NUR 590 Topic 4 DQ 1 What are some of the obstacles or barriers to implementing evidence-based practice (EBP) in nursing?
NUR 590 Topic 4 DQ 1
Explain whether you would select a qualitative or quantitative design to collect data and evaluate the effectiveness of your evidence-based practice project proposal. Identify which data collection tool you would specifically use and explain why this design is best for your evidence-based practice project proposal.
I would select a quantitative design to collect data and evaluate the effectiveness of the evidence-based practice project proposal. The goal of quantitative research is to gain a better understanding of the social world (GCU, 2021). Researchers use quantitative methods to observe situations or events that affect people. Quantitative research generates objective data that may be expressed concisely using numbers and statistics. The PICOT question asks whether providing pre-admission educational sessions will improve health literacy and health outcomes in orthopedic patients and families with low health literacy. This question can be answered with quantitative data, such as scores on a health literacy assessment or measures of health outcomes.
There are a few reasons why a quantitative design is best for this project proposal. First, quantitative data is more objective and reliable than qualitative data, and it can be analyzed using statistical methods to provide a deeper understanding of the effects of the intervention (GCU, 2021). This is important because the project proposal is trying to measure the effectiveness of an intervention, and objective data is more likely to provide accurate results. Second, quantitative data can be analyzed using statistical methods, which can help to identify patterns and trends in the data. This can help to provide a deeper understanding of the effects of the intervention.
During the 90-day postoperative period, quantitative methods such as surveys or questionnaires could be used to collect data on variables such as health literacy levels, patient-reported outcomes such as pain levels, mobility, functional status, and healthcare utilization such as hospital readmissions and emergency room visits. This quantitative data would allow for statistical analysis and comparison between the intervention group (pre-admission educational sessions) and the control group (standard care), providing objective evidence of any improvements. To collect the data, a validated tool such as the Health Literacy Assessment Tool or the Short-Form Health Survey (SF-36) could be used to assess health literacy, according to the Agency for Healthcare Research and Quality (n.d.). These tools have established reliability and validity in assessing the constructs of interest in healthcare research.
References
Gcu. (2021, June 7). Why Is Quantitative Research Important? GCU. https://www.gcu.edu/blog/doctoral-journey/why-quantitative-research-important
Personal Health Literacy Measurement Tools. (n.d.). Agency for Healthcare Research and Quality. Retrieved July 7, 2023, from https://www.ahrq.gov/health-literacy/research/tools/index.html
NUR 590 Topic 4 DQ 1
What are some of the obstacles or barriers to implementing evidence-based practice (EBP) in nursing? Explain how at least one of the obstacles you have described could impact the implementation for your EBP project.
Obstacles that prevent evidence-based practice research from reaching its full potential. Resource management, interdisciplinary collaboration, and a lack of support are all barriers to evidence-based practice research that vary in severity depending on the study setting or issue being examined. Building research within a medical facility has both advantages and disadvantages in terms of reaching health-related research goals. In terms of research implementation, patient-care treatments can sometimes take precedence over health-related education. (Swindle et al., 2019; Johnson et al., 2019;
Davenport et al., 2019; Whiteside-Mansell et al., 2019; Thirunavukarasu et al., 2019; Sadavsin
Interdisciplinary communication for educational purposes is one barrier that I believe may obstruct the implementation process. Although education can be used to disseminate information to health care practitioners and the general public, it can be difficult to achieve multidisciplinary information and coordination. This would have an impact on my project because collaboration with nutrition and educational departments will be critical to the research’s success, and the level of involvement or coordination required may be influenced by the ability to leverage these partnerships with other disciplines (Shayan, Kiwanuka & Nakaye, 2019).
