Barriers and Facilitators of Evidence-Based Practice

This assignment delves into the challenges and enablers of implementing evidence-based practice (EBP) within healthcare settings. It requires a critical analysis of research articles focusing on factors influencing nurses' adherence to clinical practice guidelines, the impact of organizational culture on EBP adoption, and the role of patient involvement in care decisions. The assignment encourages you to synthesize findings from various studies to provide a comprehensive understanding of the complexities surrounding EBP implementation.

Project part B

TABLE OF CONTENTS
SECTION 1: Literature Review ......................................................................................................1
Introduction......................................................................................................................................1
Review.............................................................................................................................................1
Conclusion ......................................................................................................................................4
SECTION 2 : PROJECT PLAN .....................................................................................................4
Project outline: ...........................................................................................................................4
Target audience: .........................................................................................................................4
Recommendations and suggestions: ..........................................................................................5
Presentation format: ...................................................................................................................5
Feedback approach: ....................................................................................................................5
SECTION 3: PRESENTATION .....................................................................................................5
SECTION 4: EVALUATION OF FEEDBACK ..........................................................................12
REFERENCES .............................................................................................................................14

SECTION 1: Literature Review
Introduction
For regularly improving the quality of health care services and to meet the national safety
standards it is essential that clinical practices must involve the changes. According to Peterson &
et.al., (2015), advancements in the clinical practices leads to the better and desired output related
to health quality of individuals. In the case study of Ysabel Green it was observed that national
safety standard of partnering with consumer was not followed. Due to this Ysabel and her
husband both were very troubled and confused about the clinical procedures which were going
on. It affected the psychological state of the patient as well. This literature review will analyse
the barriers and facilitators involved in changing clinical practices for further improvement
(Clinton & LaCross, 2017). It will also evaluate the impact of these factors on clinical practices
in case of Ysabel's care.
Review
DiCenso, Guyatt & Ciliska (2014) states that, it is critical task for the healthcare
professionals to implement changes in their clinical practices. However, for sustaining the
quality healthcare it is required that these changes must be supported as per demand. For
instance, Ysabel and her husband were not included in any of the decision making during her
treatment. If they were also involved in decision making then, probably her health condition
would have been more qualitative.
In the given case study the quality of health services provided is not effective. It does not
follow the standards of national safety. To avoid such incidences in future it is necessary for
health care providers to consider the need for change in their clinical practices (Dang &
Dearholt, 2017). These changes will enable the health institutes to keep the patient safety at the
priority and to follow all necessary standards of safety and quality. In the view of Jun, Kovner &
Stimpfel (2016), changes in clinical practices will help professionals to identify the needs of their
patients so that appropriate treatment can be provided to them with minimum risks. However,
there are certain factors which influences the ways to implement changes in clinical practices.
Barriers of implementing changes in clinical practices: There are several factors which acts as
barriers to the changes.
Gap between research and implementation:
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There are instances when health professionals find it difficult to adopt the changes. For
example in case of Ysabel nurses assumed that there is no need to involve patient and her family
in decision making to provide them information regarding the treatment procedure. Such
approach always prohibits the demand to implement changes in the clinical practices. According
to Williams, Perillo & Brown (2015), clinical practice provides the standards for design,
performance, analysis and monitoring of clinical trials. It is very complex process for the
individuals to adopt changes which can be implemented in all the above processes. The cost
limitations and feasibility servers as important barriers before implementing changes. For
instance clinical trials may require informing decisions and status of patient but they may not
have system or application for supporting it (Edvardsson, Watt & Pearce, 2017). The new
implementation will require budget consideration as well as approval from the management.
Lack of cooperation from top management and fellow members:
Whenever some changes are proposed they are highly criticised by the peer groups or
other health organisations. It is usually considered that these changes are not required or will
bring risk and are not useful. Hence, health groups discourage these clinical changes and does
not show positive response towards their implementation. Chamberlain, Pollock & Fulbrook,
(2018) states that the innovations and changes cannot be helpful in achieving goals if they are not
accomplished by all participants with same efforts. When clinical practices require amendments
then it is necessary that all associated groups such as patients, nurses and other health carers
equally cooperate with it. For instance when patients want to participate in decision making of
clinical trials but if nurses does not allow them or guide them with information then patient will
not be able to participate and hence no clinical changes will be observed (Tobiano & et.al.,
2015).
Information constraints: As per the discussion in Trevena & et.al., (2017) nurses maywant to
provide information to patients but they do not have much information. Hence, they are unable to
follow healthcare standards. Thus changes must be made in clinical approaches so that nurses
also have awareness regarding the health status of their patient.
Barriers related to management and decision making within health organisations: This is
significant barrier related to the above mentioned issue. Health organisation are satisfied with
their structure and procedures. They believe that there is no need to implement these changes and
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current practices are effective enough. When nurses, patients and other members encourage the
clinical changes but if these organisations does not sanction budgets or management does not
provide team to do so then goals cannot be achieved. When hospital management will permit the
changes only then, they can be implemented in clinical practices.
