Introduction
Evidence Based Principle (EBP) is a fundamental problem-solving approach to enhance care in nursing practice. EBP incorporates the best selected and available evidence to align the clinician’s expertise to patient’s needs; considering patient’s values and preferences. Extensive literature searches are fundamental to support EBP. The development of clinical practice guidelines and medical position statements are highly supported by governments and medical associations. This is an indication that the EBP guidelines are highly regarded as a timely recommendation for practice. Hence, implementation of EBP is critical in healthcare settings to improve patient outcome and increase healthcare safety. The decision-making aspect in health care is equally critical. In a hospital setting nurses are confronted with different presentation of patient’s conditions, which may be critical. Therefore, making informed decision is important. In different cases, healthcare providers are faced with the need to make instant and effective decisions concerning a patient’s life. A clinical organization that has adopted a good EBP structure is in a better position to make quality decisions concerning a patient’s condition (Lyman et al., 2019). Thus, healthcare facilities with effective structures that implement the principles record positive results which include reduced healthcare costs, eliminated tests and procedures and reduced harm. Readiness to implement evidence based practice may be influenced by experience, exposed to EBP leadership roles, working years in nursing, group cohesion and positive organization culture. Further, health care providers are faced with various experiences that may act as barriers to the implementation of EBP principles. Nurses may have a good attitude towards EBP but at the same time lack practical implementation of the principles. Further, healthcare providers that are experienced may be familiar with the principles but that might not mean that they practice EBP in daily services. Some nurses may embrace EBP with a positive attitude but may lack sufficient knowledge on EBP. Therefore, even though the wealth of knowledge on EBP principles in nursing care is available, implementation of the principles is crucial to ensure positive patient outcome is realized. I believe that the daily practice forms core values that influence nursing practice and contribute to organizational culture that influences inter-professional teams.
Healthcare facilities that adopt EBP culture in nursing practice are in a better position to make quality decisions and assure patients effective and efficient services. In teaching and training more emphasis is focused on designing a culture that ensures daily practice of EBP principles are in place. Other than ensuring better patient outcome, achieving a level of clarity in the implementation of the principle enhance inter-professional collaboration with a unifying focus to improve patient care. EBP encourages critical thinking skills that influence knowledge and behaviour. Critical thinking represents better clinical judgement and the application of the thinking skills positively impact patient outcome. During decision making, some of the principles may not answer the clinical questions, therefore, the nurses are required to reason beyond the scope of training to obtain quality clinical judgement. Implementation of EBP in clinical practice is beneficial to both the patient and the healthcare provider. The healthcare provider develops knowledge while providing care making it less monotonous for the care provider. Further, use of EBP may be viewed as an opportunity for growth in clinical practice.
Integrating EBP into clinical practice is a crucial aspect in the planning and implementation stage. I found out that proper planning and consistent implementation of the principles is a pillar in clinical training (Mackey & Bassendowski, 2017). During my clinical training program, my mentor took time to transfer very important skills beyond my knowledge in EBP, skills that I uphold to-date. She led a team attending to a patient in the intensive care unit. At the time, the focus for care was based on assessing, preventing and managing delirium for an ICU patient. She started by giving me background information on how EBP are formulated. The first step was to select a model or framework for decision making process. In her case she used a theoretical framework to guide the process for integrating research into practice. I understood that understanding the differences in the models and frameworks assists nurses in identifying the best model to implement the principles in a clinical process. Secondly, to establish teams that will continually emphasize interprofessional collaboration serves as the basis of successful implementation of EBP. Further, part of this team will provide leadership in implementing EBP. As we attended the patient, my mentor explained to me how she went through the clinical questions for the patient that assisted in identifying the clinical problem. She outlined the PICOT questions used to identify the clinical problem. The questions assisted to enquire about the identity of the patient’s population. The identity information was to clarify on healthcare problems related to the patient’s identity. Other enquiries involved specific methods of interventions, treatment and alternative treatments that will result to the expected outcome. Based on the PICOT questions, I understood that as a nurse I need to consider substantial change of culture and behaviour that attends to the situation and in most cases the influence is not limited to the scope of training within the medical team. Using the PICOT terms the information is used to identify the best evidence. At the time she conducted a systematic review that will assist in answering clinical questions.