Also Read: N 510 Advanced Pathophysiology Module 8 Assignment
References:
Swindle, T., Johnson, S. L., Davenport, K., Whiteside-Mansell, L., Thirunavukarasu, T., Sadasavin, G., & Curran, G. M. (2019). A Mixed-Methods Exploration of Barriers and Facilitators to Evidence-Based Practices for Obesity Prevention in Head Start. Journal of Nutrition Education and Behavior, 51(9), 1067–1079. https://doi-org.lopes.idm.oclc.org/10.1016/j.jneb.2019.06.019
Shayan, S. J., Kiwanuka, F., & Nakaye, Z. (2019). Barriers Associated With Evidence‐Based Practice Among Nurses in Low‐ and Middle‐Income Countries: A Systematic Review. Worldviews on Evidence-Based Nursing, 16(1), 12–20. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12337
Mathieson and Brooke found that “barriers to EBP include a lack of time, a lack of staff, a high number of patients, family obligations, a lack of knowledge of EBP, negative beliefs about it, and a lack of academic skills” (Mathieson et at., 2019). Staff shortages and a lot of patients are not new to nursing, but they are felt very strongly when nurses are tired and have to make hard decisions about what is right.
As a lifelong learner with an ADN, a BS in biology, and a future MSN, I feel a lot of pressure to keep learning and want to learn more about nursing. But I don’t have enough time to take care of my family, work, and school responsibilities.
My EBP project can’t be done because I don’t have enough time. During a shift, the floor nurse, CNAs, and other members of the EBP team have limited time. Even though making a note in the EHR documentation might only take a few seconds, it can be hard to find those few seconds on a busy floor with too few people. People who are going to finish educational modules may not have enough time to do so. People who are taking part may be too busy or not give the education enough importance to finish. If participants and team members don’t have enough time to do what they need to do for the project, the data will be skewed.
Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20http://dx.doi.org.lopes.idm.oclc.org/10.1017/S1463423618000488
There will always be barriers when implementing change. A study written by Mathieson, et al, in 2019 explored the barriers to implementing EBP in nursing. It was found that organizational changes – restructuring and the decentralization of services – had a negative impact upon implementation. I think the biggest barrier to change is timing. If the unit or hospital is not fully invested or there are other priorities then the EBP changes will suffer. The timing of implementation is crucial to the success of a project.
For example, for my EBP proposal I think there will be obstacles because of our staffing issues. The lack of proper staff takes priority and it can be difficult to train and implement a new process when there is constant turnover of nurses. I am hopeful with a recent change in leadership, there will be better staffing models and my unit can return to focusing on improving nursing practice instead of staffing shortages.
Reference:
Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: A systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20 doi:http://dx.doi.org.lopes.idm.oclc.org/10.1017/S1463423618000488
The process of evidence-based practice (EBP) begins with a clinical query and then moves on to seeking and critically evaluating the evidence. When implementing evidence-based practice in nursing, there will be obstacles and barriers that will affect health care practices. Barriers can come in various forms on an organizational level or personal level. Examples of organizational level include the lack of human resources, shortage of internet service at work, and high workload were all issues at the organizational level (Khammarnia et al., 2017).
Personal barriers examples included a lack of time to study literature, a lack of computer skills, and a poor command of the English language. Resistance is another barrier to healthcare when trying to implement evidence-based practice. Resistance is an obstacle that would impact the evidence-paste project; culture can be seen as a significant challenge on Hospital units (Ginex, 2019). It takes more than one person to alter a practice, which is why establishing a culture that promotes a spirit of inquiry and an evidence-based approach to treatment is crucial. When there is resistance in a unit towards change, it inhibits the progression of quality improvement.
Ginex, P. (2019). Overcome barriers to applying an evidence-based process for practice change. ONS Voice. https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-change
Khammarnia, M., Haj Mohammadi, M., Amani, Z., Rezaeian, S., & Setoodehzadeh, F. (2017). Barriers to implementation of evidence-based practice in zahedan teaching hospitals, iran, 2016. Nursing Research and Practice, 2017, 1–5. https://doi.org/10.1155/2015/357140
Technology has been the most common barrier I have encountered while participating in or initiating organizational change. The only constant in the future is technological progress. The nursing profession has changed dramatically in the last decade, with computer technology advancing practice. Medication is now scanned using bar code administration rather than a check within a box on a paper chart, and charting has moved from paper to electronic health records.
