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
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.
Barriers to evidence-based practice research can prevent research from reaching potential. Barriers that involve resource management, interdisciplinary involvement and lack of support are common in evidence-based practice research in varying levels depending on the research setting or question being explored. Building research within a medical center has its benefits as well as its barriers to obtaining research goals for health outcomes. Health related education especially can sometimes take a back seat to patient care interventions in terms of implementation of research (Swindle, Johnson, Davenport, Whiteside-Mansell, Thirunavukarasu, Sadavsin & Curran, 2019)
One barrier that I would predict would interfere with the implementation process deals with interdisciplinary communication for educational purposes. Although using education can be used to disseminate information to health care providers and the public, interdisciplinary information and coordination may make this difficult. This would impact my project because coordinating with nutrition and educational departments will become very important to the research outcomes and the amount of involvement or coordination may revolve around the ability to utilize these connections with other disciplines (Shayan, Kiwanuka & Nakaye, 2019).
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.
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 reported “barriers (to EPB) frequently reported include lack of time, staff shortage, heavy patient caseload, family commitments, limited knowledge of EBP and negative beliefs toward it, and limited academic skills” (Mathieson et at., 2019). Staff shortages with heavy caseloads are not new to nursing, but are intensely felt with nurse burnout and ethical conundrums. As a life-long learner with an ADN, BS Biology, and eventual MSN, I feel intense pressure to continue gaining knowledge and desire to increase nursing knowledge However, lack of time makes a war between my family, work rand educational responsibilities.
Lack of time is a one barrier to implementation of my EBP project. Several members of the EBP team, like the floor nurse and CNAs, have limited time during a shift. While a note in the EHR documentation may only take a moment, it can be hard to find those extra minutes on a busy and understaffed floor. Lack of time may be a barrier for the participants who will be completing educational modules. The participants, informal/family caregivers, may be busy or not give the education priority enough to finish. If team-members and participants don’t have the time to complete their needed responsibilities to the project, the data will be biased.
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.
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
The most common barrier that I have experienced while participating or initiating organizational change is technology. The future consists of nothing but technological change. Especially within the last 10 years alone the nursing profession has drastically changed, advancing practice with computer technology. Charting has transitioned from paper chart to electronic health records, medication is now scanned using bar code administration replacing a check within a box on a paper chart. Nursing is driven by technology and will only become more advanced as the technology advances lack of familiarity and uncertainty about the skills related to the use of technical applications can affect acceptance of the systems: staff members may have insufficient knowledge of computers and difficulties handling the applications (Koivunen & Saranto, 2018). It was determined that if applications were easy to use and users were well educated in utilizing them, staff felt more satisfied with the implementation of application and more likely to make sufficient use of it (Koivunen & Saranto, 2018). While the advancement of technology is used to advance and improve the healthcare delivery system, it can serve as a barrier to implementation amongst nurses. While the implementation of my project does not include the use of new technological applications, it involves the use of new technological devices to carry out continuous compressions during defibrillation. This will require significant educational and hands on simulation opportunities to competency 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.
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.
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.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer Health.
Delivery of high-quality and consistent services is a big challenge in the health care system nowadays. Evidence based practice (EBP), a problem-solving approach to patient care based on the best available and valid evidence, leads to enhanced quality of care, reduced costs, and the individual and professional development of nurses and other health workers. Moreover, EBP based on international standards enhances the quality of clinical practice. EBP has been promoted as a way for clients to receive the best level of care.
Several studies have found that both human and organizational factors are associated with barriers to the use of EBP including lack of time to read literature, heavy workload, lack of staff experienced in EBP, and lack of resources. A current systematic review showed that there are many barriers to the implementation and use of EBP and concluded that identifying barriers is the first step to removing them (Khammamia et al., 2015).
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).
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.
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/