Related to Pressure Ulcer Prevention and Treatment in Nursing Homes? Journal of American Geriatric Society, 51(9). DOI: 10.1046/j.1532-5415.2003.51403.x Dracup, J. (2006). Evidence-Based Practice is Wonderful †¦ Sort Of, American Journal of Critical Care. 15(4) Ferrel, B., Otis-Green, S, Baird, R.P., & Garcia, A. (2013). Nurses’ Responses to Requests for Forgiveness at the End of Life. Journal of Pain System Management, DOI: 10.1016/j.jpainsymman.2013.05.009 Houser, J. (2012). Nursing Research: reading, using, and creating evidence. (2nd ed.). Salisbury, MA: Jones & Barlett Publishing Mitchell, G. (1999). Evidence-based practice: Critique and alternative view. Nursing Science Quarterly, 12(1), 30-35. Retsas A. (2000). Barriers to using research evidence in nursing practice. Journal of Advanced Nursing, 31:599-606. Rosswurm, M. A., & Larrabee, J. (1999). A model for change to evidence-based practice. Journal of Nursing Scholarship, 31(4), 317-322.