Nursing is driven by technology and will only improve as technology advances. Lack of familiarity and uncertainty about skills related to the use of technical applications can affect system acceptance: staff members may lack computer knowledge and have difficulty handling the applications (Koivunen & Saranto, 2018). It was determined that if applications were simple to use and users were well educated on how to use them, staff were more satisfied with the application’s implementation and were more likely to use it sufficiently (Koivunen & Saranto, 2018).
While technological advancement is used to advance and improve the healthcare delivery system, it can also serve as a barrier to implementation among nurses. While my project does not involve the use of new technological applications, it does include the use of new technological devices to perform continuous compressions during defibrillation. This will necessitate extensive educational and hands-on simulation opportunities for staff.
Koivunen, M., & Saranto, K. (2018). Nursing professionals’ experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scandinavian journal of caring sciences, 32(1), 24-44. NUR 590 Topic 4 DQ 1 What are some of the obstacles or barriers to implementing evidence-based practice (EBP) in nursing?
Care that is not evidence based is likely unethical and incompetent (DeNisco, 2021). In order to provide the best care to patients EBP needs to be integrated into daily practice (DeNisco, 2021). An important step in implementing a successful EBP project is identifying barriers and obstacles.
Some common barriers are:
- Lack of organizational infrastructure. (DeNisco, 2021).
- Lack of authority for clinicians to make changes. (DeNisco, 2021).
- Lack of time in the workday. (DeNisco, 2021).
- Lack of administrative support. (DeNisco, 2021).
- Lack of financial incentives. (DeNisco, 2021).
- Competing priorities. (DeNisco, 2021).
- Lack of knowledge and skills of EBP.(Rahmayanti et al., 2020).
- Lack of adequate training.(Rahmayanti et al., 2020).
- Lack of access to comprehensive literature libraries.(Rahmayanti et al., 2020).
Luckily the organization that I am implementing my EBP project in has all the tools needed to support EBP. The only barrier that I will need to address is the lack of time due to workload. Post COVID we are dealing with staffing shortages like many hospitals. Bedside nurses have higher patient ratios and increased acuity levels.
As a Manager I will need to provide the necessary time to educate the staff on the project and assist in implementation. I will also have to look at the ideal time to implement this in order to be successful. That time will depend on when RN vacancies are filled and orientation is completed.
DeNisco, S.M. (Ed.). (2021). Advanced practice nursing: Essential knowledge for the profession(4th ed.). Jones & Bartlett Learning. NUR 590 Topic 4 DQ 1 What are some of the obstacles or barriers to implementing evidence-based practice (EBP) in nursing?
Rahmayanti, E.I., Kadar, K.S., & Saleh, A.(2020). Readiness, barriers, and potential strength of nursing in implementing evidence-based practice. International Journal of Caring Services, 13(2): https://search-ebscohost-com.lopes.idm.oclc.org
While evidence-based practice (EBP) improves quality and patient outcomes, implementation is a complex process. The time lag for translating new knowledge into clinical practice ranges from 8 to 30 years, with many barriers also lasting the test of time (Melnyk & Fineout-Overholt, 2018). These long-term barriers include lack of time, lack of EBP education, and lack of resources. Integration of EBP continues to be perceived as burdensome and is often delegated, avoided, or ignored.
Embracing EBP implementation strategies must be designed to shift practice from provider-centric care to evidence-based and patient-centered care. The practice gap at the baccalaureate nurse level needs models to integrate the skills and competencies to integrate the existing evidence. Models to guide the process are increasing and bring strengths for implementation and integration and help to educate the current and future workforce. Raising the bar of practice and performance is a dynamic process and leaves many questions for all stages.
Evaluating data and calculating a budget is just a couple of uncertainties. Lack of funds and resources are obstacles that impact project implementation and quickly put an end to the project. More experience in the process and mentor access will eventually decrease many of the questions that remain unanswered and unknown. NUR 590 Topic 4 DQ 1 What are some of the obstacles or barriers to implementing evidence-based practice (EBP) in nursing?
