Integrating Evidence-Based practice

Monica Mwaniki

Aspen University

Nurs 494:  Essential of Nursing Research

Linda Marcuccilli, PhD, RN, MS, BSN

March 7, 2022
 Integrating Evidence-Based Practice

To address individual patient and community health concerns, evidence-based

practice (EBP) must be integrated into daily health care operations. EBP aids the nurse in

analyzing the patient's condition, weighing potential treatment options, and selecting the

most appropriate, efficient, and effective approach (Melnyk & Fineout-Overholt, 2015).

No health-care system's objectives can be realized without research-based nursing

practice (Melnyk & Fineout-Overholt, 2015). These medications increase the burden of

illness on individuals and families. The fundamental job of a nurse is to assist patients in

shifting from disease to well-being. Each nursing intervention must be justified (Melnyk

& Fineout-Overholt, 2015). This paper discusses the eight steps involved in

implementing EBP in clinical settings. The author then explores various obstacles to EBP

and ways to overcome them. Furthermore, the paper outlines six internal data sources

that provide information to improve patient outcomes.

Part 1

The Eight Steps to Integrating Evidence-Based Practice into the Clinical Environment

The first step is formalizing implementation teams to ensure the incorporation of

evidence-based practice. The formation of a team at an early stage is critical for success. It is

vital to motivate leaders and key stakeholders to adopt new practices. Invite guest speakers to

assist with the new developments in order to engage and encourage important stakeholders. If

unit members and leaders are enthusiastic, they may be able to share in the success of an

endeavor (Fineout-Overhold & Melnyk, 2015).

Step two is building excitement. While nursing programs teach all of the core clinical

skills, the majority of graduates will need to practice and continue their education in order to
achieve full proficiency, especially in specialist areas such as critical care, emergency medicine,

and infusion therapy. Managers should keep this in mind when they motivate and build

excitement nurses to practice evidence-based medicine. Preceptorships and mentorship programs

can help nurses develop a greater sense of purpose and be excited on practicing evidence-based

practice. As professionals, nurses must regularly assess their competence and avoid taking on

tasks that are above their capacities without assistance or more training. To begin, the oath of a

healthcare professional is to do no harm. To be the sort of nurse that someone would want to care

for an ill or injured loved one, nurses must be committed to lifelong learning and motivated to

keep current with industry developments.

The dissemination of evidence is the next stage. Education should be designed to close

knowledge gaps. To assist in closing knowledge gaps and communicating the change plan and its

implementation. Positive results must be disclosed in order to indicate potential for growth. This

stage elucidates the importance of transformation. You can identify the problem and its solutions

by developing a PICOT statement (Mick, 2017). When compared to treatment, psychological

interventions (counseling and an epilepsy education program) have been shown to be more

effective than traditional epilepsy therapy in reducing seizure frequency and sudden death in

epilepsy (SUDEP) in adolescents with epilepsy.

Step four of assisting employees in transforming their practice is developing clinical tools

and change procedures. The documentation for patient care must be updated. Employees must

have easy access to clinical materials. Staff who are constantly exposed to evidence-based

information gain a better understanding of why they do what they do. Workflow alerts and

reminders should be included in workflow activities to assist workers.

and the institutions leadership strength. Additionally, pilot sites should consider diversity, acuity,

and location. The population selected for piloting should be similar to the target population. The

problems arising from the piloting are addressed at their source and the practice is adjusted.

Following the conclusion of the pilot program, leaders must decide whether to adopt, adapt, or

abandon the new process (Fineout- Overholt & Melnyk, 2015).

The sixth step is to preserve energy sources. Employees must be involved in this step. By

strategizing, manager can keep a cheerful and energetic atmosphere. Taking on smaller

responsibilities gradually relieves boredom and boosts self-esteem. Leaders must be patient and

perseverant in the face of adversity. Sharing success stories can help to keep the project moving

forward and alleviate waiting fatigue

The seventh stage is to develop a success timeline. It is necessary to plan when and where

the change is expected to happen. A timetable allows the evidence-based practice enough time to

be integrated into the care routine. Project phases that are planned help to keep a project's

deadline. This step also entails quantifying outcomes. It is critical to raise critical questions about

how the project's success will be measured. The results demonstrate the importance of

implementing best practices (Fineout-Overholt & Melnyk, 2015).

The last stage is to congratulate staffs on their accomplishments and celebrating success.

This section recognizes an employee's contribution to the project team during its planning and

execution. The mangers take note of those who accepted the new paradigm. This stage also

involves publicizing the success in a hospital newsletter or memos.

Even when it is welcomed, change is difficult. We dislike change, especially when we

have been doing the same thing for a long time. Why would you fix something that isn't broken?

Inadequate EPB mentors, social and organizational factors, and financial constraints are

frequently cited as barriers to EBP adoption (Fineout-Overhold & Melnyk, 2015). On the other

hand, increased use of modern technology has exacerbated the nursing shortage. Kowalczuk et al

(2020) discovered that changes in nurses' psychological and physiological states had a direct

impact on the quality of patient care. Stressed-out nurses may take unnecessary sick days, adding

to the staff's workload.