The above mentioned barriers are critical and greatly affect the clinical changes and
advancements.
Facilitators to amendments in clinical practices:
There are various facilitators which promotes and encourages the need of clinical practice
amendments. According to Zanello & et.al., (2016), Rogers' Diffusion of innovation model,
adoption of new guidelines for clinical practices has following facilitators:
Feedbacks and flexible suggestions: At the persuasion stage nurses follow certain steps to
maintain the quality of practices. The quality can be assured by providing feedbacks and
suggestions. It promotes the clinical advancements so that quality of services can be sustained.
Empowerment and training sessions: When health service providers are trained regarding their
practices and duties they take more initiatives to improve the clinical practices. Like in case of
Ysabel if front line nurses were trained enough and were provided with adequate information of
patient then they would have able to properly communicate with the Ysabel's husband.
Resource availability and acceptance of innovation: Clinical practice guidelines (CPG) is
facilitated by availability of technical tools. Lúanaigh & Hughes, (2016) states that when health
organisations have sufficient resources then, it is easy for them to implement new changes.
Along with this the evidence-based strategies are more likely to bring productive results. The
changes in clinical practices as per CPG states the mandates and are encouraged by innovations.
Impact of barriers and facilitators on implementation of clinical changes:
As per discussion in Kadu & Stolee (2015), communication for safety standard is one of
the important safety standard. It states that health organisations must implement effective system
to communicate with patient, families and other multidisciplinary teams so that safety of patient
is not compromised. The feedbacks and empowerment will assure that nursing care providers are
liable to communicate with the patients and carers so that collective decision can be taken.
Ysabel and her husband were not informed about any complication or treatment approach. But if
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nurses were empowered and trained to provide information then they might have informed her
husband.
Similarly, lack of resources can affect the clinical practices. The MRI of Ysabel was due
to shortage of staff on public holiday. It was possible to avoid such incidents if health institute
was aware regarding the prior arrangements of resources so that procedures were not delayed.
The postponed MRI leads to delay in treatment procedure and hence her situation degraded.
There must be a proper coordination between staff members so that carers are not confused and
well aware about procedures. As per the view of Tobiano & et.al., (2015) empowerment and
training session will make the clinical practices transparent and more effective. The patients will
also find it easy to manage the situation with ease.
Conclusion
The literature review has highlighted the importance of clinical practice guidelines. It has
also evaluated the different facilitators and barriers which affects the process of clinical changes.
Thus, it can be concluded from the literature review that for delivering the quality health care
services the national standards of health must be followed. In order to achieve this objective
changes must be implemented in practice guidelines of health-professionals.
SECTION 2 : PROJECT PLAN
Project outline:
The project will focus on the health standard of communication for safety. For providing
quality and accurate services it is essential that patient and carers must have knowledge about
treatment methods and its impact (Gill & et.al., 2015). Ysabel and her husband were not
informed about any of the safety consideration. The nursing staff gave her discharge after
providing medications without informing them about after discharge precautions or possible
risks. It resulted in more critical condition. If they both were informed about the situation then,
probably Ysabel's condition could have been improved. The presentation will highlight the
impact of the standard and how it can be crucial in health deterioration cases.
Target audience:
The project will be presented to health professionals especially registered nurses. It will
help them to understand the need and significance of the above quoted standard.
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Recommendations and suggestions:
The project aims at providing message to nurses that communication for safety standard
must be integral part of their clinical practices. When carers and family members are not
involved in decision making patients may feel anxious and worried. This psychological effect
affects the quality of nursing to a great extent. Thus, health service providers must ensure that
they must regularly inform the status and need of procedures to the patients and carers (Dang &
Dearholt, 2017). It will help them to relax and better recovery will be observed. Another point of
consideration is that individuals have the right to know about their well beings and risks related
to the clinical approaches. Hence, nurses must acknowledge them with adequate information.
Presentation format:
The power point format has been intended to use for presenting this project. The
presentation format highlights the key issues and provides a chance to audience to question or
comment. When their questions are addressed orally in front of them then, it gives better
understanding to them and message is delivered successfully (Pereira & et.al., 2014).
Feedback approach:
For evaluating the effectiveness of the presentation it is necessary to evaluate the
feedbacks from the audience. For obtaining feedback from the users the various evaluation tools
can be used. For this purpose surveys such as questionnaires can be used. This evaluation tool
will help to analyse the perspective of audience and their opinion on the belief. The questions
will provide an accurate analysis of the understanding developed through the presentation
(Runciman, Merry & Walton, 2017).
SECTION 3: PRESENTATION
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SECTION 4: EVALUATION OF FEEDBACK
The following questionnaire can be used to evaluate the feedback from customers.
Question 1: Do you believe that patients must be informed about every decision, planning
and designing of clinical practices.