Reference NUR 590 Topic 4 DQ 1 What are some of the obstacles or barriers to implementing evidence-based practice (EBP) in nursing?
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer Health.
The provision of services that are both reliable and of consistently high quality is currently one of the most significant challenges facing the health care system. Evidence-based practice (EBP), also known as a problem-solving approach to patient care that is based on the best available and valid evidence, can result in an increase in the overall quality of care provided, a decrease in associated costs, and the personal and professional growth of nurses and other health workers.
Additionally, evidence-based practice (EBP) that is based on international standards improves the quality of clinical practice. EBP has been marketed to clients as a means of providing them with the highest possible quality of care.
Multiple studies have come to the conclusion that there are human and organizational factors that are associated with barriers to the use of evidence-based practice (EBP). These factors include a lack of time to read the relevant literature, a heavy workload, a shortage of staff experienced in EBP, and a dearth of resources. (Khammamia et al., 2015) NUR 590 Topic 4 DQ 1 What are some of the obstacles or barriers to implementing evidence-based practice (EBP) in nursing?
A recent systematic review found that there are numerous hurdles to the implementation and usage of EBP and came to the conclusion that identifying barriers is the first step in removing them. The review demonstrated that there are several barriers to the implementation and use of EBP. NUR 590 Topic 4 DQ 1 What are some of the obstacles or barriers to implementing evidence-based practice (EBP) in nursing?
The barrier my proposed Evidence based practice may encounter is heavy workload. The heavy workload of hospital nurses is a major problem for the American health care system. The demand for nurses is increasing as a result of population aging. There are several important consequences of high nursing workload. Research shows that a heavy nursing workload adversely affects patient safety. In addition to the higher patient acuity, work system factors and expectations also contribute to the nurses’ workload: nurses are expected to perform nonprofessional tasks such as delivering and retrieving food trays; housekeeping duties; transporting patients; and ordering, coordinating, or performing ancillary services. (Carayon & Gurses, 2008).
Reference
Khammarnia, M., Haj Mohammadi, M., Amani, Z., Rezaeian, S., & Setoodehzadeh, F. (2015). Barriers to implementation of evidence based practice in zahedan teaching hospitals, iran, 2014. Nursing research and practice, 2015, 357140. NUR 590 Topic 4 DQ 1 What are some of the obstacles or barriers to implementing evidence-based practice (EBP) in nursing?https://doi.org/10.1155/2015/357140
Carayon, P., & Gurses, A. P. (2008). Nursing Workload and Patient Safety—A Human Factors Engineering Perspective. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 30. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2657/
For my specific EBP project, I was able to collect both qualitative and quantitative design research. To be honest, I cannot pick one over the other because both give depth and valuable insights on my chosen topic. The quantitative design provided me with objective, numerical data that gives a black-and-white answer to a specific question. Per Melynk & Fineout-Overholt, (2019), quantitative studies provide a systematic, controlled, empirical and critical investigation of hypothetical propositions (Melynk & Fineout-Overholt, 2019). On the other hand, the qualitative research gave me perspective and understanding of values not measured by numbers such as emotions and opinions. Nevertheless, the term qualitative research is not clearly distinguished from quantitative research and that they have overlapping characteristics. Further, some types of research may be either qualitative or quantitative. Historical research, feminist inquiry, and meta-analysis are examples of research approaches that may be either quantitative or qualitative or both. (Melynk & Fineout-Overholt, 2019)
The randomized clinical trial is often, although not always, held up as the gold standard against which relevant studies are appraised. (Melynk & Fineout-Overholt, 2019)
Careful planning is essential to all research. Even with a randomized control trial, it is very difficult to fill in the gaps, reduce preventable biases, or correct other mistakes that were made in planning the study. Nevertheless, this kind of research style will provide a clearer picture of my EBP project.
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.).