Systematic review and critical assessment are important aspects in the planning and implementation process. At the time, this stage was a rigorous process which was tiring and time consuming. My feeling was that we were going through documents that looked similar and I did not understand what we were expected to achieve. My mentor noted and explained that the purpose of the process is to summarize the data for critical appraisal to make appropriate recommendation for clinical practice. As explained by my mentor, there are different presentation of patient cases that may not be answered sufficiently by the available guidelines. Therefore, the critical assessment helps the nurses to make decisions that may assist in the immediate presented situation (Buccheri & Sharifi, 2017). To select the implementation strategy, we conducted a search using sites approved by the healthcare stakeholders. The clinical questions were queried using PubMed, Psych INFO, Cochran and CINAHL. The searches were guided by the need to find strategies for delirium-oriented intervention for adult patients in ICU. For most of the literature we read, the outcome of the process was described hence assisting in making solid decisions. Later, I was guided on how one derives the implementation strategies based on the process of measure. We also went through the methodology to formulate individual strategies reflected on feedback, custom interventions and audit results. I noted a limiting factor which was also confirmed by the mentor; there was limited data on effectiveness of the implementation strategies. Other limitation derived from the reports included relating process measures to the changes in the outcome. At the end of the process we took time to reflect on the process giving us time to take note of positive outcome and identified needs for improvement.
Implementation of EBP assisted to determine the type of implementation strategies tested and approved for ICU clinicians. As a clinician in training, I was tested in my ability to effectively access, prevent and treat delirium. In addition I was able to evaluate the effect of the strategies on the clinical outcome. A patient in ICU is considered as a patient undergoing critical care and there is need for routine monitoring for any deteriorating signs and symptoms associated with delirium. In the course of treatment we needed to use frameworks updated with the current evidence on pain, agitation and delirium management (PAD). Further we employed the ABCDE bundle as a strategy for early awakening. The bundle was used to assist in the process of assessing the process of awakening, breathing, screening and monitoring early exercise. Inter-professional team formation for me seemed like a very critical process that needs proper team leadership especially to ensure implementation (Pitsillidou et al., 2021). Evidence review and critique provided the needed assessment of the presented records and approving implementation from a point of knowledge. From the mentorship process I understood that the process of ongoing evaluation was very important because it assisted the clinicians to discuss their expectations of the outcome and were able to measure and reflect on the points of improvement.
Conclusion
Like a precedent, the EBP concept works as a proven recommendation by experienced professional societies to foster patient safety. Translating evidence into practice is critical in ensuring that the most accurate decisions are made and implemented. It might not mean much to have wealth of information on EBP and less application in practice. Thus, formation of leadership teams and effective collaborations is important to ensure that EBP is fully implemented in clinical practice. Team collaboration in implementing EBP guidelines is important for clinicians in practice and those in training. Clinical practice of EBP guidelines helps in developing better patient outcome. EBP guidelines that are not put into practice remain undeveloped because they are not tested and assessed for improvement. Using the EBP guidelines is important in confirming the evidence presented by different professionals. The practical application and the rigorous appraisal of literature is important in the knowledge development of the healthcare provider. It is through the search of information from clinical questions that nurses provide answers to the clinical questions. In cases where clinical questions are not answered by the guideline’s nurses make quality decision based on the appraisals. The decision to implement the guidelines on real life situations can pose as a very challenging position for a nurse. However, supported by the team and confirmed EBP guidelines an informed process of practice will be applied. The advantage of using EBP is that the healthcare providers are guided by proven protocols that are measurable. Further, after care practice using the EBP principles, the guidelines are open to review and reflection by the team for quality application in future. Implementation of EBP as daily practice is the most critical step for practice as it is the one that determines decision making. EBP serves as a tested and proven process of providing care and is supported by governments and healthcare associations. Thus, nurses critically assessing and reviewing literatures recorded by fellow nurses assists the new nurses in training to have confidence improving the guidelines from a point of knowledge. Nurses may rely on their experience and the years of service however, cases presented may require more knowledge that the information at hand. Therefore, evidence based practice is the core for provision for quality care.
References
Buccheri, R. K., & Sharifi, C. (2017). Critical appraisal tools and reporting guidelines for evidence-based practice. Worldviews on Evidence-Based Nursing, 14(6), 463–472. https://doi.org/10.1111/wvn.12258
Lyman, B., Hammond, E. L., & Cox, J. R. (2019). Organisational learning in hospitals: a concept analysis. Journal of Nursing Management, 27(3), 633–646. https://doi.org/10.1111/jonm.12722
Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing, 33(1), 51–55. https://doi.org/10.1016/j.profnurs.2016.05.009
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: Casopis Drustva Za Medicinsku Informatiku Bih, 29(4), 281–287.
Schaefer, J. D., & Welton, J. M. (2018). Evidence based practice readiness: a concept analysis. Journal of Nursing Management, 26(6), 621–629. https://doi.org/10.1111/jonm.12599