A. Yes patients and carers have the right to be informed.
B. No it is completely irrelevant. Health-professionals need not to answer every query.
C. Cannot say
D. Not all decisions but only risks associated with treatment must be informed to patients.
Interpretation: This question will help to identify that according to audience consumer
partnership is required or not.
Question 2: According to you what must be the criteria of the changes in clinical practices.
A. Resource availability
B. Health standards which promotes quality of health services
C. Comfort of health-professionals
D. Changes must not be introduced in clinical practices
Interpretation: It will help to assess that how nurses and other health-professionals receives the
need to changes their existing clinical practices (Iyer & et.al., 2015).
Question 3: Do you think that the outcomes and concepts delivered from the presentation
must be involved in the practice and implementation.
A. I could not understand the message delivered from the presentation.
B. Yes health organisation must consider these changes as necessity.
C. No there is no requirement for it, current practices are effective enough.
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D. Current practices are effective but simply regular monitoring of them can meet the objectives.
Interpretation: This question will help to assess that whether presentation was effective or not. It
will also given an idea that according to audience present practices are effective or it is required
to monitor them or to completely change them (Happell & et.al., 2015).
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REFERENCES
Books and Journals
Chamberlain, D., Pollock, W., & Fulbrook, P. (2018). ACCCN Workforce Standards for
Intensive Care Nursing: Systematic and evidence review, development, and
appraisal. Australian Critical Care. 31(5). 292-302.
Clinton, S. C., & LaCross, J. (2017). Clinical Practice Guidelines. Journal of Women’s Health
Physical Therapy.41(2). 100-101.
Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model and
guidelines. Sigma Theta Tau.
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to
Clinical Practice. Elsevier Health Sciences.
Edvardsson, D., Watt, E., & Pearce, F. (2017). Patient experiences of caring and person‐
centredness are associated with perceived nursing care quality. Journal of advanced
nursing. 73(1). 217-227.
Gill, F. J., Leslie, G. D., Grech, C., Boldy, D., & Latour, J. M. (2015). Development of A
ustralian clinical practice outcome standards for graduates of critical care nurse
education.Journal of Clinical Nursing. 24(3-4). 486-499.
Happell, B., Platania‐Phung, C., Byrne, L., Wynaden, D., Martin, G., & Harris, S. (2015).
Consumer participation in nurse education: A national survey of Australian
universities.International journal of mental health nursing.24(2). 95-103.
Iyer, S. P., Pancake, L. S., Dandino, E. S., & Wells, K. B. (2015). Consumer-Involved
Participatory Research to Address General Medical Health and Wellness in a Community
Mental Health Setting. Psychiatric Services. 66(12).1268-1270.
Jun, J., Kovner, C. T., & Stimpfel, A. W. (2016). Barriers and facilitators of nurses’ use of
clinical practice guidelines: an integrative review. International Journal of Nursing
Studies.60. 54-68.
Kadu, M. K., & Stolee, P. (2015). Facilitators and barriers of implementing the chronic care
model in primary care: a systematic review. BMC family practice. 16(1). 12.
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Lúanaigh, P. Ó., & Hughes, F. (2016). The nurse executive role in quality and high performing
health services. Journal of nursing management. 24(1). 132-136.
Pereira, J., Echeazarra, L., Sanz-Santamaría, S., & Gutiérrez, J. (2014). Student-generated online
videos to develop cross-curricular and curricular competencies in nursing
studies.Computers in Human Behavior, 31, 580-590.
Peterson, D. E., Boers-Doets, C. B., Bensadoun, R. J., & Herrstedt, J. (2015). clinical practice
guidelines.
Runciman, B., Merry, A., & Walton, M. (2017). Safety and ethics in healthcare: a guide to
getting it right. CRC Press.
Tobiano, G., Bucknall, T., Marshall, A., Guinane, J., & Chaboyer, W. (2015). Nurses' views of
patient participation in nursing care. Journal of advanced nursing. 71(12). 2741-2752.
Tobiano, G., Marshall, A., Bucknall, T., & Chaboyer, W. (2015). Patient participation in nursing
care on medical wards: an integrative review. International Journal of Nursing
Studies.52(6). 1107-1120.
Trevena, L., Shepherd, H. L., Bonner, C., Jansen, J., Cust, A. E., Leask, J., ... & Hoffmann, T.
(2017). Shared decision making in Australia in 2017. Zeitschrift für Evidenz, Fortbildung
und Qualität im Gesundheitswesen. 123. 17-20.
Williams, B., Perillo, S., & Brown, T. (2015). What are the factors of organisational culture in
health care settings that act as barriers to the implementation of evidence-based practice?
A scoping review. Nurse education today. 35(2). e34-e41.
Zanello, G., Fu, X., Mohnen, P., & Ventresca, M. (2016). The creation and diffusion of
innovation in developing countries: A systematic literature review. Journal of Economic
Surveys.30(5). 884-912.
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