Shortage in the Nursing Workforce

Nursing shortages are especially acute in developing countries, where resources are

scarce, and diseases are common. To avoid epilepsy fatalities, the nurse must provide patient-

centered care. The nurse informs the patient about the risk factors for seizures (Kowalczuk et

al., 2020) but this is not possible during acute shortage of staff. Furthermore, the guidelines

recommend teaching the patient sleep-promoting relaxation exercises. Inadequate staffing

adds to the workload and jeopardizes patient safety. Nursing shortages harm both patients and

nurses. Patient satisfaction is lower in hospitals where nurse staff shortages have persisted for

an extended period of time. Workload is associated with nurse burnout and poor patient

outcomes, according to Kowalczuk et al (2020). When there is a nursing shortage, nurses

cannot successfully prevent SUDEP.

Strategies to Reduce Staff Shortage

There are several ways for nurses to avoid being overworked. Job reorganization and job

sharing may help to mitigate the effects of staff shortages. When possible, nurse managers may
perform nursing tasks such as medication administration to relieve nurses of unnecessary

pressures (Kowalczuk et al., 2020). Allowing nurses to take brief breaks between shifts may help

them recharge. Additional work for nurses may aggravate exhaustion and perpetuate the cycle

(Cullati et al., 2017; Kowalczuk et al., 2020). Employees who are physically or emotionally

exhausted, irritated, or introverted should be assigned lighter tasks.

Lack of Teamwork Among Epilepsy Care Teams

Multiple teams are necessary to deliver various aspects of health care to epilepsy patients.

Diverse health care teams work well together with proper communication (Melnyk & Fineout-

Overholt, 2015). Collaborations help to ensure that care components are seamlessly integrated.

Collaboration across professions prevents duplication of care and redundancies (Melnyk &

Fineout-Overholt, 2015). Because of mistrust, inpatient therapy is frequently delivered in silos.

Each member of the care team must have faith in the expertise of their colleagues. It is critical

that members communicate effectively with one another. To avoid misunderstandings, the team's

methods and SUDEP recommendations must be agreed upon.

Ways of Achieving Teamwork in Epilepsy Care

Collaboration necessitates communication and knowledge exchange. Collaboration on

patient evaluations and consultations must be effective for the patients to benefit from the care

team. Typically, the primary physician consults with other experts. Following evaluation, the

invited team may provide findings to assist the physician in planning care.
 Part 2

The Six Sources of Internal Evidence Used in Providing Data in Outcome Improvement

Quality and safety are critical in the nursing profession. Consistently providing superior

and safe care benefits patients in a variety of ways (Melnyk & Fineout-Overholt, 2015). Access

to quality care remains an issue in many parts of the United States (Melnyk & Fineout-Overholt,

2015). Hospital falls, pressure ulcers, advanced drug reactions, and medical errors are just some

of the data being analyzed for improvement. Experts offer advice on how to effectively use EBP

to improve patient outcomes (Melnyk & Fineout-Overholt, 2015). As a result of their breadth of

knowledge and expertise, they are setting the standard in Before reaching a decision, experts'

opinions are weighed against the guidelines' recommendations.

It is critical to investigate the effects of clinical practice changes on patients, clinicians,

and organizations or systems (Fineout-Overholt, & Melnyk, 2015). The outcome reveals the

extent to which the change has influenced and progressed. Electronic Health Records (EHRs)

and healthcare systems serve as internal evidence sources. Quality management programs

compile reports on falls, prescription errors, near misses, and even fatalities. To learn from these

incidents and train their employees on how to avoid recurrences. Billing and registration systems

store financial information. These include the costs of tests, supplies, prescriptions, and

equipment, as well as patient demographics. Human resources receive information from

employees and payroll systems. This could include information on staff turnover, employee

education, and even dispensary staff reports. They collect and manage a wide range of data

(Fineout-Overholt & Melnyk, 2015). These may include data from laboratories, x-rays, and

pharmaceuticals. This information may have an impact on reimbursement. It electronically

records each patient visit, prescription, doctor, and anything else that occurred during their
hospital stay. To gain a better understanding of a patient, clinicians may review previous

encounters to see if there are any red flags.

Conclusion

Integration of evidence-based practice is critical in health care. This can be accomplished

with a simple eight-step procedure. The eight steps are used to conduct preliminary evaluations

and quality assurances on new evidence. While new practices face a number of challenges, there

are solutions. Six internal data sources can help hospitals improve patient care.
 References
Cullati., Cheval, B., Schmidt, R. E., Agoritsas, T., Chopard, P., & Courvoisier, D. S. (2017).

Self-rated health and sick leave among nurses and physicians: The role of regret and

coping strategies in difficult care-related situations. Frontiers in Psychology, 8(APR).

https://doi.org/10.3389/fpsyg.2017.00623

Kowalczuk, K., Krajewska-Kułak, E., & Sobolewski, M. (2020). Working excessively and

burnout among nurses in the context of sick leaves. Frontiers in Psychology, 11.

https://doi.org/10.3389/fpsyg.2020.00285

Melnyk, B. M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare:

A guide to best practice (3rd ed.) Philadelphia, PA: Wolters Kluwer Health

Mick, J. (2017). Call to action: How to implement the evidence-based nursing practice.

Nursing2018, 47(4), 36-43. https://pubmed.ncbi.nlm.nih.gov/28328773/